Health promotion and text messaging services?
As the U.S. government report cover shows on the right, not all text messaging services involves two-way, unstructured interaction. Text-messaging has been carefully developed by a number of research teams to deliver alerts or periodic prompts. A fair amount of research has been conducted, reviewed, and summarized into meta-analyses. A 2013 study conducted by Head and colleagues included 19 studies in their meta-analyses. They concluded that:
Smoking cessation and physical activity interventions were more successful than interventions targeting other health outcomes. Message tailoring and personalization were significantly associated with greater intervention efficacy. No significant differences were found between text-only interventions and interventions that included texting plus other components. Interventions that used an individualized or decreasing frequency of messages over the course of the intervention were more successful than interventions that used a fixed message frequency.1
Published in 2014, DeLeon, Fuentes, and Cohen conducted a key review. Building on research in smoking cessation, diet, and exercise, these researchers summarized the previous literature’s reports that such low-cost prompts to be effective in changing health behavior in the short term. They also commented that such research has been more extensively published in the health intervention literature, but that applications are relevant to reducing the cost of services by serving as low-cost alternatives to repeated clinic or counseling interventions. They selected 42 or 55 potential reports that included text messaging services, email, and in some instances, telephone. They concluded:
Periodic messaging interventions yield positive results for short-term health behavior changes. Interventions including feedback and prompts that included strategies were more likely to report significantly positive outcomes. Work remains to better understand elements that make periodic prompts successful and whether they are effective in producing long-term outcomes.
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Leaders in the area of text-messaging, Dr. Fred Muench and colleagues have published several articles examining the ways in which linguistic variations in message content can affect user receptivity and preferences. For example, in a 2014 publication, they reported several well-organized, highly relevant research projects that have identified which patients respond well to such alerts, what kind of alerts they prefer, and when to send them. They stated:
Results indicate global preferences of more than 75% of subjects for certain types of messages, such as those that were grammatically correct, free of textese benefit-oriented, polite, nonaggressive, and directive as opposed to passive, among others. For several classes of messages, few or no clear global preferences were found. There were few personality– and trait-based moderators of message preferences, but subtle manipulations of message structure, such as changing “Try to…” to “You might want to try to…” affected message choice.
The results indicate that individuals are sensitive to variations in the linguistic content of text messages designed to help them achieve a personal goal and, in some cases, have clear preferences for one type of message over another. Global preferences were indicated for messages that contained accurate spelling and grammar, as well as messages that emphasize the positive over the negative.
Dr. Muench and colleagues have continued this basic research about text messaging services. In a 2017 article entitled, More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions, they delved deeper into what they are calling “digital triggers” to tailor messages for behavioral change.
There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger’s target, trigger’s structure, trigger’s narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation.
Therapists are finding that clients are increasingly asking for text messaging in therapy. TBHI’s online training event entitled, “Text Messaging Therapy? 12 Risk Management Considerations to Keep You Out of Hot Water” will review basic risk management approaches to using text messaging as the basis for clinical care. It will outline 12 ways in which text messaging therapy may expose you and your client or patient to undue risk including HIPAA-compliant text messaging, types of text messaging services, and ethical codes that relate to text messaging. It will also clarify considerations for accepting employment from online text messaging therapy companies.
Recommended Text Messaging Therapy Articles:
- Text Messaging Therapy in Telehealth
- Texting in Behavioral Health as Professionals
- Address Problems with Texting in Telehealth
- Text Messaging Therapy & App Security in Telehealth