N = 111 | |
Mean (Std) | |
Pain (1-10) | 5.8 (2.2) |
Frustration (1-10) | 4.4 (2.9) |
How helpful was the content (1-10) | 8.8 (1.7) |
Liked receiving messages score | 4.8 (0.4) |
Text messages helped me feel connected score | 4.6 (0.6) |
N (%) | |
Liked receiving messages | |
Strongly agree | 96 (86.5) |
Agree | 13 (11.7) |
Neutral | 2 (2.3) |
Disagree | 0 |
Strongly disagree | 0 |
Frequency | |
Wanted more | 14 (12.6) |
Just right | 94 (84.7) |
Too many | 3 (2.7) |
Text messages helped me feel connected | |
Strongly agree | 68 (61.3) |
Agree | 38 (34.2) |
Neutral | 5 (4.5) |
Disagree | 0 |
Strongly disagree | 0 |
Helped avoid calling office | |
Agree | 102 (91.9) |
Disagree | 9 (8.1) |
Would rather have received communication through: | |
6 (5.4) | |
MyChart | 2 (1.8) |
Letter in mail | 0 |
Phone call | 8 (7.2) |
Preferred text messages | 95 (85.6) |
Content liked the most (check all that apply) | |
Office surgery scheduling updates | 101 (91.0) |
Tips for at-home pain control | 56 (50.5) |
Video messages from healthcare team | 52 (46.9) |
Website links to local/state health department | 15 (13.5) |
Website links to educational content from AAHKS | 23 (20.7) |
A total of 84.7% of patients rated the frequency of the updates as just right; 91.0% of patients rated ‘scheduling updates' as the most valuable content. Patients with higher pain levels reported more frustration with their surgery delay (5.3 versus 2.8 on 1 to 10 scale, P value < 0.01). More frustrated patients wished they received more text messages (24.4% versus 4.6%, P value = 0.04) and found the content less helpful (8.2 versus 9.2 on 1 to 10 scale, P value = 0.01).
Of the seven text messages that included embedded destination URLs, the links with the highest patient engagement included video messages from attending surgeons (eg, Dr. #3 and Dr. #2 video message viewed 139% and 129%, respectively). The link with the third highest engagement (109%) directed patients to the AAHKS portal, 1 which provides patients with peer-reviewed education resources written by surgeon members of the AAHKS Patient Education Committee. The lowest engagement rates were observed with links directed to the COVID-19 section of the State Department of Health website (24%) and a video message about home pain control modalities (34%). The engagement rates for the embedded links are shown in Table 3 .
Date | Link | Recipients | Clicks |
April 6, 2020 | Dr. #2 video message | 89 | 117 |
April 8, 2020 | Dr. #3 video message | 49 | 69 |
April 9, 2020 | PA-C video message | 120 | 118 |
April 13, 2020 | Department of Health|COVID-19 updates | 277 | 68 |
April 15, 2020 | Message from physical therapy | 282 | 220 |
April 15, 2020 | AAHKS|COVID-19 updates | 300 | 341 |
May 9, 2020 | Tips on pain control from PA-C | 298 | 118 |
In this study, we sent our patients, whose surgery had been delayed because of the COVID-19 elective surgery restriction, text messages in an attempt to keep them informed, educated, and engaged to our office when we awaited the resumption of surgery. The most notable result from this study is that the patients found that text updates are a helpful and convenient way for them to receive general information from the office because their surgeries were postponed because of COVID-19. Because of the COVID-19 effect on our health system, surgical cancelations and postponements lasted for 8 weeks, and we still have not been able to return to pre-COVID surgical case levels. We learned rather quickly that our patients who were awaiting surgery desired some sort of connection to our office to help them cope with the anxiety regarding the uncertainty of COVID-19 and how it would affect their individual care.
To maintain communication with our patients whose surgery had been delayed, we searched internally for an appropriate communication platform. We considered e-mail, MyChart messages (EPIC Health System) and phone calls but realized there were specific limitations with each that made them unusable for this particular use case. For e-mail, it did not feel personal enough, and our experience has been that our patients are not reading their e-mails regularly. Our health system discouraged us from sending mass MyChart messages for the specific purpose in this study because they suspected it could be confusing to patients who also have internal medicine physicians and other specialists using the same MyChart portal as well. We also did not want to burden our patients by having them log into MyChart to read their messages. Finally, although phone calls seemed like the most personable way to connect, we have routinely had limited success getting our patients to answer their phone, given how ubiquitous robocalling has become. Our medical assistants get into a vicious cycle where they leave voicemails and then when patients return their calls, the assistants are already on another patient call, forcing the patient to leave a voicemail and wait for a callback. Moreover, calls tend to take quite a bit of time because patients start to have conversations with our staff about other unrelated topics. Ultimately, calling 300 + patients for each update we wanted to provide was not feasible for our staff.
Texting has increased in popularity year-after-year and has been adopted by every age group. It is reported that Gen X'ers (45 to 54 years) send and receive about 33 text messages per day and baby boomers (56 to 76 years) send and receive about 16 text messages per day. 2 The benefits of texting a group of patients are the speed and the highly interactive nature of SMS. Texting is a native feature to every cell phone, and by mass texting, we were able to reach our patients quickly. In total, 90% of SMS marketing messages are opened within three minutes, and 99% are opened within 20 minutes. 3 This is in stark contrast to e-mail message open rates, which have been reported to be 20%. 4 Today, most patients are used to sending and receiving text messages, so by meeting them where they already are, we felt we were more likely to engage them. We did not feel this type of efficiency, and engagement could be found with any other communication channels.
In this study, we were not able to capture read rates for each individual text message, but we were able to gain insight into engagement because we tracked the click rates for the embedded URLs. We found click rates over 100% (meaning some patients clicked on the links more than one time) for the physician video messages and the AAHKS COVID-19 patient education portal. We were surprised by this finding, but feel strongly that physicians can have a strong calming effect for patients, especially during this time. These engagement rates suggest that text messaging is an acceptable and engaging communication platform. The average open rate for health and fitness e-mail campaigns is reported to be 21.48%, with click rates of only 2.69%. 5 Although 97% of secure portal messages (eg, MyChart) are read by patients, it is reported that most hospitals (62%) see fewer than 25% of their patients activate their patient portal. 6
Our study is not without limitations. This study was completed at a single academic center and may not be wholly representative of the patient population in other geographic areas. Moreover, this study is observational in nature, consisting of only a single cohort of patients who elected to receive text messages during the COVID-19 shutdown. We do not have a comparative cohort of patients who did not receive the messages. In addition, there is some selection bias at play because the only patients eligible were those who had access to a cell phone. In addition, we were unable to conceal patient allocation by blinding the participants. This has previously been reported to exaggerate the estimate of effect size of interventions. 7 Finally, the patient self-reported data within our study are also subject to response bias, introspective ability, and the inherent limitations of rating scales and questionnaires.
The restriction on elective surgeries presented our group with a unique challenge because we managed a growing list of patients whose surgeries were postponed or canceled. We sent text message alerts to our patients to keep them informed, educated, and engaged to our office because we navigated the pandemic. Patients reported high satisfaction and ease of use with this communication medium. We will continue to study the benefits of this technology going forward because we ramp up and return to a new sense of normalcy.
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Frank j. schwebel.
a University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America
b University of Washington, Department of Psychiatry and Behavioral Sciences, 1100 NE 45th, Suite 300, Office 312, Box 354944, Seattle, WA 98105, United States of America
Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes.
A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews.
Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable.
Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.
In 2017, there were an estimated 7.7 billion mobile phones used, approximately one phone per person on the planet ( International Telecommunication Union, 2017 ). Mobile phones, and more recently smartphones, have quickly changed the way people communicate and the way treatment providers think about service delivery ( Atun and Sittampalam, 2006 ). Mobile phones are used in a variety of settings for various purposes, including in impoverished countries where mobile phones offer a relatively inexpensive method of communication ( Ben-Zeev et al., 2015 ; Free et al., 2010 ); for treating individuals with psychological problems ( Thomas et al., 2017 ); and for routine communication among individuals of all ages ( Center for Substance Abuse Treatment, 2009 ; Global Attitudes Project, 2012 ). Due to the ubiquity of text messaging (short message service, SMS) ( Gatwood et al., 2016 ), customizability (e.g., Downer et al., 2005 ), relative low cost (e.g., Rohman et al., 2015 ), rapid and automated delivery (e.g., Chung et al., 2015 ), and acceptability ( Garofalo et al., 2016 ), SMS has become a focus of researchers in the health care field and is recommended for use by leading organizations in various health care fields (e.g., American Medical Association, 2016 ; World Health Organization, 2012 ). Nevertheless, SMS is a relatively nascent technology. Using it in research requires continuous researcher education on ever-changing SMS treatment guidelines and implementation methods, and frequent training of research staff that help implement the rapidly evolving interventions.
Research on SMS in health care services has been focused on two main areas: behavior change interventions and reminders. Mobile Health (mHealth) is defined as the use of mobile computing and communication technologies in health care and public health ( Berrouiguet et al., 2016 ; Free et al., 2010 ). Behavior change interventions and reminders both fall under the umbrella of mHealth. Although mHealth reminder research has primarily focused on outcomes such as appointment attendance and medication adherence ( Berrouiguet et al., 2016 ; Kannisto et al., 2014 ), SMS reminders can also play an important role in behavior change. As proposed in the transtheoretical model of change, reminders can serve as coaching or prompts to help facilitate behavior change ( Prochaska et al., 1994 ). They are likened to stop signs at a busy intersection—reminding us how to respond next. Reminders can be used to enhance prospective memory, which is remembering to complete an activity in the future ( Guynn et al., 1998 ; McDaniel et al., 2004 ).
Before the cell phone era, Prochaska et al. (1994) highlighted the utility of alarm clocks, calendars, and timers as tools for delivering personal reminders. These tools are now easily and frequently accessed from one source: the mobile phone ( Madden et al., 2013 ; Nelson and Nelson, 2010 ). Mobile phones can receive automated SMS reminders or notifications that remind the user to do (or not to do) a specific behavior. For example, if an individual is attempting to decrease their substance use, they can receive an automated SMS that reminds them of their goal at certain high-risk times; and if an individual is attempting to lose weight, they can receive a reminder not to snack between meals. Recently, some research has begun to investigate the impact of adjunct reminders (i.e., mHealth reminders as an adjunct to a behavior change intervention) (e.g., Aguilera et al., 2017 ). Due to the paucity of research on adjunct reminders at this time, they will not be included as part of the systematic review. However, this topic is covered in the Discussion section. The current review will address the following questions about the use of mHealth reminders in health care: What specific uses mHealth reminders been applied to in health care? How has the impact of mHealth reminders been assessed? What have we learned about designing reminders for health care? The review methodology has been aligned with the PRISMA guidelines for systematic reviews ( Moher et al., 2009 ).
The objective of this study is to provide a systematic narrative review of the application of SMS reminders in health care services. All studies were categorized using a two-step process. First, all the titles and abstracts were reviewed for relevance to the topic and to see if they met inclusion criteria. Second, the studies were read and categorized by methodology, treatment goal, and target health condition.
An extensive literature search was conducted in April 2018 using the PsychINFO, CINAHL, PubMed, and Web of Science electronic databases. The search terms used were selected to broadly examine the impact of text message reminders on health care outcomes (see Fig. 1 ). Titles, abstracts, and reference lists of the selected studies were also reviewed to check for other potentially relevant studies.
PRISMA flowchart of primary study selection.
The review was limited to peer-reviewed articles published in English between 2003 and 2018, with an abstract available online. The starting date of the search was selected for three reasons: (1) the majority of mHealth research has occurred after 2003, (2) the rate of text messaging and cell phone ownership has greatly increased since 2003 ( International Telecommunication Union, 2017 ; Kannisto et al., 2014 ), and (3) 2003 is a typical beginning date for mHealth literature reviews ( Berrouiguet et al., 2016 ; Kannisto et al., 2014 ). The review was limited to studies of SMS reminders used to support patient health care. While the majority of studies sent SMS directly to the patients, some health care needs necessitate the reminders be sent to guardians or caretakers rather than the patient. There was no limitation on patient population, age, or diagnosis. Excluded from this review were: articles that assessed patients' feelings toward SMS for non-clinical purposes (e.g., to create a list of SMS messages or assess expected acceptability of receiving messages), theoretical papers, statistical reviews, dissertations, editorials, letters, and study protocols. Both randomized control trials (RCTs) and non-RCTs (e.g., feasibility studies, before-and-after studies, cross-sectional studies, cohort studies) were included.
