Produced by: The Center for Research in Implementation Science and Prevention (CRISP)

University of Colorado School of Medicine, October 2013

Contributors: Lisa Schilling, MD, MSPH, University of Colorado School of Medicine

Gary Bennett, PhD, Duke University Obesity Prevention Program
Sheana Bull, PhD, Colorado School of Public Health
Alison Kempe, MD, MPH, University of Colorado School of Medicine
Michelle Prahl Wretling, MA, University of Colorado School of Medicine
Elizabeth Staton, MSTC, University of Colorado School of Medicine

Funded by: Agency for Healthcare Research and Quality (AHRQ) Department of Health and Human
Services Research Program Project, Grant Number 5P01HS021138-02. Contents are the
authors’ sole responsibility and do not necessarily represent official AHRQ views.

0
 Introduction

The Text Messaging in Healthcare Research Toolkit

was developed for medical and health services
researchers who are planning to use text messaging
as part of a healthcare intervention or a method for
data collection.

Opportunities for research in mHealth and text

messaging are growing as funding agencies offer
increasing support for research on the use of
technological communication in healthcare. The past
success and future potential of text messaging to reach
the right audience at the right time with the right Text messaging in healthcare
message at a minimal cost has caught the attention of
the health research community.1 Settings
 Primary care
 Hospitals
As of 2012, there were 321.7 million wireless  Public health
subscriptions within the U.S., and the number of  Healthcare research
text messages sent monthly during that year Purposes
amounted to 184.3 billion.2 Because of its  Behavior modification
accessibility and ubiquity, text messaging is a cost-  Disease management and treatment
effective option with the abilities to reach a large adherence
 Prevention and public health education
audience, support provider-patient communication,  Appointment and immunization delivery
deliver health information and education, and  Reminders
collect patient data.3  Motivational messages
 Data collection
 Disease surveillance
The implementation of a text messaging system
requires basic knowledge of SMS technology and Populations
 Children and adolescents
design considerations specific to your needs and
 Adults
resources. This toolkit overviews the basics of short  Elderly
message service (SMS) technology and regulations,  Minorities
and provides information and tools to aid  People in underdeveloped countries
 Women in postpartum period
researchers in developing an effective text
messaging system. *See a full list of studies in Appendix D: Table of Text
Messaging Studies.

1
 Inside
Topics and Features
 SMS Basics (p. 3)
 SMS Feature Checklist and Guide (p. 6)
 Application and Hosting Options (p. 8)
 Selecting a Text Messaging Vendor (p. 12)
 Developing a Communication Strategy (p. 13)
 Security and Privacy Considerations (p. 16)
 Text Messaging Glossary of Terms (Appendix A p. 19)
 Text Messaging Bibliography (Appendix C p. 24)
 Table of Text Messaging Studies (Appendix D p. 30)

Tools (Appendix B)
Tool 1: Checklist for Assessing Functionality Needs (p. 20)
This tool will help you identify what features you will need in your text messaging platform and can be
used in conjunction with the SMS System Feature Checklist and Guide (p. 6) .

Tool 2: Platform Type Decision Making Checklist (p. 21)

This checklist is intended to provide a starting point from which you can determine what type of
system your project may require. It can be used in combination with the SMS Provider
Platform Comparison Matrix (p. 23) to determine customizability needs.

Tool 3: SMS System Implementation Planning Tool (p. 22)

This worksheet was designed to assist with SMS system planning. It offers questions to guide you
through the assessment and decision making process, and can be completed as you read through each
of the sections in this toolkit.

Tool 4: SMS Provider Platform Comparison Matrix (p. 23)

This matrix can be used for the comparison of SMS service providers and platforms to help with the
decision making process. It can be adapted and customized according to your list of required features
and implementation plan.

Sources

(1) Labrique A, Vasudevan L, Chang LW, Mehl G. H_pe for mHealth: More y or o on the horizon? Int. J. Med. Inform.
(2012), http://dx.doi.org/10.1016/j.ijmedinf.2012.11.016
(2) CITA-The Wireless Association, (2012). Wireless Quick Facts. Retrieved from
http://www.ctia.org/advocacy/research/index.cfm/aid/10323
(3) Adler R. (2007). Health care unplugged: The evolving role of wireless technology. California HealthCare
Foundation. Retrieved from
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/H/PDF%20HealthCareUnpluggedTheRoleOfWire
less.pdf

2
 SMS Basics

Short Messaging Service (SMS)

SMS is a method for sending text messages between
mobile devices. The common use of text messaging
is person-to-person, from one mobile phone to
another (or multiple) mobile phone(s). However, it is
also possible to send bulk messages to a number of
recipients using an SMS software application. The
focus of this toolkit is on the implementation
considerations for using and evaluating text
messaging as a health care intervention, in contrast
to personal text messaging applications.

