How can Text Messaging be Used for Health Communication?

1. How can Text Messaging be Used for Health Communication? Reed Morrison Feb 08 2011

2. Objective • To know when in the planning process to consider text messaging • To learn of the types of projects where text messaging can be an appropriate tool • To learn how you would go about using text messaging as a medium of health communication • To have the appropriate resources to carry this out

3. Where does it fit in? • Macro plan • Strategic health communication plan • Implementation plan • Evaluation plan • Partnership plan • Publication plan

4. Do not overestimate! Text messaging is just a medium of communication (do not build a program around it) • The medium is the message; text messaging must be compatible with your campaign message

5. When is text messaging appropriate? • Message must be short and easy to understand (or you can break your message into bite size pieces) • Can be used for education, marketing, political, or everyday health communication; given an appropriate message • Part of a larger program, or a program where people sign up

6. For whom is it appropriate? • Analyse your target audience! • Do they have cell phones? • Is this appropriate for age, culture, literacy status? • Audience must be familiar and have access to texting • Most importantly: when we already have the phone numbers! You must have people sign up in some way!!

7. Education based projects • ‘Did you know?’ campaigns • Daily tips for smoking cessation, weight loss, etc • Specific reminders: “a UV index of ten today – don’t forget your sunscreen”

8. Marketing • using messages which are framed within a marketing framework: • Focus on benefits • Help minimize barriers

9. Try it out! • Adapt the following to a 140 character did-you-know, or gain/loss frame: “But there’s a subtle point whose implications are only now being appreciated: sitting (or lying down) too much is not the same as exercising too little. Two new studies highlight the growing consensus that long bouts of uninterrupted sedentary behaviour carry health risks that can’t be erased even if you’re getting plenty of exercise at other times during the day.” Alex Hutchinson. Can sitting too long really hurt my health? The Globe and Mail; Feb 7, 2011.

10. Everyday Communication • Clinical management (appointment reminders) • Test results • Infection exposure notification • Reminders for medication, birth control, blood glucose monitoring, etc • Two way information – patients can text clinics with questions, or text public health for programs • Patients can text doctors with results from home tests (many monitors can be linked to a blue tooth device)

11. Try it out! • Text your postal code and the words ‘health clinics’ to 466453 • For e.g. A1A 2B2 health clinics • Imagine if all health questions could be answered that easily!

12. Gr8 stuff (Advantages) • Cell phones are portable • Fast • Convenient (texts are stored in the phone, or can be read immediately) • Very cheap compared to other methods • Can be sent from anywhere (mobile, computer, and some land lines) • Multiple recipients • Not overused (yet) unlike email... that’s why we have the term SPAM • Evenly distributed among social classes (in medium and high income countries) • Mobiles are common even in developing countries • Helps with difficult-to-reach populations • Easy to use applications to help • It is popular! • People are busy – there is a need for repetition and reminding • Anonymous

13. Challenges and Disadvantages • Relatively low ability to communicate complex information • May ignore certain portion of the population • Short messages = high potential for something to be wrong, unclear, or misunderstood • Not able to print messages • Not able to organize into folders or themes (unlike email) • Do Not Overuse! • Language and illiteracy • Voice calls far outweigh text messages in developing countries (the reverse is true in most developed countries) • Extremely difficult to ‘scale up’ • Must first have the phone number (unlike T.V., Radio, or print)

14. How do I do this? • Must have phone numbers or access to phone number database • Download text messaging software • Consider targeting or tailoring your message if your population is heterogeneous • Make sure your message will fit into a standard text • Segment your participants based on a relevant characteristic • Remember the 4 P’s  your audience will likely get the text right away (place)

15. Hardware • Mobile • Computer with internet • Some land lines

16. Software • iPlato: www.iplato.net (most thorough, cost) • Mobile health interventions: www.healthtxts.com (A free service for professionals, or sign-up style program for individuals) • Frontline SMS: www.frontlinesms.com (free for NGO’s or individuals doing charitable work) • FHI: www.fhi.org (large organization, but have done consulting work in this area)

17. Final points • Consider text messaging once you have your audience and message • Keep messages simple but in line with your program goals • Use an affordable and easy-to-use application • Consider using text messaging for other purposes than education or marketing • Try google example again – text: • ‘define AIDS’ • ‘web depression’

18. References • Kaplan WA. (2006). Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries? Globalization and Health. 2:9. • Latimer AE, Brawley LR, Bassett RL. (2010). International journal of behavioural nutrition and physical activity. 7:36. • Lim MS, Hocking JS, Hellard ME, Aitken CK. (2008). SMS STI: a review of the uses of mobile phone text messaging in sexual health. International Journal Of STD & AIDS. 19 (5), 287-90. Wangberg SC, Arsand E, Andersson N. (2006). • Andersson, N., Wangberg, S., Arsand, E. (2006) Diabetes education via mobile text messaging. Journal of Telemedicine and Telecare. 12(1): 55-56.

19. Additional references • Ybarra, M., Bull, S. (2007). Current Trends in Internet and Cell phone-based HIV Prevention and Intervention Programs. Current HIV/AIDS Reports: 4: 201-207. • McFarlane, M., Bull, S. Technology-based health promotion. Thousand Oaks, Calif.: Sage Publications, 2011. • Boren, S.A., Balas, E.A., Krishna, S. (2009). Healthcare via cell phones; a systematic review. Telemedicine journal and e-health. 15 (3). • Lefebvre, C. (2009). Integrating Cell Phones and Mobile Technologies Into Public Health Practice: A Social Marketing Perspective. Health Promotion Practice. 10 (4): 490-494.