The steps illustrating the literature search and article review process are shown in Fig. 1 . The initial search produced 2316 articles. An additional 62 articles were found by looking at the reference list of each article. After checking for duplicates as well as screening titles and abstracts for relevance to the topic, 196 potential full-text articles were obtained, with 162 articles ultimately meeting inclusion criteria after full-text review.
Author, year, country, research setting, type of study, patient group, sample size, and message dose (i.e., timing of messages, frequency of messages, total number of messages) were extracted to describe the characteristics of the study. These results have been summarized in Table 1 . The number of articles published on this topic has gradually increased over time, peaking in 2015 (35/162; 22%). Approximately one-third of the studies reviewed were conducted in the United States (60/162; 37%).
Basic study information with review of messaging details and outcomes.
Study | Sample size | Study design | Intervention description | Goal of text message | Rate of messaging | Timing of message | Intervention outcome |
---|---|---|---|---|---|---|---|
503 | RCT | Interactive, personalized, automated text messages designed to help support smoking cessation among adults in the United States | Smoking cessation | Individually customized for six months; maximum of five per day | Individually customized | Intervention produced statistically significant improvement in smoking abstinence | |
160 | RCT | Automated text message reminders designed to increase medication adherence for adult patients with cardiovascular disease in Jordan | Medication adherence | Three reminders per day (one each of medication reminder, diet reminder, smoking cessation reminder) for three months | Individually customized | Intervention produced statistically significant improvement in medication and healthy diet adherence. No significant difference on intention to quit smoking. | |
Total not reported | Quasi-experimental | Automated text message reminder designed to increase appointment attendance among outpatient adults in Saudi Arabia | Appointment reminder | Two messages per scheduled appointment | Delivered five days and one day before scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
123 | RCT | Automated, two-way messaging designed to increase frequency of blood pressure measurement among outpatients at a clinic in the United States | Medical treatment adherence | Two messages per day for up to 15 days | Morning and evening | Intervention produced statistically significant improvement in blood pressure measurement rate | |
70 | RCT | Automated text message reminder designed to increase sunscreen application among young adults in the United States | Treatment adherence | One message per day for six weeks | Between 6:30 and 7:00 AM | Intervention produced statistically significant increase in sunscreen application adherence | |
23 | Quasi-experimental | Automatic text message reminders in five categories (1. Educational and motivational 2. Medication reminders 3. Healthy living challenges 4. Trivia 5. Phone links) designed for adults taking medication for diabetes management in the United States | Medication adherence | Three messages per day for three weeks | At 9:00 AM, 12:00 PM, and 6:00 PM | Intervention produced increase in medication adherence and diabetes self-efficacy | |
324 | RCT | Automated text messages designed to increase attendance at scheduled post-ED discharge outpatient visits among patients in the United States | Appointment reminder | Three messages per scheduled appointment | 7, 3, and 1 day before schedule appointment | Intervention produced statistically significant improvement in appointment attendance | |
185 | Quasi-experimental | Multi-component reminders to complete colorectal cancer screening including automated text messages, mailed letters, and phone calls among a high cancer risk population in the United States | Screening reminder | One message sent two days after testing kit was mailed, and one message after two weeks if kit was not returned | Schedule coincided with send date of mailed testing kit | Intervention produced improvement in screening completion rate | |
40 | RCT | Automated text message reminders and educational messages designed to improve disease severity and quality of life measures among adult outpatients (ages 18–65) treated for psoriasis at an outpatient dermatology clinic in Italy | Medication reminder and educational messages | 1 message per day for 12 weeks (3 reminders and 4 educational per week) | Not reported | Intervention produced statistically significant improvement in disease severity, quality of life, and adherence to therapy | |
304 | RCT | Automated health information and reminder text messages designed to increase immunization rates of newborn children in Zimbabwe | Vaccine reminder | Three messages | 6, 10, and 14 weeks after child birth | Intervention produced statistically significant improvement in vaccination completion rate | |
862,745 | Quasi-experimental | Personalized text message reminders designed to decrease failure to attend rate at an outpatient dental clinic at a dental hospital in Australia | Appointment reminder | One reminder message per scheduled appointment | One day before scheduled appointment | No significant difference in failure to attend rate | |
65 | RCT | Automated text message reminder designed to increase usage rate of accelerometer among adolescents in rural Ireland | Usage reminder | One message per day for 4 weeks | Before 8:00 AM on weekdays and before 9:30 AM on weekends | Intervention produced statistically significant increase in accelerometer use | |
877 | Quasi-experimental | Automated text message reminders designed to increase appointment attendance among low-income post-partum women (14–26 years old) in the United States | Appointment reminder | Three reminders per scheduled appointment | 4 days, 1 day, and 2 h before scheduled appointment | Intervention produced increased rate of appointment attendance | |
33 | RCT | Automated text message reminder designed to increase adherence to acne medication regiment among patients in the United States | Medication adherence | Two messages per day for 12 weeks | One in the morning and one in the evening | Intervention did not produce increase in medication adherence | |
301 | RCT | Reminder either by mail, call, or automated text message designed to decrease rate of missed appointments among orthodontic patients in the Netherlands | Appointment reminder | One message per scheduled appointment | One day before scheduled appointment | Intervention did not produce change in appointment attendance | |
3551 | Quasi-experimental | Automated text message reminder designed to increase HIV re-testing rate among men who have sex with men in Australia | Appointment reminder | One message per scheduled appointment | Not described | Intervention produced statistically significant increase in re-testing rate | |
50 | RCT | Automated reminder and encouraging text messages designed to decrease amount of plaque on teeth | Tooth brushing reminder | 12 messages during first 4 weeks, 1 message per week for following 8 weeks | Individually customized | Intervention produced statistically significant decrease in plaque amount on teeth | |
201 | Quasi-experimental | Customized text message reminder designed to decrease ophthalmology clinic missed appointment rate in the United Kingdom | Appointment reminder | One message per scheduled appointment | Two weeks before scheduled appointment | Intervention produced a decrease in missed appointment rate | |
48 | Quasi-experimental | Manually-entered text message reminders designed to increase outpatient psychotherapy appointment adherence among adolescents in the United States | Appointment reminder | One message per scheduled session for 3 months (47/48 participants received 1 message per week) | The night before scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
110 | RCT | Automated text message reminders designed to promote hypertension medication adherence and educational messages with hypertension management recommendations for African-Americans in the United States | Medication adherence | Two medication reminders per day and two weekly educational messages both for one month | Individually customized | Intervention produced consistently higher numerically, but not statistically significant, medication adherence | |
539 | Quasi-experimental | Automated text message reminder designed to increase STI re-testing rates among adult patients at high risk for STI in the United Kingdom | Medical treatment adherence | One message | Individually customized (between 2 and 12 weeks after initial testing) | Intervention did not significantly improve STI re-testing rate | |
221 | Quasi-experimental | Automated text message reminders designed to increase knowledge about diabetes and insulin injections among patients with diabetes mellitus in Turkey | Informational reminders | 12 messages sent twice a week for 6 months | Not specified | Intervention produced statistically significant improvement in injection technique and diabetes knowledge | |
1848 | RCT | Automated phone call or text message reminder designed to increase appointment attendance rate at a health promotion center in China | Appointment reminder | One message per scheduled appointment | Three days before scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
11 | Quasi-experimental | Automated text message reminders designed to increase Baduanjin exercise adherence among patients with severe mental illness in Taiwan | Exercise reminder | Two messages per week for eight weeks | Randomly selected | Intervention produced increased exercise rate on days receiving text messages | |
66 | RCT | Automated text message reminders designed to exercise compliance for adults with “frozen shoulders” treated at an outpatient clinic in Northern Taiwan | Exercise reminders | One message per day for two weeks | Either at 8 PM or individually customized | Intervention produced statistically significant improvement in exercise compliance and shoulder forward flexion/external rotation/internal rotation | |
710 | RCT | Tailored, automated text message advice, motivational reminders, and support designed to decrease LDL cholesterol among adult patients with coronary heart disease receiving treatment at a hospital in Australia | Behavior change | Four messages per week for six months | Randomly selected time and date | Intervention produced statistically significant decrease in LDL cholesterol, BMI, and systolic blood pressure | |
202 | RCT | Automated text message reminders and informational messages for completing a monthly breast cancer self-evaluation among patients that underwent surgery for breast cancer in Korea | Self-monitoring reminder | One reminder and one informational message per month for six months | The 1st (reminder) and 15th (informational) of each month | Intervention produced statistically significant increase in breast self-evaluation | |
139 | RCT | Automated text message reminder designed to increase intake appointment attendance at an outpatient training clinic in Australia | Appointment reminder | One message per appointment | Between 8:30 and 9:00 AM | Intervention did not significantly improve appointment attendance | |
102 | RCT | Automated text message reminders designed to increase medication adherence among adults with cell phones in Canada | Medication adherence | One message daily for first two weeks; One message every other days for final two weeks | Not reported | Intervention produced increase in medication adherence | |
32,709 | Quasi-experimental | Automated text message reminder designed to decrease missed appointment rate at outpatient clinics in Brazil | Appointment reminder | One message per scheduled appointment | One day before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
21 | RCT | Automated text message reminder designed to increase ART medication adherence among HIV-positive Brazilian women | Medication adherence | One message per day on Saturday and Sunday and one message every other day during the week for 4 months | Sent 30 min before final scheduled daily medication dose | Intervention produced increase in medication adherence | |
830 | RCT | Automated text message reminders designed to increase retention in treatment among HIV-positive patients in Mozambique | Treatment adherence | Individually customized for 12 months | Individually customized | Intervention produced increase rate of treatment retention | |
254 | RCT | A leaflet reminder or leaflet + automated text message reminders before initial psychotherapy session among primary care mental health service patients in England | Appointment reminder | One message | 48 hours before first appointment | Intervention did not produce a change in appointment attendance rate | |
1786 | RCT | Automated text message reminder designed to decrease appointment cancellation rate for adult outpatients (ages 18–60) with a scheduled endoscopic surgery in Western China | Appointment reminder | Nine messages between scheduling and appointment date | Individually customized | Intervention produced a statistically significant decrease in appointment cancellation rate | |
18 | Quasi-experimental | Automated text message reminder designed to increase treatment adherence for adults with diabetes in the United States | Treatment adherence | One message per day for four weeks and one weekly treatment reminder | Not described | Intervention produced statistically significant increase in treatment adherence and in treatment self-efficacy | |
2,864 | Quasi-experimental | Automated text message reminder designed to decrease rate of missed appointments at an outpatient clinic in Australia | Appointment reminder | One message per scheduled appointment | Three business days before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
76 | RCT | Manually sent text message reminder designed to increase chlamydia re-testing rates among young adults in Australia | Re-testing reminder | One message per scheduled appointment | Delivered the Monday before a scheduled appointment | Intervention produced statistically significant increase in re-testing rates | |
21 | Quasi-experimental | Automated, personalized text message reminder designed to increase ART medication adherence for HIV positive adolescents and young adults in the United States | Medication adherence | Two messages per scheduled medication for 24 weeks | Individually customized based on medication schedule | Intervention produced increase in medication adherence | |
42 | RCT | Automated text message reminders designed to increase oral hygiene among orthodontic patients (ages 11–19) at a University clinic in the United States | Tooth brushing reminder | One message per weekday; duration varied (mean of 5.44 months) | 5:15 PM | Intervention produced statistically significant decreases in plaque index, bleeding index, and modified gingival index scores | |
172 | RCT | Automated text message reminder designed to decrease missed appointments at an outpatient primary care center in the United Kingdom | Appointment reminder | One message per scheduled appointment | Between 8:00 AM and 9:00 AM, and 4:00 PM and 5:00 PM | Intervention produced decrease in missed appointment rate | |
350 | RCT | Text message reminders designed to increase medication adherence for pulmonary tuberculosis patients in China | Medication adherence | One message per day | Morning | Intervention produced statistically significantly higher medication adherence | |
4,000 | Quasi-experimental | Automated text message reminder designed to decrease missed appointments and increase cancellations ahead of time at sexual health and HIV clinics in the United Kingdom | Appointment reminder | One message per appointment | Two days before scheduled appointment | Intervention produced statistically significant decrease in missed appointments and increase in advance cancellations | |