SMS Messaging Components

Large-scale text messaging programs require
specialized software applications and services to
handle message content and delivery scheduling,
and message routing services to deliver messages via
multiple cellular network carriers. SMS messaging The system that will work best for you depends on the
application software supports scripting, scheduling, complexity of your intervention program, the
replying, and routing to an SMS gateway based on programming and technical resources you have
pre-configured algorithms, thus eliminating the need available, and the amount of customization your
for an individual to send, monitor, and respond to project will require. Many messaging application
each text. In this process, a sender uses an SMS providers and SMS gateway providers provide both
messaging application to enter necessary data application and gateway services, in addition to
(message script, message sending schedule, professional services to assist with implementation
messaging algorithms or logic, etc.) An SMS gateway and customization.
(also known as SMS provider, aggregator, or The most common platform options are either a
messaging server) encodes and routes text messages simple, ready-to-go application or a customizable
according to the specific requirements of the application with vendor support. It is also possible,
recipient’s wireless network operator or carrier. although costly and requiring in-house programming
Network operators have SMS centers (SMSC) that expertise, to develop a system from the ground up.
forward the messages to recipients’ mobile phones The Application and Hosting Options section (p. 8)
(see figure below). SMS responses are routed back offers more information about these options.
through the same channels.

Text messages sent through an SMS gateway

SMSC Wireless Network Text Message
SMS Gateway
Operator Recipient

SMSC Wireless Network Text Message

Operator Recipient
SMS System SMS Software
User Application

SMSC Wireless Network Text Message

Operator Recipient

3
SMS Application Features
The sophistication and complexity of your intervention
program will also determine your SMS functional
requirements. For example, a project limited to
reminders or educational information may only require
simple, unidirectional texting. In contrast, an
intervention that includes replies to incoming
responses will require bidirectional texting. For
bidirectional texting, you will need to determine if the
incoming responses will be closed ended (choice of
1,2,3) or open ended responses written by the end
user, which require reading of each response. If more
than one message will be sent, the ability to automate
a schedule or trigger for sending messages is required.

Additionally, outgoing responses may be customized

with conditional branching logic for tailored messages.
This branching capability allows you to send an
automatic, customized response to different types of
closed-ended responses (e.g. If “yes” send outgoing interface with most computer systems, databases, and
response “Keep up the good work”; if “no” send “Try spreadsheet applications. However, it is important to
to get 30 minutes of exercise tomorrow”). know what data you will need to collect and how you
want to store it, so you can verify a platform’s
Most SMS software has the capability to track data compatibility with your needs. Learn more about
such as the number of messages that are sent, messaging features in the SMS System Feature
delivered, opened, or undeliverable. Bidirectional Checklist and Guide (p. 6).
systems also track responses. These programs typically

Short and long codes

SMS messages are limited to 160 characters and can be sent using either a short code or a long code. Short codes are
usually five or six digits so they are easier to remember. A potential drawback is that a recipient may mistake a message
from a short code for spam if the code is not customized. Short codes can be either custom (vanity) or random; vanity
short codes typically cost more. All codes are numeric, but vanity short codes typically spell out something when
translated on a typical phone keypad and are easier to remember. Examples of vanity short codes include:
 COKE: 2653
 ABCTV: 22288
 Obama: 62262

Short codes may be either “dedicated” or “shared,” and shared short codes typically cost less. Short codes are leased
from either an SMS gateway provider, who acts as a re-seller of short codes, or through the US administrator, the
Common Short Code Administration (CSCA) or www.usshortcode.com. CSCA was created jointly by Neustar and the
Cellular Telecommunications & Internet Association (CTIA), which oversee the federally mandated regulations of phone
and Internet carriers, to administer all US short codes. “Common” short codes are common across all major carriers,
whereas a short code (that is not common) is specific to one carrier (such as AT&T). See http://www.usshortcodes.com/
for more information about common short code use and cost.
Long codes are 10- or 11-digit dedicated phone numbers. They were originally intended for person-to-person
communication, and were not supported for sending bulk text messaging and were often blocked or filtered when used
for bulk messaging. As more and more businesses communicate and provide services via text messaging, long codes are
being used more frequently. A business can use its own, recognizable phone number for telephone, fax, email, and
texting. Long codes (regular phone numbers) can be used for texting without additional leasing costs.

