Using Health Text Messages to Improve Consumer Health Knowledge, Behaviors, and Outcomes: An Environmental Scan

Background and objectives. The rapid expansion of mobile health (mHealth) programs through text messaging provides an opportunity to improve health knowledge, behaviors, and clinical outcomes, particularly among hard-to-reach populations. To support future efforts by the U.S. Department of Health and Human Services (HHS) related to text messaging programs specifically and mHealth initiatives more broadly, this environmental scan reviews the current landscape on the effectiveness and acceptance of health text messaging programs. This environmental scan examines the technology context related to cell phone ownership and text messaging use, current evidence on the effectiveness and acceptance of text messaging interventions, and implications for future research and program implementation.

Methods. This environmental scan includes studies on the effectiveness and acceptance of health text messaging interventions published between January 2009 and October 2012, including seven systematic reviews and a synthesis of evidence from the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange. The scan focuses on individual-level interventions in the United States and other high-resource countries. The scan excludes studies of interventions that had been implemented primarily in developing countries or that targeted only system-level interventions (such as those aimed at the physician workforce or hospital administrative systems).

Results. A substantial body of research has shown that health text messaging programs can bring about behavior change to improve short-term smoking cessation outcomes as well as short-term diabetes management and clinical outcomes (increasing frequency of blood glucose monitoring and reducing HbA1c levels). Research has also shown that text messaging improves treatment compliance, including both medication adherence and appointment attendance. Research suggests that text messaging can improve immunization rates, increase sexual health knowledge, and reduce risky behaviors related to HIV transmission, although the literature is less definitive in these areas.

Conclusions. With the recent proliferation of health text messaging applications in the United States, emphasis should be placed on addressing gaps in knowledge about the effectiveness and acceptance of health text messaging programs. Future efforts should include (1) conducting an ongoing environmental scan of the field, (2) performing systematic reviews of new research and sharing lessons learned, and (3) determining the reach of text messaging programs, particularly among underserved populations. In addition, future research should focus on assessing long-term outcomes of text messaging interventions.

The trends toward wide spread ownership of cell phones and widespread text message use across virtually all segments of the U.S. population will continue to support the spread of health text messaging programs. This scan provides encouraging evidence related to the use of health text messaging to improve health promotion, disease prevention, and disease management.