6 | Quasi-experimental | Personalized, automated smartphone task completion reminders among individuals with TBI in the United Kingdom | Task reminder | One individually customized message per scheduled task | Five minutes before each scheduled task | Intervention produced a statistically significant improvement in task completion rates | |
47 | Quasi-experimental | Automated text message reminder designed to increase treatment and medication adherence for adults with diabetes in the United States | Medication adherence | Three treatment adherence reminders per week for three months and three appointment reminders per scheduled appointment | Treatment adherence reminders: Monday, Wednesday, and Friday at 7:15 AM and appointment reminders: 7, 3, and 1 day before scheduled appointment | Intervention did not produce change in medication adherence but did increase frequency of blood glucose reading | |
709 | Quasi-experimental | Automated text message reminder designed to decrease rate of missed appointments at an outpatient clinic in the United Kingdom | Appointment reminder | One message per scheduled appointment | One day before scheduled appointment | Intervention produced statistically significant decrease in missed appointments | |
580 | Quasi-experimental | Automated text message reminder designed to increase medication adherence for individuals with chronic diseases in the United States | Medication adherence | Individually customized by participant | Individually customized by participant | Intervention produced statistically significant increase in medication adherence | |
90 | RCT | Automated, personalized text message reminders designed to support and remind individuals of treatment goal for youth and adolescents with diabetes in the United Kingdom | Treatment reminder | One message per day for one year | Not described | Intervention produced statistically significant improvement in self-efficacy and treatment adherence | |
105 | RCT | Personalized, two-way, automated text message reminders designed to increase ART medication adherence among HIV-positive adolescents and young adults in the United States | Medication adherence | One reminder message and one follow-up message per day for six months | Timed to coincide with individual medication schedule | Intervention produced statistically significant increase in medication adherence | |
43 | RCT | Tailored, automated text message reminders designed to increase diabetes medication adherence among adults with uncontrolled diabetes in the United States | Medication adherence | One tailored text message per day for 90 days | Timed to coincide with first scheduled medication dose of the day | Intervention did not statistically significantly increase medication adherence but did increase perceived benefits and competence | |
4 | Quasi-experimental | Automated text message reminder sent by electronic medication dispenser designed to increase HIV prevention medication adherence in South Africa | Medication adherence | One message per use of medication | When medication dispenser is opened (up to twice per day) | Intervention produced increase in medication adherence | |
2920 | Quasi-experimental | Customized, automated text message reminders designed to increase prescription coverage for South African adults (18+) taking anti-retroviral therapy (ART) medication | Medication adherence | One message per week | Not reported | Intervention produced statistically significant increase in prescription coverage | |
8966 | Quasi-experimental | Automated text message reminder designed to decrease missed appointments at an ear, nose, and throat (ENT) clinic in Ireland | Appointment reminder | One message per scheduled appointment | Three days before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
58 | RCT | Automated reminder sent by either smartphone app or electronic medication dispenser designed to increase medication adherence for older adults with heart failure in the United States | Medication adherence | One reminder per scheduled medication for 28 days | Individually customized based on medication schedule | Intervention did not produce change in medication adherence | |
42 | Quasi-experimental | Automated text message reminders designed to increase socialization and medication adherence and to decrease symptoms of auditory hallucinations among schizophrenic patients in the United States | Medication adherence | Three sets of four messages per day (Monday through Saturday) for 12 weeks | One set of messages each morning, afternoon, and evening | Intervention produced increase in medication adherence and social interactions and decrease auditory hallucinations | |
48 | RCT | Automated text messages designed to increase rate of stent removal during appropriate time-frame among patients undergoing endoscopic stent insertion at a hospital in China | Stent removal adherence | One message per month for four or six months (depending on stent guidelines) | Not reported | Intervention produced statistically significant improvement in stent removal adherence | |
681 | Quasi-experimental | Automated text message reminder designed to increase rate of chlamydia re-screening among teens and young adults in Australia | Appointment reminder | One message per scheduled appointment | Individually customized with provider after initial testing appointment | Intervention produced statistically significant increase in re-screening rate | |
1116 | RCT | Automated text message reminders designed to increase infant vaccination rate at an outpatient clinic in Kenya | Vaccine reminder | Two messages per appointment for two appointments | Two days before and on day of scheduled appointment | Intervention produced increase in vaccination rate | |
29 | Quasi-experimental | Automated text message reminders designed to increase treatment adherence for youth and young adults with diabetes in the United States | Treatment adherence | Individually customized by participant | Individually customized by participant | Intervention produced statistically significant increase in treatment adherence | |
19 | RCT | Automated, customized text message reminder designed to increase ART medication adherence for adults with HIV in the United States | Medication adherence | Daily messages, customized to coincide with medication schedule | Individually customized based on medication schedule | Intervention produced increase in medication adherence | |
8 | Pilot RCT | Participant created automated text message reminders designed to increase goal-related activity in individuals with traumatic brain injury (TBI) in the United States | Behavioral intention reminder | Individually customized; majority received half their messages every other day for eight weeks | Individually customized | Intervention produced statistically significant group by time interaction for community activity and social relations | |
8269 | RCT | Automated text message reminder designed to increase return of colorectal cancer screening kit among adults (ages 60–74) in London | Screening reminder | One message | Seven weeks into screening window | Intervention produced increased on-time return of kit and amount of first-time invitees that completed their screening | |
, | 5304 | RCT | Automated informational and interactive text message reminders for urban and low-income parents to take their child to receive the influenza vaccination in the United States | Vaccine reminder | Five messages per week for two months and two messages during the third month | Individually customized, typically sent during the day | Intervention produced statistically significant increase in vaccination completion |
, | 2054 | RCT | Automated text messages to help patients schedule vaccinations and a reminder text designed to increase appointment attendance for 9.5–10.5 month old infants from four urban academically affiliated pediatric clinics in the United States | Vaccine reminder and appointment reminder | Up to three, weekly, scheduling reminder texts and one appointment reminder text | Appointment reminder: two days before scheduled appointment | Intervention produced statistically significant increase in scheduling rate and on-time vaccination completion |
73 | RCT | Automated text message reminder designed to increase oral contraception pill adherence among females in the United States | Medication reminder | One message per day for three months | Individually customized based on medication schedule | Intervention did not produce a change in medication adherence | |
1198 | RCT | Automated text message reminders designed to increase medication adherence among adult outpatients released from a hospital in China with a prescription lasting 7+ days | Medication adherence | One message per medication per day for seven days | Researcher selected; not otherwise specified | Intervention produced decrease in delayed medication doses and increase in overall medication adherence | |
1312 | RCT | Automated text message reminders designed to decrease missed and delayed medication doses among Taiwanese adults (20+) | Medication adherence | One message per day for seven days | Morning | Intervention produced statistically significant decrease in delayed medication doses and increased overall medication adherence | |
98 | RCT | Customized, automated text messages designed to increase medication adherence for outpatient adolescents with asthma in the United States | Medication adherence | Individually customized messages daily for three weeks | Individually customized | Intervention produced statistically significant improvement in medication adherence, quality of life, and self-efficacy | |
18,186 | Quasi-experimental | Automated education and reminder messages designed to increase vaccination rates for infants under one year old in the United States | Vaccine reminder | Up to three messages | Not reported | Intervention produced increase in odds of vaccination rate for mothers intending to vaccinate infants and for mothers not intending to | |
6450 | RCT | Automated text message reminder designed to decrease missed appointment rate among patients at an outpatient academic primary care clinic in Switzerland | Appointment reminder | One message per scheduled appointment | 24 hours before scheduled appointment | Intervention did not produce change in appointment attendance rate | |
200 | RCT | Tailored, automated text message medication adherence reminders and informational messages for adult stroke survivors in Pakistan | Medication adherence | One daily reminder message and two informational messages per week for two months | Reminders individually customized based on medication schedule; informational messages sent on Wednesday and Saturday | Intervention produced statistically significant improvement in medication adherence and decrease in diastolic blood pressure | |
45 | Quasi-experimental | Automated text message reminder designed to increase rate of Parkinson's medication adherence among adults in Finland | Medication adherence | One reminder per scheduled medication for 24 weeks | Individually customized based on medication schedule | Intervention produced increase in medication adherence | |
2240 | RCT | Automated text message reminder designed to increase rate of first routine breast cancer screening among women in the United Kingdom | Appointment reminder | One message per scheduled appointment | 48 hours before scheduled appointment | Intervention produced statistically significant increase in breast cancer screening rate | |
116 | RCT | Automated text message reminders designed to increase iron supplementation adherence among pregnant women (gestational age: 14–16 weeks) in Iran | Medication adherence | 3 reminders and 4 educational messages per week for 12 weeks | Not reported | Intervention produced statistically significant improvement in medication adherence | |
205 | RCT | Tailored, automated text message reminder designed to help promote weight loss among worksite workers in Korea | Exercise reminder | Three messages per week for six months | Morning | Intervention produced decrease in weight | |
28 | Quasi-experimental | Automated text message reminders including informational links to social welfare services and appointment reminders designed to promote increased help-seeking behaviors among individuals with high levels of suicidal ideation among outpatient psychiatric patients in Japan | Supportive messaging and appointment reminder | Two messages per week for six months | 12:30 PM every Monday and Thursday | Intervention produced increase in appointment attendance and in seeking support for suicidal ideation | |
10 | Quasi-experimental | Automated text message reminder designed to increase treatment adherence among adults with diabetes in Austria | Treatment adherence | One message per day (if less than three blood glucose measurements had been received) for three months | In the evening | Intervention produced statistically significant improvement in metabolic control | |
9,959 | Quasi-experimental | Automated text message reminder designed to decrease missed appointments at a hospital outpatient clinic in the United Kingdom | Appointment reminder | One message per scheduled appointment | One day or four days before scheduled appointment | Intervention produced a decrease in missed appointment rate | |
1819 | RCT | A reminder by either mail, call, or automated text message designed to decrease missed appointments in an outpatient psychiatric clinic in the United Kingdom | Appointment reminder | Mail: one letter; call: up to 2 attempts; text: 2 messages | Mail: 2 weeks prior to appointment; call: 1 week prior to appointment; text: 14 days and 2 days prior to appointment | Intervention did not produce change in appointment attendance | |
964 | RCT | Manually entered text message reminder designed to increase follow-up appointment attendance at a primary care clinic in Malaysia | Appointment reminder | Up to three reminders (if no response) per scheduled appointment | 24 to 48 hours before scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
46 | Quasi-experimental | Automated, tailored text message reminders designed to increase medication adherence for people with HIV in the United States | Medication adherence | One to three per day based on medication regimen | Individually customized based on medication schedule | Intervention produced increase in medication adherence | |
769 | RCT | Automated text message reminder designed to decrease missed appointment rate adults with diabetes in Malaysia | Appointment reminder | One message per scheduled appointment | 24 to 48 hours before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
258 | RCT | Automated text message reminder designed to increase appointment attendance rate among children with pediatric cataracts in China | Appointment reminder | Two reminders per scheduled appointment | Four days and one day before scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
332 | RCT | Automated text message reminders designed to increase medication adherence among HIV-positive adolescents and young adults (ages 15–22) in Uganda | Medication adherence | One message per week for 48 weeks | Sunday at 9 AM | No statistically significant difference in medication adherence | |
6989 | RCT | Automated text message reminders designed to decrease missed appointments among adult outpatients scheduled for an MRI in the United States. | Appointment reminder | One message per scheduled appointment | One day before scheduled appointment | Intervention produced statically significant decrease in missed attendance but did not impact appointment punctuality | |
126 | Quasi-experimental | Automated reminders (email or SMS) designed to increase treatment adherence for individuals with irritable bowel syndrome in the United Kingdom | Treatment adherence | Up to three messages per scheduled appointment | On Monday, one week before appointment, the week of the appointment, and the week after | Intervention produced increase in treatment adherence | |
2550 | RCT | Automated text message reminder designed to increase appointment attendance among pregnant women in Zanzibar | Appointment reminder | Two messages per month before gestational week 36, two messages per week after | Not described | Intervention produced a statistically significant increase in skilled delivery attendance | |
2550 | RCT | Automated text message reminders designed to increase ante-natal doctors visits for pregnant women in Zanzibar | Appointment reminder | Approx. 2 messages per month from enrollment until gestational week 36; approx. 2 messages per week from gestational week 36–6 weeks after delivery | Individually customized | Intervention produced statistically significant increase in appointment attendance | |
71 | RCT | Automated text message reminder designed to increase medication adherence among individuals with asthma in China | Medication adherence | Two messages per day for 12 weeks | At 10:00 AM and 8:00 PM | Intervention produced statistically significant increase in quality of life and medication adherence | |
104 | RCT | Automated text message reminders designed to increase medication adherence among non-treatment adherent HIV/AIDS patients in Nigeria | Medication adherence | Two messages per week for four months | Monday and Thursday mornings | Intervention produced statistically significant increase in medication adherence and CD4+ cell count | |
37 | Quasi-experimental | Automated text message reminders designed to increase vaccine completion at optimal time among youth (ages 12–22) at an urban outpatient clinic in the United States | Vaccine adherence | Three messages per dose | Seven days before dose, on dose date, seven days after dose | Intervention produced increase in vaccination completion rate | |
100 | Quasi-experimental | Automated text message reminder designed to increase medication adherence for hospital outpatients in China | Medication reminder | One message per day for up to 19 days | 10 minutes before scheduled medication | Intervention produced increase in medication adherence | |
200 | RCT | Automated text message reminders designed to increase medication adherence among HIV-positive adults in Cameroon | Medication adherence | One message per week for six months | Wednesday at 9 AM | Intervention did not find change in medication adherence | |
20 | Quasi-experimental | Automated text message reminder designed to decrease missed appointments at a medical center among homeless veterans in the United States | Appointment reminder | Two messages per appointment for eight weeks | Five days and 2 days before scheduled appointment | Intervention produced decrease in missed appointments | |
704 | Quasi-experimental | Automated text message reminders designed to increase rate of Hepatitis B vaccination completion in Australia | Vaccine reminder | One message per scheduled appointment | One day before scheduled appointment | Intervention did not produce a significant difference in vaccine completion rate | |
112,194 | Quasi-experimental | Automated text message reminder designed to decrease missed appointment rate at a consultant outpatient clinic in the United Kingdom | Appointment reminder | One reminder per scheduled appointment | Two days before scheduled appointment | Intervention produced a decrease in missed appointment rate | |
41 | Quasi-experimental | Automated text message reminder designed to increase medication adherence for youth and adolescents after receiving a liver transplant in the United States | Medication adherence | Individually customized based on medication schedule | Individually customized based on medication schedule | Intervention produced statistically significant increase in medication adherence as measured by mean tacrolimus level | |
51 | RCT | Automated, individualized text message reminder designed to increase medication adherence among children with inflammatory bowel disease in the United States | Medication adherence | Individually customized | Individually customized | Intervention produced statistically significant increase in medication adherence | |
465 | RCT | Automated text message reminder designed to increase rate of malaria rapid diagnostic test among adults having purchased an anti-malarial drug in Nigeria | Medication adherence | One message | One day after purchasing anti-malarial drug | Intervention produced statistically significant increase in medication adherence | |
251 | RCT | Automated text message reminder designed to increase medication adherence for individuals with schizophrenia in Spain | Medication adherence | One message per day for three months | At 11:00 AM or 2:00 PM | Intervention produced statistically significant increase in medication adherence | |
50 | RCT | Personalized, automated HIV medication reminders for HIV+ individuals with co-occurring bipolar disorder in the United States | Medication adherence | One or two per day (depending on medication regiment) for 30 days | Individually customized based on medication schedule | Intervention produced statistically significant improvement in taking medication on time | |
1557 | RCT | Reminder either by mail, email, or automated text message sent to parents of adolescents not up-to-date on vaccinations in the United States | Vaccination reminder | Up to 3 reminders: 1st sent 2 weeks after enrollment, 2nd sent 3 months after, 3rd sent 3 months after | Individually customized and based on the adolescent being up-to-date on vaccinations or not | Intervention produced statistically significant improvement in vaccination completion | |
37 | RCT | Tailored, automated text message reminders designed to increase exercise among older Malaysian adults (55–70) that do not exercise regularly | Exercise reminders | Five messages per week for 12 weeks | Between 8 and 11 AM | Intervention produced increase in exercise | |
2386 | RCT | Automated text message reminders designed to increase colorectal cancer screening rates among Alaska Natives and American Indians | Appointment reminder | Up to three messages | Day 1, day 31, and day 60 | Intervention produced statistically significant increase in screening completion rate | |
117 | RCT | Automated text message reminders designed to increase attendance and completion of a parent training program in the United States | Attendance reminder | One message per week for nine weeks | One day before a scheduled class | Intervention produced statistically significant improvement in training completion rate | |
999 | RCT | Automated text message reminder designed to decrease missed appointment rate among youth (ages 12–24) clinic outpatients in Switzerland | Appointment reminder | One message per scheduled appointment | Between 8 and 11 AM the day before scheduled appointment | Intervention produced decrease in missed appointment rate | |
318 | RCT | Automated text message reminder designed to decrease failure to attend rate at a pediatric dental University clinic in the United States | Appointment reminder | One message per scheduled appointment | 48 hours before scheduled appointment | Intervention found that phone reminders were more effective than text messages | |
57 | RCT | Automated text message reminders designed to remind parents to complete vaccination for their infant children in the United States | Vaccine reminder | Six total messages | Based on age of infant (messages at: 4, 7, 12, 15, 20, and 23 weeks) | Intervention did not find a change in vaccination completion rate | |
, | 15 | Quasi-experimental | Automated educational and medication adherence reminder text messages designed for adults taking medication for heart failure in the United States | Educational, medication adherence, and appointment reminders | One medication reminder per day for 30 days; 1 appointment reminder 2 days before scheduled appointment | Individually customized based on medication and appointment schedule | Intervention produced increase in medication adherence |
, | 18 | Quasi-experimental | Automated text message reminders designed to increase treatment adherence for adults with diabetes in the United States | Treatment adherence | Daily, twice a week, or once a week | Not described | Intervention produced increase in treatment adherence, self-efficacy, and social support |
539 | Quasi-experimental | Personalized, automated text messages designed to increase STI retesting rates among individuals (ages 15–61) in the United Kingdom | Appointment reminder | One message | Six weeks after initial testing | Intervention produced statistically significant improvement in STI retesting rates | |
1200 | RCT | Automated text message reminders designed to increase appointment attendance among adult (18+) male circumcision patients in Kenya | Appointment reminder | One message per day for seven days | Not reported | Intervention produced statistically significant increase in appointment attendance rate | |
984 | RCT | Automated text message reminder designed to deter early resumption of sexual activity after male circumcision in Kenya | Medical safety reminder | One message per day | 14 researcher selected days; timing individually customized | Intervention did not reduce rate of early resumption of sexual activity | |
4587 | RCT | Automated, two-way text messages designed to increase rate of vaccination completion among adolescents in the United States | Vaccine reminder | Up to four messages over six weeks | Initial reminder followed by additional message every two weeks | Intervention produced statistically significant increase in completing all needed services and vaccinations; and in completing any vaccination | |
230 | RCT | Automated text message reminders designed to increase ART medication adherence and decrease treatment interruptions among ART-naïve individuals in South Africa | Medication adherence | One message per late dose for 48 weeks | 30 minutes after missed dose | Intervention produced statistically significant decrease in treatment interruptions | |
84 | RCT | Automated educational only or education and reminder messages designed to increase medication adherence for patients with coronary heart disease in the United States | Medication adherence | 14 educational messages; 2 reminder messages per day for 30 days | Individually customized based on medication schedule | Intervention produced statistically significant increase in number of doses completed and doses completed on time | |
280 | RCT | Automated text message reminder designed to increase completion of second medication dose among adult (18+) outpatients at a University hospital in Korea | Medication adherence | One message | Individually customized | Intervention produced statistically significant increase in medication adherence | |
25 | Quas-experimental | Automated text message reminder designed to increase treatment adherence for adults and adolescents with atopic dermatitis in the United States | Treatment adherence | One message per day: treatment reminder three times per week, educational message four times per week | Between 7:00–9:00 AM and 4:00–6:00 PM | Intervention produced statistically significant improvements in treatment adherence, self-care behaviors, skin severity, and quality of life | |
447 | Quasi-experimental | Automated text message reminder designed to decrease missed appointment rate at a dental clinic in the United Kingdom | Appointment reminder | One message per scheduled appointment | One day before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
5 | Quasi-experimental | Automated text message reminder designed to increase goal-directed behavior, medication adherence, and appointment attendance for individuals with schizophrenia in the Netherlands | Medication reminder and appointment reminder | Customized based on participant preference | Customized based on participant preference | Intervention produced increase in medication adherence and appointment attendance | |
47 | RCT | Automated text message reminder designed to increase functioning for individuals with schizophrenia in the Netherlands | Treatment adherence | Two message prompts per day per scheduled goal activity | One hour and 10 min before scheduled activity | Intervention produced increase in functioning | |
428 | RCT | Automated text message reminder designed to increase ART medication adherence for individuals with HIV in Kenya | Medication adherence | One message per day or week | At 12 PM | Intervention produced statistically significant increase in medication adherence | |
1405 | RCT | Automated text message reminder designed to increase rate of return to blood center among serologically-active blood donors in Brazil | Appointment reminder | One phone call, letter, or text | 15 days after blood draw | Phone reminder was most effective intervention, followed by text, and letter | |
206 | RCT | Automated text message reminder designed to increase appointment attendance at a dental clinic in India | Appointment reminder | Two reminders per schedule appointment | 24 hours before scheduled appointment and morning of scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
Total not reported | Quasi-experimental | Automated text message reminders designed to decrease cancellations on the day of a scheduled surgery in the United States | Surgery reminder | One reminder of scheduled surgery time | The night before scheduled surgery | Intervention produced significant reduction in appointment cancellations | |
3 | Quasi-experimental | Personalized, automated text message reminders sent by electronic medication dispenser if scheduled diabetes medication is not taken among adults with Type 2 diabetes in the United States | Medication adherence | One message per missed medication | Personalized by medication time | Intervention produced increase in medication adherence | |
1140 | RCT | Automated reminder and encouraging text messages designed to increase rate of medication adherence among adults (18+) receiving malaria treatment in Ghana | Medication adherence | Two messages per day for three days | 8 AM and 7 PM | Intervention produced statistically significant increase in medication adherence | |
2050 | RCT | Automated text message reminder delivered to parents on adolescents, designed to increase HPV dose 1 vaccination rates for publicly insured adolescents in the United States | Vaccination reminder | Up to 4 messages: initial notice of enrollment and reminder of dose 1, 2, and 3 | Not described | Intervention produced statistically significant increase in vaccination completion rate | |
135 | RCT | Automated text message reminders designed to increase receipt rate of third dose of human papillomavirus (HPV) vaccine and HPV vaccination rates in the United States | Vaccine reminder | One message per week for up to three weeks | Beginning one week before each dose was due | Text message intervention produced statistically significant improvement in vaccination completion | |
12,354 | RCT | Automated text message reminder designed to increase flu vaccine completion among unvaccinated high risk flu patients in Australia | Vaccine reminder | One tailored message | Not reported | Intervention produced statistically significant improvement in vaccination completion | |
264 | RCT | Automated electronic (text message and email) appointment reminders and educational messages designed to increase rates of HPV vaccination completion and increase HPV knowledge among female college students (ages 18–26) in the United States | Vaccine reminder | One message per month for 7 months (4 educational, 2 appointment reminders, 1 survey reminder) | Timed to coincide with scheduled appointments | Intervention did not significantly improve vaccination completion but did significantly increase participant knowledge | |
65,567 | RCT | Automated text message reminder designed to decrease missed appointment rates at a hospital-based orthopedic clinic in the United Kingdom | Appointment reminder | One message per scheduled appointment | One week before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
14 | Quasi-experimental | Automated text message reminder designed to help participants lose weight among obese patients in the United States | Weight loss reminder | One message per day for one month | At 9:00 AM | Intervention produced decrease in participant weight | |
1,256 | Quasi-experimental | Automated text message reminder designed to increase appointment attendance at a mental health clinic in the United Kingdom | Appointment reminder | 7 and 5 or 7 and 3 days before scheduled appointment | At 6:00 PM | Intervention produced statistically significant increase in appointment attendance rate | |
24 | Quasi-experimental | Automated text message reminder designed to increase completion of colonoscopy among minority patients eligible for a colonoscopy in the United States | Appointment reminder | Two reminder messages | 14 days and 3 days before scheduled appointment | Intervention produced increase in colonoscopy completion rate | |
301 | RCT | Automated text message reminder designed to increase completion rate of at-home chlamydia retesting in Australia | Testing reminder | One reminder to complete retest | Three months after initial chlamydia diagnosis | Intervention produced statistically significant improvement in chlamydia retest rate | |
71 | RCT | Automated electronic (email or text message) substance use related goal reminders among adult (ages 19–62) probationers in the United States | Goal reminder | One message per reminder | Individually customized | Intervention produced statistically significant increase in goal selection and appointment attendance rate | |
8804 | RCT | Mobile phone reminders: an interactive voice response (IVR) call and a follow up automated text message reminder designed to increase appointment attendance at an outpatient primary care clinic in the United States | Appointment reminder | One message for participants with cell-phones | One business day before scheduled appointment | Intervention produced statistically significant increase in appointment attendance | |
, | Study 1: 196 Study 2: 174 | RCT | Automated text message reminders designed to increase rates of child vaccination completion among urban and low-income parents in the United States | Vaccine adherence | Study 1: up to five messages; Study 2: up to three messages | Study 1: Weeks 1, 2, 3, 6, and 7; Study 2: Not reported | Study 1 and Study 2: Intervention produced statistically significant increase in vaccination completion rate |
, | 7574 | RCT | Automated text message reminders designed to increase vaccination adherence among low-income children and adolescents at community-based clinics in the United States | Vaccine adherence | Up to five messages | One message per week for up to five week | Intervention produced increase in vaccination completion rate |
1143 | RCT | Automatic text message reminder designed to increase completion rate of influenza vaccination among urban and low-income pregnant women in the United States | Vaccination reminder | Two reminder messages | Individually customized based on scheduled appointments | Intervention produced statistically significant increase in vaccination completion rate and women in the third trimester exhibited the greatest intervention effect | |
660 | RCT | Automated text message reminders (educational + reminder vs reminder only) designed to increase second dose of influenza vaccination rates among low-income families in the United States | Vaccination reminder | Up to three messages | 1) Three days before dose was due, 2) on day dose was due, 3) 2 weeks after dose was due | Intervention produced statistically significant increase in vaccination completion rate | |
37 | RCT | Automated text message reminder designed to increase medication adherence for individuals with alcohol use disorder in the United States | Medication adherence | One message per day for eight weeks | Not described | Intervention did not produce increase in medication adherence | |
22 | RCT | Automated text message reminder designed to increase asthma treatment adherence in Denmark | Treatment adherence | One message per day for eight weeks | At 10 AM | Intervention produced statistically significant increase in treatment adherence | |
200 | RCT | Tailored, automated text messages designed to increase medication adherence among patients discharged from a hospital in the United States with an antibiotic prescription | Medication adherence | Individually customized | Individually customized | Intervention produced increase in medication adherence | |
10 | Quasi-experimental | Automated text message reminders sent by electronic medication dispenser if scheduled medication is not taken for HIV and TB patients in Tanzania | Medication adherence | One message per missed dose for three months | Three hours after missed dose | Intervention produced increase in medication adherence | |
675 | RCT | Automated or manual text message reminder designed to decrease missed appointment rate at a physical therapy outpatient clinic in Australia | Appointment reminder | One message per schedule appointment | 24 to 48 hours before scheduled appointment | Intervention produced statistically significant decrease in missed appointment rate | |
710 | RCT | Automated text message reminders designed to increase recreational physical activity and target physical activity levels among individuals in Australia with coronary heart disease | Medical treatment adherence | One message per day, four times per week (days randomly selected) for six months | Between 10 AM and 4 PM | Intervention produced statistically significant increase in exercise activity | |
95 | RCT | Automated text message reminders designed to increase appointment attendance rate among outpatients with first-episode psychosis in Nigeria | Appointment reminder | Two messages | One message sent five days and three days before first appointment | Intervention produced improvement in appointment attendance | |
150 | RCT | Automated text message reminders designed to decrease daily sitting time among patients with rheumatoid arthritis in Denmark | Medical compliance reminder | Not reported | Not reported | Intervention produced statically significant reduction in daily sitting time | |
70 | Quasi-experimental | Automated text message reminder designed to increase appointment attendance and medication adherence for adolescents with lupus in the United States | Appointment reminder and medication adherence | 7, 3, and 1 day(s) before scheduled appointment, and one or two medication reminders per day | Individually customized based on medication schedule | Intervention produced increase in appointment attendance rate but did not find a change in medication adherence | |
165 | RCT | Automated text message reminder designed to increase rate of appointment attendance at a medical clinic in Finland | Appointment reminder | One reminder message | Delivered two days before scheduled appointment | Intervention produced increase in appointment attendance rate | |
100 | RCT | Automated text message reminder designed to increase appointment attendance among adolescent and young adult women (ages 13–21) in the United States | Appointment reminder | One reminder message per day | 72 hours before appointment and every 24 until appointment or until message response | Intervention produced statistically significant increase in return for first clinic appointment | |
276 | RCT | Automated text message reminders designed to increase attendance for testing among mothers with gestational diabetes in Australia | Appointment reminder | Intervention group: three messages; Control group: one message | Intervention: six weeks, three months, and six months post-partum; Control: six months post-partum | Intervention produced increase in appointment attendance rate | |
104 | RCT | Automated text message reminder designed to increase medication adherence among individuals with diabetes in the Netherlands | Medication reminder | One message per day | Delivered if patient had not opened medication canister | Intervention produced statistically significant increase in medication adherence | |
161 | RCT | Automated text message reminder designed to increase refill adherence among individuals with Type 2 diabetes and suboptimal medication adherence in the Netherlands | Medication adherence | One message per missed medication dose for one year | Individually customized | Intervention produced statistically significant increase in refill adherence | |
12,786 | Quasi-experimental | Automated text message reminder designed to increase appointment attendance among 50–69 year old women in Spain | Appointment reminder | One message | Three days before scheduled appointment | Intervention produced statistically significant increase in appointment attendance rate | |
4,589 | Quasi-experimental | Automated text message designed to increase vaccination adherence for individuals in Spain | Vaccination reminder | One message per scheduled appointment | Few days before scheduled appointment | Intervention produced increase in vaccination adherence rate | |
303 | RCT | Automated, two-way text messaging designed to increase medication adherence among patients receiving cardiovascular preventative treatment in the United Kingdom | Medication adherence | Daily messages for first 2 weeks; every other day for next 2 weeks; once a week for final 22 weeks | Individually customized | Intervention produced statistically significant increase in medication adherence | |
50 | RCT | Automated text message reminders designed to improve increase medication adherence and improvement appointment attendance rates among outpatients with allergic rhinitis in China | Medication adherence and appointment reminder | 1 message per day for 30 days | At 7 AM, Monday–Friday and at 9 AM on Saturday and Sunday | Intervention produced statistically significant improvement in appointment attendance, medication adherence, and symptom severity | |
95 | RCT | Automated text message reminders designed to increase follow-up appointment attendance rate among adolescents hospitalized with pelvic inflammatory disease in the United States | Appointment reminder | Four personalized messages over four days | Sent on days 2, 3, 4, and 5 after discharge from ED. Sent between 3:30 and 4:30 PM during the week and at 10 AM on the weekend | Intervention produced statistically significant improvement in follow-up appointment attendance | |
209 | RCT | Personalized, automated text message designed to increase follow-up appointment attendance following trabeculectomy at a hospital in China | Appointment reminder | One text message | Three days before scheduled appointment | Intervention produced statistically significant increase in follow-up appointment attendance | |
317 | RCT | Automated text message reminders designed to increase influenza vaccination completion among pregnant women in Canada | Vaccine reminder | Two messages per week for four weeks | Not reported | Intervention produced increase in vaccination completion |
RCT – randomized control trial.
Nearly two-thirds (111/162; 68%) of the studies reviewed were randomized control trials (RCTs), with a marked increase in RCTs after 2013. Non-RCTs were recorded as quasi-experimental. Additional descriptive characteristics of the studies are presented in more detail in Table 1 .
The reported purpose of the study, description of the intervention, and dose of the intervention were extracted to describe the most commonly studied application of mHealth reminders in health care. SMS reminders were primarily used to remind patients to comply with a medical practice (e.g., taking medication on time, following non-medical treatment guidelines, and completing vaccinations) (93/162; 57%) or attend a clinical appointment (56/162; 35%). Reminders for appointment attendance were generally used as a method to increase clinical appointment attendance and the rate of advance cancellations (as opposed to not showing up). Various studies assessed the impact of SMS reminders on decreasing the rate of missed appointments across a variety of settings, including first-time psychotherapy appointments ( Clough and Casey, 2014 ), recurring medical appointments ( Branson et al., 2013 ; Tolonen et al., 2014 ), and completing vaccinations ( Stockwell et al., 2014 ).
In a majority of studies (140/162; 86%), SMS reminders were the only intervention used. The remaining studies used a secondary or complimentary component in conjunction with the SMS reminder. These include educational or informational messages about the treatment target (e.g., Stockwell et al., 2014 ), links to additional educational information (e.g., Kodama et al., 2016 ), phone call reminders and/or mailed reminders (e.g., Baker et al., 2015 ), and motivational or supportive messages (e.g., Celik et al., 2015 ).
Across the studies, it was most common that the dose (number) and timing of messages were individually customized based on the patients' medication or treatment schedule, or scheduled appointments. Other studies used researcher-selected dosing ( Belton et al., 2013 ; Odeny et al., 2014 ). Many studies sent daily or weekly messages, however, not all studies reported details about message timing. Some studies set message dosage based solely on patient preference (e.g., Spohr et al., 2015 ), and others reported the total amount of reminders sent rather than when they were sent (e.g., Celik et al., 2015 ).
Specific timing of reminders varied across studies. Detailed timing (e.g., a specific time or time frame) was reported in 75 of 162 (46%) of the studies reviewed. Medication reminders typically were sent near the scheduled medication time (e.g., Mao et al., 2008 ). Specific appointment reminder time was reported in 86% (49/57) of studies. These reminders occurred between two weeks ( Kunigiri et al., 2014 ) and the morning of ( Prasad and Anand, 2012 ) a scheduled appointment. Additionally, studies reminding individuals to complete a medical follow-up exam sent a reminder message up to six months after initial contact ( Van Ryswyk et al., 2015 ).
Of the studies reviewed, 56 of 162 (35%) used SMS appointment reminders. Some of these studies targeted increased appointment attendance ( Thomas et al., 2017 ), while others targeted decreased missed appointments ( Altuwaijri et al., 2012 ) or increased cancellations ahead of time (rather than not showing up) ( Farmer et al., 2014 ). The study of appointment reminders has occurred in a variety of settings, including primary care ( Steiner et al., 2016 ), dental care ( Perry, 2011 ), and psychotherapy clinics ( Delgadillo et al., 2015 ). Appointment attendance reminders were found to either increase the rate of appointment attendance, increase the rate of appointments cancelled ahead of time, or decrease the rate of missed appointments in 48 of the 56 studies (86%) ( Altuwaijri et al., 2012 ; Arora et al., 2015 ; Berenson et al., 2016 ; Bourne et al., 2011 ; Brannan et al., 2011 ; Branson et al., 2013 ; Chen et al., 2008 ; da Costa et al., 2010 ; Deng et al., 2015 ; Downer et al., 2005 ; Fairhurst and Sheikh, 2008 ; Farmer et al., 2014 ; Foley and O'Neill, 2009 ; Geraghty et al., 2008 ; Hofstetter et al., 2015a , Hofstetter et al., 2015b ; Kerrison et al., 2015 ; Koshy et al., 2008 ; Leong et al., 2006 ; Liew et al., 2009 ; Lin et al., 2012 ; Liu et al., 2017 ; Lund et al., 2012 ; Lund et al., 2014 ; McInnes et al., 2014 ; Milne, 2010 ; Muller et al., 2017 ; Murray et al., 2015 ; Narring et al., 2013 ; Nundy et al., 2013a , Nundy et al., 2013b ; Nyatsanza et al., 2016 ; Odeny et al., 2012 ; Perry, 2011 ; Pijnenborg et al., 2007 ; Prasad and Anand, 2012 ; Pratap et al., 2015 ; Rohman et al., 2015 ; Sims et al., 2012 ; Sly et al., 2014 ; Steiner et al., 2016 ; Taylor et al., 2012 ; Thomas et al., 2017 ; Ting et al., 2012 ; Tolonen et al., 2014 ; Trent et al., 2015 ; Van Ryswyk et al., 2015 ; Vidal et al., 2014 ; Wolff et al., 2016 ; Yang et al., 2016 ).
Six of the eight studies that did not find improved outcomes for individuals receiving SMS reminders reported neutral results. Of the six studies, one reported being underpowered to assess appointment attendance differences ( Fischer et al., 2012 ); two found no significant difference between a phone call, mailed, and SMS reminder ( Bos et al., 2005 ; Kunigiri et al., 2014 ); one found no significant difference between a mailed reminder and a mailed reminder in addition to a SMS reminder ( Delgadillo et al., 2015 ); one found no significant difference between a SMS reminder and no SMS reminder ( Bellucci et al., 2017 ); and one found no significant difference between a telephone call and a SMS reminder ( Junod Perron et al., 2013 ). The seventh study ( Clough and Casey, 2014 ), found SMS appointment reminders were not significantly more effective than the control group at increasing intake appointment attendance at an outpatient training clinic. The results trended toward more participants receiving reminders dropping out before their intake appointment. Despite this, the authors still suggest that with further research SMS may prove to be a viable appointment reminder system. The eighth study ( Nelson et al., 2011 ) found that phone reminders were more effective than SMS reminders at increasing pediatric dental appointment attendance. Despite this, the authors suggested continuing to investigate the effectiveness of messages based on patient preference (i.e., sending text messages to individuals that prefer them as a reminder method). Kunigiri et al. (2014) found SMS reminders were not statistically significantly more effective than calls or mailed reminders. Yet, they suggest continuing to use SMS messages as an appointment reminder mechanism due to its ease and relative inexpensiveness.
Of the studies reviewed, the most common application of SMS reminders is for medical compliance reminders. The term medical compliance reminders is used in this review to encompass reminders to follow a medication regimen (e.g., taking anti-retroviral therapy medication on time), to follow a non-medication treatment guideline (e.g., returning for sexually transmitted infection re-testing), and to complete vaccinations (e.g., fully immunizing infants). Ninety-seven of the 162 studies reviewed (59%) assessed the impact of SMS reminders on medical compliance reminders. Medication regimen adherence was the intervention outcome for 52 of these studies, non-medication treatment adherence was the intervention outcome for 24, and vaccination adherence was the intervention outcome for 21. Medical compliance reminders were found to improve (e.g., taking medication at a scheduled time, completing non-medication follow-up treatment, completing a vaccination regimen) when using an SMS-reminder intervention in 85% (83/97) of studies ( Akhu-Zaheya and Shiyab, 2017 ; Anthony et al., 2015 ; Armstrong et al., 2009 ; Arora et al., 2012 ; Baker et al., 2015 ; Balato et al., 2013 ; Bangure et al., 2015 ; Berenson et al., 2016 ; Chow et al., 2015 ; Chung et al., 2015 ; Cocosila et al., 2009 ; da Costa et al., 2012 ; Davey et al., 2016 ; Dick et al., 2011 ; Downing et al., 2013 ; Dowshen et al., 2013 ; Fang and Deng, 2017 ; Ferguson et al., 2015 ; Foreman et al., 2012 ; Franklin et al., 2006 ; Garofalo et al., 2016 ; Gengiah et al., 2014 ; Georgette et al., 2017 ; Granholm et al., 2012 ; Gu et al., 2016 ; Guy et al., 2013 ; Haji et al., 2016 ; Hanauer et al., 2009 ; Hardy et al., 2011 ; Hirst et al., 2017 ; Hofstetter et al., 2015a ; Hofstetter et al., 2015b ; Huang et al., 2017 ; Huang et al., 2013 ; Johnson et al., 2016 ; Jordan et al., 2015 ; Kamal et al., 2015 ; Keränen and Liikkanen, 2013 ; Khorshid et al., 2014 ; Kollmann et al., 2007 ; Lewis et al., 2013 ; Ludlow et al., 2009 ; Lv et al., 2012 ; Maduka and Tobin-West, 2013 ; Mao et al., 2008 ; Matheson et al., 2014 ; Miloh et al., 2009 ; Miloh et al., 2017 ; Modrek et al., 2014 ; Montes et al., 2012 ; Moore et al., 2015 ; Morris et al., 2015 ; Nundy et al., 2013b ; Nundy et al., 2013a ; O'Leary et al., 2015 ; Orrell et al., 2015 ; Park et al., 2014 ; Park et al., 2015 ; Pena-Robichaux et al., 2010 ; Pijnenborg et al., 2007 ; Pop-Eleches et al., 2011 ; Raiff et al., 2016 ; Raifman et al., 2014 ; Rand et al., 2015 ; Rand et al., 2017 ; Regan et al., 2017 ; Smith et al., 2015 ; Stockwell et al., 2014 , Stockwell et al., 2015 ; Stockwell et al., 2012a ; Stockwell et al., 2012b ; Strandbygaard et al., 2010 ; Suffoletto et al., 2015 ; Sumari-de Boer et al., 2016 ; Thakkar et al., 2016 ; Thomsen et al., 2017 ; Vervloet et al., 2012 , Vervloet et al., 2014 ; Vilella et al., 2004 ; Wald et al., 2014 ; Wang et al., 2014 ; Yudin et al., 2017 ).
Of the 14 studies that did not find a positive improvement, all but one reported the intervention had a neutral effect on participants. Three of the studies found that despite the medical compliance reminders not being more effective than the control group, the reminders still had benefits, including increasing medical knowledge ( Richman et al., 2016 ), increasing self-efficacy in disease self-management ( Gatwood et al., 2016 ), and increasing the rate of consecutive days taking medication ( Stoner et al., 2015 ). Two of the studies reported being unpowered to find a statistically significant difference ( Boker et al., 2012 ; Buis et al., 2017 ). Niederhauser et al. (2015) reported that their experimental group had more barriers to immunization than control and hypothesized that with a larger trial they might expect to find statistically significant results. One study reported most of their control group used their own reminder, potentially confounding the non-significant outcomes ( Hou et al., 2010 ), and a second study hypothesized that many participants in the control group used their own reminder (although this was not formally assessed) ( Mbuagbaw et al., 2012 ). Another study found that a phone call reminder was more effective than a SMS reminder at increasing treatment follow-up appointment completion ( Porto-Ferreira et al., 2017 ). Two studies found both the treatment and control group had a significantly higher medication adherence and appointment attendance rate than typical ( Burton et al., 2014 ; Goldstein et al., 2014 ); and another hypothesized that due to the length of their study, the novelty and benefit of a medication reminder may have worn off ( Ting et al., 2012 ). Two studies did not find that SMS reminder helped increase rate of Hepatitis B and anti-retroviral therapy (ART) medication adherence and, in fact, displayed lower rates of adherence than no reminder or treatment as usual (respectively) ( Linnemayr et al., 2017 ; McIver et al., 2016 ). Lastly, all studies that included a measure of feasibility and/or acceptability found positive results (e.g., Garofalo et al., 2016 ; Gengiah et al., 2014 ; Park et al., 2014 ), even if the intervention was not found to be statistically significant (e.g., Buis et al., 2017 ; Richman et al., 2016 ).
The remaining studies (15/162; 9%) that did not meet inclusion criteria as either an appointment or medical compliance reminder are grouped below by intervention outcome and briefly described.
All six studies assessing the impact of SMS reminders on exercise and weight loss found improvements in exercise frequency, exercise consistency, or weight lost for individuals receiving reminders ( Belton et al., 2013 ; Chen et al., 2017 ; Chen et al., 2016 ; Kim et al., 2015 ; Muller et al., 2016 ; Shaw et al., 2013 ). These studies targeted a range of demographics, including age, from middle school students (mean age: 12) ( Belton et al., 2013 ) to older adults (between 55 and 70 years old) ( Muller et al., 2016 ); and location, Ireland ( Belton et al., 2013 ), Malaysia ( Muller et al., 2016 ), Taiwan ( Chen et al., 2017 ; Chen et al., 2016 ), Korea ( Kim et al., 2015 ), and the United States ( Shaw et al., 2013 ). Four of the studies were randomized control trials (RCTs) ( Belton et al., 2013 ; Chen et al., 2017 ; Kim, 2017 ; Muller et al., 2016 ) and the rest were quasi-experimental studies ( Chen et al., 2016 ; Shaw et al., 2013 ).
Two studies assessed the impact of SMS reminders on the amount of plaque and level of oral hygiene. Bowen et al. (2015) found that SMS reminders helped adolescents and young adults (ages 11 to 18) decrease the amount of plaque on their teeth. Eppright et al. (2014) found that reminders helped adolescents and young adults (ages 11 to 19) improve their level of oral hygiene. Both studies were RCTs and were conducted at outpatient University clinics in the United States.
One study assessed the impact of reminders on perceived diabetes knowledge and injection skill among adults (ages 18 to 75) with diabetes mellitus in Turkey. The studies found reminders were effective at increasing patient-perceived diabetes knowledge and injection skill ( Celik et al., 2015 ).
Pijnenborg et al. (2010) found SMS reminders helped inpatients and outpatients at a University clinic in the Netherlands with schizophrenia achieve a higher percentage of goal-directed behaviors (e.g., carrying out leisure activities). The study was quasi-experimental and utilized a wait list control.
Hart and Vaccaro (2017) found SMS reminders helped individuals nearing discharge from intensive outpatient brain injury treatment with a TBI in the United States to more effectively implement goal-directed behaviors (e.g., seeking out appropriate social interaction). The study was an RCT with the control group receiving treatment as usual (TAU).
Kodama et al. (2016) found SMS messages with informational links to social welfare services made psychiatric outpatients with high levels of suicidal ideation in Japan more likely to seek help when experiencing suicidal ideation. The study was quasi-experimental.
Spohr et al. (2015) found SMS reminders helped adults (ages 19 to 62) on probation in the United States maintain substance use abstinence and initiate substance use treatment while in a criminal justice setting. The study was a RCT with the control group receiving no reminders.
Odeny et al. (2014) used SMS reminders to deter adult males in Kenya from resuming sexual activity too soon after circumcision. This basic intervention was not successful in reducing early resumption of sexual activity. The researchers suggest further investigation of SMS reminders should be paired with a behavioral intervention, citing the high likelihood that participants may not have understand postoperative instructions.
Abroms et al. (2014) used SMS reminders to help adults (mean age: 35.7 years old) in the United States stop smoking. The study found that the interactive, personalized reminders helped individuals abstain from smoking statistically significantly more than the control group that received self-help TAU.
The results of this literature review demonstrate SMS reminders can be effectively implemented worldwide (e.g., Chen et al., 2008 ) and in a variety of settings (e.g., Stockwell et al., 2014 ) to help improve health care services. SMS reminders show excellent promise as an automated support mechanism. The review found 86% (48/56) of appointment-reminder studies and 85% (83/97) of medical compliance reminder studies reported positive results associated with SMS messages. The reminders helped increase appointment attendance (e.g., Guy et al., 2013 ) and before-appointment cancellations (an unexpected outcome; e.g., Steiner et al., 2016 ), as well as decrease missed appointments (e.g., Altuwaijri et al., 2012 ). By decreasing missed appointments and increasing advance cancellations, health care providers can save time and money, maintain uninterrupted care, and allow other patients to receive needed treatment ( da Costa et al., 2010 ; Farmer et al., 2014 ; Rohman et al., 2015 ; Ting et al., 2012 ). SMS reminders also helped increase the rate of medication adherence (e.g., Montes et al., 2012 ), non-medication treatment adherence (e.g., Balato et al., 2013 ), and vaccination completion (e.g., Stockwell et al., 2014 ).
SMS reminders showed promising results in studies of various diseases and conditions, including HIV, diabetes, heart problems, schizophrenia, skin problems, asthma, IBS, Parkinson's disease, psychosis, stroke, Hepatitis A and B, and breast cancer. A minority of studies did not find positive results. However, even these authors suggested that potential limitations such as small sample size ( Fischer et al., 2012 ) or control group participants using their own reminders ( Hou et al., 2010 ; Mbuagbaw et al., 2012 ) may have confounded the results. The review found a single study investigating each of the following: IBS, Parkinson's disease, psychosis, stroke, breast cancer, and oral contraception. Given the lack of research in these areas, further research would be helpful to better understand the impact SMS reminders can have on these particular health care problems. However, given the composite effectiveness of SMS reminders for health care problems and the initial promising results described above, it seems probable SMS reminders are effective if implemented as a reminder mechanism.
SMS messages are relatively inexpensive, easily customized, automatically sent directly to individuals, and a part of many individuals' daily life. Given these attributes, it is not surprising many studies utilize SMS as a reminder to help improve health care services. SMS can function as a reminder both for recurring (e.g., daily medication adherence) and distal, one-time (e.g., to complete a follow-up vaccination two months after initial vaccination) behaviors. Clinics report major financial savings after implementing an automated, SMS-reminder system, and attribute the savings to the relative inexpensiveness of SMS reminders and the decreased rate of missed appointments (e.g., Pratap et al., 2015 ; Rohman et al., 2015 ). SMS messages may also help individuals who need additional support or structure to remember things or to engage in a behavior (e.g., individuals with schizophrenia or a TBI) ( Hart and Vaccaro, 2017 ; Pijnenborg et al., 2010 ).
Medical professionals can use technology to help guide their treatment. With technology, they can receive more accurate information about treatment adherence when they are treating patients whose recall and self-report may not be accurate (e.g., Boker et al., 2012 ).
Patient confidentiality is frequently cited as a risk of using SMS in health care treatment (e.g., Branson et al., 2013 ; Downer et al., 2005 ). While confidentiality is a risk, there are steps that can be taken to mitigate the concern. These steps include: sending generic reminders (e.g., “See you next Thursday at 5”); informing individuals to open messages in a private location and delete messages after reading them; and suggesting individuals use password protection on their phones. However, SMS is an inherently insecure system technology. Unless an encrypted messaging application is being used, there is a possibility that any message sent can be read by someone other than the intended recipient—a risk that most individuals take on a daily basis (willingly or unwittingly).
One drawback is individuals not reading the messages they've received. A potential strategy to mitigate the possibility of messages being ignored is to utilize interactive or two-way messaging that elicits a response from message recipients. Another drawback is the possibility that recipients may become annoyed at receiving multiple messages over time. Note that none of the studies reviewed found SMS reminders caused adverse iatrogenic results.
SMS reminders show great promise for use across the broad scope of health care services. This review found SMS reminders are highly effective as both an appointment and medical compliance reminder. Additionally, SMS reminders were found to be effective at prompting a number of other health behaviors, including self-medical examinations, socialization, and goal-directed behaviors. As of now, it is unclear what is the most effective dose of SMS reminders (i.e., timing, frequency, and total number of messages) and under what conditions should dosage be changed over time. It is likely dosage varies between individuals and is impacted by the perceived importance of the reminder (e.g., is it for something crucial to your health or for changing a behavior you aren't particularly motivated to change?). Additionally, the underlying mechanism that makes SMS reminders effective and aid prospective memory is not understood. Further research on these topics can help inform future implementations of reminders.
There is an existing body of research on the use of SMS to deliver interventions (e.g., Haug et al., 2012 ). Some studies have also investigated using SMS reminders as an adjunct (e.g., receiving an appointment reminder to continue attending the main intervention) to therapy (e.g., Abroms et al., 2014 ). However, very few studies have investigated the effectiveness of using SMS as a supportive adjunct to behavioral health treatment. One such study ( Aguilera et al., 2017 ) used text messages not only as a reminder, but also as a support mechanism for racial/ethnic minority patients receiving cognitive-behavioral therapy (CBT) for depression. While the study did not find a statistically significant benefit of SMS, this is an area that may require further research to better understand how to implement reminders as a prompt to help support behavior change.
While this review draws from many diverse sources, the data were synthesized using a narrative method rather than a meta-analysis, thus the findings cannot be used to recommend a preferred strategy for the use of SMS reminders in health care. The studies varied in methodological rigor, which may have impacted their results and biased the interpretation in this review. Studies were only selected from peer-reviewed, English-language journals, which may have restricted the findings.
The findings for the use of SMS reminders in health care treatment are very promising. A rapidly increasing body of literature on SMS reminders demonstrates the value of using SMS reminders. The results indicate SMS reminders provide an inexpensive, easily implemented, and automatable method to help increase medical compliance and improve appointment attendance. Additionally, these results suggest SMS reminders may be helpful in improving prospective memory and supplementing behavior change interventions by reminding recipients to engage (or not engage) with behaviors they wish to change.
The authors declare that there is no conflict of interest with respect to the research, authorship, and/or publication of this article.
This work was supported by the National Institute on Alcohol Abuse and Alcoholism [grant number 1F31AA025531-01].
Addicted to text messaging new research explains why..
Posted September 28, 2018
A new study published in Computers in Human Behavior shows how attitudes about communicating online — such as whether a person believes texting will lead to miscommunication, is easier than face-to-face communication or is an important part of maintaining relationships — can explain “text intensity,” or how dependent that person is on text messaging.
According to Dr. Andrew Ledbetter , there are five attitudes people can hold about online communication. People vary on how much they hold each of these five attitudes. Those variations can come from the way a person grew up communicating with their family, or that person’s competence or skill at communicating with others.
1. The attitude of self-disclosure refers to the anxiety people may have about sharing personal and private information online.
2. The attitude of apprehension refers to feelings of dread or fear of communicating online.
3. The attitude of miscommunication refers to beliefs about how common misunderstandings and conflict are when communicating online, because online communication makes it difficult for people to understand one another.
4. The attitude of social connection refers to beliefs about how the ability of online communication facilitates a person’s social life , and how their social connections would suffer if they were no longer able to communicate online.
5. The attitude of ease refers to how people feel about the convenience and efficiency of communicating online. This attitude also captures whether people enjoy communicating online.
In a new study conducted by myself, Dr. Megan Kenny Feister at California State University Channel Islands, and Dr. Stephanie Tikkanen at Ohio University, we found that all five online communication attitudes were associated with how much a person depends on and integrates text messaging into their lives. People who believed sharing information about themselves was easier through texting than talking face-to-face were, perhaps unsurprisingly, more dependent on texting. People who said they would feel “out of the loop” with friends if they were not able to text also reported higher text dependence. People who felt awkward communicating through texts were, on the other hand, less dependent on texting.
The research study also looked at the effect of "self-monitoring" on those attitudes and dependency on texting. "Self-monitoring" refers to a person’s ability to adapt to a variety of social situations. A person is a high self-monitor if they can recognize that they should behave differently at work, at a dinner party, and at home with their children. Not only would a high self-monitor recognize that they should act differently, but they would actually change their behaviors for each occasion. By itself, the trait of self-monitoring leads people to depend less on texting, likely because people who are socially aware recognize the limitations of texting (like the lack of nonverbal cues) and choose other ways to communicate that allow them more control over their self-image .
For people who believe that communicating online allows them to connect with others socially, self-monitoring had the opposite effect. In other words, people who are high self-monitors and who strongly believe that online communication allows them to connect to others tended to experience more dependence on texting. The same pattern was true for people who did not feel much apprehension about texting. For those people, self-monitoring was related to more text dependency.
This study shows that attitudes about online communication matter, and can be useful in understanding why some people are so dependent on texting as a form of communication.
Dorrance Hall, E., Feister, M. K., & Tikkanen, S. (2018). A mixed-method analysis of the role of online communication attitudes in the relationship between self-monitoring and emerging adult text intensity. Computers in Human Behavior, 89, 269-278. doi: 10.1016/j.chb.2018.08.002
Ledbetter, A. M. (2009). Measuring online communication attitude: Instrument development and validation. Communication Monographs, 76, 463-486. doi: 10.1080/03637750903300262
Ledbetter, A. M. (2010). Family communication patterns and communication competence as predictors of online communication attitude: Evaluating a dual pathway model. Journal of Family Communication, 10, 99-115. doi: 10.1080/15267431003595462
Elizabeth Dorrance Hall, Ph.D. , is an Assistant Professor of Communication, Michigan State University and Director, Family Communication and Relationships Lab.
Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.
Prescreening patients for immune-related adverse events during treatment with immune checkpoint inhibitors (ICIs) using text messaging may reduce the need for some in-person, preinfusion office visits, researchers reported in JAMA Network Open. The approach may help decrease the burden of cancer care for both patients and providers.
In a single-center, cross-sectional study, researchers compared use of a text message–based triage instrument to identify patient-reported ICI toxic effects to standard in-person clinician assessments documented in patients’ electronic health record. Of the 45 patients who completed the text-message prescreening, 31 (62%) were male and 44 (88%) were White, and their median age was 68.
A total of 57.8% of the patients reported ICI toxic effects through the text-messaging prescreening. The instrument had 100% sensitivity with a 0% false-negative rate, 47% specificity, and 100% negative predictive value. The most common barriers limiting patients’ ability to complete the text-messaging prescreening were visual impairments and access to a smartphone.
“We show in this cross-sectional study that a simple text message–based questionnaire can accurately identify patients who are not experiencing symptoms of ICI toxic effects,” the researchers wrote . “This implies that such patients with normal laboratory parameters can likely bypass the usual pretreatment office visit and proceed directly to ICI infusion with minimal risk of missing an immune-related adverse event, which offers the potential to reduce up to 20% of office visits.”
Listen to strategies for educating your patients about reporting toxicities on the Oncology Nursing Podcast , and find other ICI and immunotherapy resources in ONS’s Immuno-Oncology Learning Library .
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Teens enrolled in Truth Initiative’s text message-based quit-vaping program were 35% more likely to quit vaping nicotine within seven months compared to those not enrolled in the program, according to research published in the Journal of the American Medical Association . The study, which surveyed 1,503 e-cigarette users ages 13-17, also found the program is effective for teens with high levels of nicotine dependence and mental health concerns.
The research represents the first randomized clinical trial to evaluate a quit-vaping program in this age group. It found that 37.8% of teens enrolled in the interactive program reported abstaining from vaping nicotine at the seven-month mark compared to 28% in the control group, a statistically significant difference. Quit rates among teens exceeded those of a similar clinical trial conducted among users ages 18-24 enrolled in the program and were significantly higher than abstinence rates in most teen quit smoking trials .
The quit-vaping program from Truth Initiative and its national truth public education campaign is a first-of-its-kind, free and anonymous text messaging program designed to help young people quit vaping nicotine. The program incorporates messages from other teens who have attempted to or successfully quit e-cigarettes. The text message intervention tested in this study is called This is Quitting, now part of the EX Program from Truth Initiative. Since This is Quitting launched as a text message program in 2019, over 750,000 young people have enrolled in the program.
Teens and young adults can text DITCHVAPE to 88709 to receive free quit vaping support from the program.
By texting DITCHVAPE to 88709, you consent to recurring messages from Truth Initiative to help you quit vaping, and agree to the Terms & Conditions and Privacy Policy . Text STOP to opt-out. Text HELP for info. Msg & Data Rates May Apply.
All participants of the clinical trial, which took place between October 2021 and October 2023, received incentivized monthly text messages about e-cigarette use to encourage them to complete the study. The intervention group was also enrolled in the program, while control participants did not receive additional support. As a double-blind study, researchers randomly assigned participants to groups and participants did not know which intervention they were receiving.
The study found that This is Quitting was effective among teens with high levels of nicotine dependence and mental health issues. Most teens in the study were highly addicted to nicotine. More than three-quarters (76.2%) used e-cigarettes within 30 minutes of waking – a common way to measure addiction – and 93.6% reported feeling somewhat or very addicted to vaping nicotine. Most (87.3%) had tried to quit in the past year, and more than half (53.4%) had previously made three or more quit attempts. Teens also shared problems with depression, sleep, anxiety, trauma, and substance use, as well as high rates of using multiple substances.
“The significant treatment effect observed in this study against this backdrop of risk factors underscores the power of a digital behavior change intervention to drive clinically meaningful outcomes,” the researchers write.
E-cigarettes are the most popular nicotine product with young people today. In 2023, 10% of high school students used e-cigarettes with more than one in four vaping daily, according to the National Youth Tobacco Survey . Interest in quitting vaping also remains high: 67% of 15- to 24-year-old e-cigarette users said they were considering quitting as a New Year’s resolution , according to a December 2023 Truth Initiative survey. A separate study that analyzed reasons for quitting among young people enrolled in the program found that health, mental health, and social influence were among the top reasons for quitting vaping nicotine.
Studies show that mental health symptoms improve after quitting nicotine . Quitting smoking is linked with lower levels of anxiety, depression, and stress, according to a 2014 meta-analysis of 26 studies published in the British Medical Journal. And while evidence of a link between quitting vaping and improvements in mental health symptoms is emerging, Truth Initiative survey data show support for this connection: 90% of e-cigarette users who quit said they felt less stressed, anxious, or depressed.
This study builds on previous research demonstrating the effectiveness of This is Quitting in young people. A previous randomized clinical trial found that young adults ages 18-24 who used This is Quitting had nearly 40% higher odds of quitting compared to a control group. A second clinical trial proved the program was not only successful in helping young people quit vaping, but also in ensuring they don’t later use combustible tobacco products in place of e-cigarettes.
Combined with the results of the most recent study, this research indicates that a tailored, interactive text message intervention can effectively deliver vaping cessation treatment and encourage youth and young adults to quit vaping.
“Text messaging is a scalable and cost-efficient approach to delivering vaping cessation treatment on a population basis,” researchers write. “These results begin to fill an important gap in understanding how to help adolescent e-cigarette users quit vaping nicotine.”
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Text message alerts are becoming the mainstay to improve research participant/patient engagement and contribute critically to the success of studies., traditionally, text message alerts have only been a one-way, push communication channel used in mobile marketing. mosio was one of the first mobile messaging companies to embrace the power of efficient, two-way text messaging software, giving alerts and notifications a new level of usefulness in healthcare and clinical trials., our text alerts module enables you to send personalized messages with text, links, or emojis. these messages can be replied back to by participants in a two-way textchat. if you don’t want participants to be able to textchat, we’ll set up autoresponders with a different call to action (calling, emailing, etc)..
Used in 90% of our clinical studies, mosio’s storyline alerts ™ feature offers the flexibility to send several different types of messages (text-based messages, urls or surveys), each catered to an individual participant’s enrollment start date., client example:, a client came to mosio wanting to run a study for diabetes with rolling enrollment. they wanted to send the intervention group a text message alert every day with tips for living with diabetes for 6 days, then on day 7 they sent a ten question survey. they also wanted participants to reply to the alerts they received and engage in a two-way conversation via text message with staff if they needed support during the week. the control group received only the survey every 7 days. storyline alerts™ enabled the client to pre-schedule the tips and surveys over the period of their study, then start each patient as they enrolled them, regardless of the time or day of the week., as a result, the client received a significant amount of data, which allowed them to finalize the study without enrolling additional patients., storyline alerts™ can be used for medication adherence, delivery of educational information, gift codes, forms or text-based gamification elements as a way to motivate participants over longer term studies., deliver actionable information in real-time, text message alerts are proven to empower participants by keeping them informed on study activities and requirements., mosio understands that informed patients are better suited to actively participate and remain engaged in studies., by fostering this type of involvement, mosio puts researchers in the better position to achieve exceptional research outcomes..
Patient newsletters and updates sent via text message alerts are another benefit of mosio’s award-winning text messaging alert platform., patients can receive timely, scheduled links to newsletters and continuously stay up-to-date on their clinical trial participation., improve recruitment efforts, new study text message alerts provide a quick and cost-effective way to cast a wide net for potential new trial participants. mosio has proven that providing captivating and timely opportunities for trial recruitment has resulted in improved enrollment outcomes ., with patient privacy and compliance in mind, mosio enables research teams to recruit potential trial participants through convenient and private mobile text message calls to action, eliminating the need for participants to make a phone call to a research site in a public place..
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Sending texts to survey panel members shortens response time.
By Kyley McGeeney and H. Yanna Yan
Text messaging has grown in popularity in recent years, leading survey researchers to explore ways texts might be used as tools in the public opinion research process. In the U.S., at least, researchers must obtain consent from respondents before they are permitted to send an automated text. This means that text messaging can’t be used in standard one-off surveys of the public – surveys where pollsters reach out to a randomly sampled list of telephone numbers. Texting also presents measurement challenges in terms of offering only limited space for writing questions and requiring respondents to type rather than click. While these factors limit the utility of texting for interviewing itself, texting has been explored as a means of alerting people to complete a survey, such as by sending them a link to a web survey. 1
A new study by Pew Research Center found that sending notifications via text to consenting survey panel members improves response time (people take the survey sooner, on average) and boosts the share of respondents completing the survey on a mobile device. It does not, however, increase the ultimate response rate over a longer field period compared with sending notifications by email only.
These results come from two experiments conducted by Pew Research Center using its American Trends Panel (ATP), a probability-based, nationally representative group of people who have agreed to take multiple surveys and receive text messages about them. The first experiment examined the effect of sending a text as a first notification to take a survey. The second experiment examined using text messages to remind people to take a survey. These messages were sent several days after the initial notification.
In the first experiment, web panelists who had previously consented to receiving text messages (2,109 out of 3,634 web panelists in total) were randomized into one of two groups: one group received survey invitations via email and the other received them via both text message and email. 2
On average, panelists in the email and text group completed the survey earlier than those in the email-only group. This difference was most dramatic at the beginning of the survey field period. By the end of the first full day, half (50%) of the email and text group had completed the survey, compared with 37% of the email-only group.
In the second experiment, all web panelists who had consented to text messages were sent survey invitations via email and text message. Those who hadn’t responded after three days were then randomized into one of two groups: One group only received reminders via email and the other received reminders via email and text 3 .
Again, on average, panelists in the text and email reminder group responded earlier than panelists in the email-only reminder group. By the 10th day, the text and email reminder group had a wave-level response rate of 48% vs. 39% in the email-only reminder group. However, there was no significant difference in the final wave-level response rate by the end of the field period.
This report examines the response patterns and demographic composition of respondents in each group for the two experiments. It also looks more broadly at who in the panel consented to receiving this type of survey text message.
When panelists received invitations via text message and email, they completed the survey earlier in the field period than those who received only email. In fact, in the first 30 minutes after the survey invitations were sent, 15% of the text message and email group had responded to the survey vs. only 6% of the email-only group. This has important implications for survey researchers who need to collect data in a short amount of time.
By the end of the first full day in the field, half of the panelists (50%) in the text and email group had responded vs. only 37% of the email-only group. By the end of the third day, 59% of the text and email group had responded vs. 49% of the email-only group. The higher wave-level response rate in the text and email group continued through the 10th day in the field.
However, given enough time in the field, the email-only group’s response rate eventually catches up with that of the email and text group. By the end of the 20-day field period, there was no difference between the two groups in terms of the percent who opened the survey or the percent who responded.
In total, 84% of the email and text group opened the survey vs. 82% of the email-only group, which led to an 82% and 81% response rate, respectively. The 84% of text and email panelists who opened the survey consisted of 54% who opened the survey from the email link and 30% who opened using the link in the text message, as they had the option to use either link.
It’s important to note that had the field period been shorter, as is typical in other web surveys, the final response rate would have been higher for the text and email group. For instance, 10 days into the field period, 78% of the text and email group had responded compared with only 74% of the email group. After 10 days the difference between the two groups narrowed to just 1 percentage point.
Not surprisingly, sending invitations via text message encourages respondents to complete the survey on a smartphone.
Within the email and text group, about half (51%) of respondents completed the survey on a smartphone, compared with only a third (33%) of respondents in the email-only group, despite similar rates of smartphone ownership in the two groups. 4
Taken together with tablets, 57% of respondents in the text and email group completed the survey using a mobile device, compared with only 42% of the email-only group. For survey researchers who want to leverage features of smartphones in their studies, such as capturing GPS (with appropriate consent) or asking respondents to take pictures, this could be quite helpful.
On the other hand, certain types of surveys are better suited for completion on a desktop or laptop computer, such as very long surveys or those using software that is not optimized for smartphones. For these types of surveys, encouraging completion on a mobile device could lead to data quality issues or higher break-off rates.
Demographically, the respondents in the text message and email group were virtually indistinguishable from respondents in the email-only group. There were no differences between the two groups in terms of sex, age, race/ethnicity, education, income, party affiliation or urbanicity. The only difference found was that the email-only group was somewhat more likely to be religiously unaffiliated (26%) than the text message and email group (21%). Even limiting the analysis to respondents from the first 10 days still produces no demographic difference between the two groups apart from religious affiliation.
This lack of demographic difference across the two sets of respondents is encouraging, as there is evidence that texting is more popular among certain demographic groups than others, such as among younger adults or those with higher education. The experiment suggests that these differences in who texts did not result in differences in who responded to the panel survey when text invitations were used. This may be due in part to the fact that in both experiments all respondents received email invitations. If, by contrast, respondents were only allowed to access the survey via the link from the text, then the effect on the demographic profile of the responding sample may have been more noticeable.
[According to the Centers for Disease Control and Prevention’s National Health Interview Survey , 91% of adults own cellphones. When last measured by Pew Research Center in 2013, 81% of cellphone owners used text messaging. Taken together, at least 74% of U.S. adults use text messaging. Given the rise in text messaging over time , this is likely an underestimate.]
Under federal law, researchers need prior consent in order to send automated text messages to potential respondents. Text messaging was possible in this panel study because consent was obtained from panelists prior to this study being conducted.
Those who consented to receiving survey text messages tend to be younger and higher income than those who didn’t consent. Consenters are more likely to live in urban areas and to be Democrats. They are less likely to be white or to be Protestant. However, there is no difference between the consenter and nonconsenters in sex or education.
Additionally, 5% of panelists consented to receiving text messages but could not receive Pew Research Center text messages because ATP texts are sent using short codes, which the panelists had blocked. Short codes are five- to six-digit phone numbers that companies use to, among other things, send automated text messages to a large set of mobile telephone numbers more quickly than if using a traditional 10-digit phone number (long code). Some cellphone carriers, device manufacturers and/or individuals choose to block text messages sent from short codes.
All in all, only 49% of web panelists could receive survey text messages because they owned a cellphone, consented to receiving text messages and did not have short codes blocked. 5 Pew Research Center uses short codes due to the volume of texts being sent and the speed efficiencies, but using a long code would allow researchers to reach these additional panelists.
In the second experiment, all consenting respondents received text message and email invitations to their surveys. Those who had not responded by the third day were randomized into either the treatment group, which received text and email reminders, or the control group, which received only email reminders. Reminders were sent on days 4, 9, and 15 of the field period.
The text message reminders resulted in earlier responses, although by day 11 the control group had caught up and was no longer statistically significantly lower than the treatment group. By the end of the 20-day field period there was no statistically significant difference in the final open or response rates between the treatment and control group. That said, the 20-day field period used in the ATP is longer than that of most public opinion surveys. If the field period had been 10 days, for example, the text message reminders would have resulted in a significantly higher final wave-level response rate.
The respondents who received only email reminders but still answered the survey were younger than the respondents who received both text and email reminders. Of the email-only group, one quarter (25%) were ages 18 to 29 versus only 15% of the text and email group. This was unexpected because of the popularity of texting among this age group. One possible explanation is that younger people use text messaging more than older adults, so the text message reminders may have been less novel. There were no other differences in demographics between the two groups of respondents.
Based on the results of these experiments, consensual text message invitations and reminders are now standard protocol for the American Trends Panel. The next step is to explore using consensual text messages to collect the survey responses themselves, rather than just using texts to send links to web surveys.
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ABOUT PEW RESEARCH CENTER Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .
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