4
Audience Preferences and Legal Rights
Consideration of your audience’s needs and Helpful links
preferences using direct input or relevant published
studies is important when developing a text Developer’s Home. (2013). Short Message Service / SMS
messaging intervention. You will want to consider Tutorial:
how many messages to send and how often, as well http://www.rapidsms.org/code/reference/guides/
as the most effective message content. We
Seattle King County Public Health. Life of a text message:
recommend designing messages carefully, http://www.kingcounty.gov/healthservices/health/preparednes
considering the desired outcomes and using a theory- s/texting/costs.aspx#life
driven, evidence-based approach. You can learn more
about communication theory and developing Common Short Code Administration:
message content in the Develop a Communication http://www.usshortcodes.com/about-sms-short-codes/sms-
marketing-overview.php
Strategy section (p. 13) and other sources listed in
the Text Messaging Bibliography section (p. 24).
CSCA Shared Versus Dedicated Short Codes:
http://www.usshortcodes.com/about-sms-short-codes/shared-
Another factor to consider is maintaining sms-vs-dedicated-sms.php
participants’ privacy. Laws and regulations regarding
patient privacy apply to text messaging in healthcare.
Although text messages are encrypted during
transfer, a message that displays on a screen may be
visible to people close by and accessible to people
who have access to a user’s phone. Researchers can
protect patient privacy by restricting the amount of
information in messages or advising research
participants to protect their cellphones with
passwords and settings that restrict the amount of
information delivered with a text message receipt
notification. Additionally, participants can use
antitheft applications that allow them to remotely
lock their phone and wipe it clear of sensitive
information.

SMS applications must allow for recipients either to

opt-in or to opt-out. The universal method of opting
out of a program is to respond with the keyword
“STOP.” Opt-in options require active acceptance by
texting a code word, such as “EATWELL” for a
program to deliver daily nutrition tips, to a
predetermined short code. Opt-in programs require
advertising or outreach to the target audience that
would also include the short code and the code
keyword so they know how to opt in. If you are
sending messages to a predetermined list, an opt-out
feature may be the best option. See the Security and
Privacy section (p. 16) for a complete list of applicable
regulations and best practices.

5
 SMS System Feature Checklist and Guide

Messaging Features
Required Features Description
 Text Blasting/Bulk Simple, one-way text messages are sent to a list of recipients. This feature is useful for
Messaging public health alerts or health education campaigns. Requires minimal or no
customizability.
 Two-Way Text The capability to send messages and receive text message responses is available in SMS
Messaging systems.
 Tailored or A personalized message feature enables you to autoreply to a response with a tailored
Personalized Text message making the message more relevant or targeted to the recipient. This feature
Messages can require more customizability and possibly the ability to interface with EHR systems
and databases.
 Short Messaging This feature allows SMS communication between the sender of a message and the
Service (SMS)-to- recipient’s email. This is useful for people who would rather receive or send information
email/email-to-SMS via email.
 Short Codes Common short codes are numbers used for sending and receiving texts. They allow
rapid, high-volume outbound messaging. These codes are normally 5-6 digits, so they are
easy to read and remember, allowing the receivers of a text to more easily identify the
sender. It is not necessary to have a short code, but they are available for lease from the
Common Short Code Administration for $500-$1000 per month or they may be obtained
through a text messaging vendor.
 Long Codes A long code is a 10-digit local number from which SMS messages are sent. They can be
obtained from an SMS service provider. In some cases long code may be preferable to
short code because they can be either leased or owned, which can reduce cost and allow
for repeated use of the code. Furthermore, a local phone number may be more
identifiable to the recipient, and some cell phone providers may block messages sent
from short codes.
 Automated A response system sends out an automated response or series of responses to an
Response incoming SMS message. Various options for tailored automated responses include
keyword response, personalized response, and scheduled response. This feature requires
variable degrees of customizability, depending on the type of response.
 Keyword Response Text message response options include keywords. Automated responses are then sent to
recipients according to the keyword they return in their response. Incoming keywords
may be in response to a marketing campaign, a reply to a text message, or a request for
more information. For example, an incoming text message with a keyword such as
“INFO” might generate an automatic response with information. This feature requires a
minimal amount of customizability.
 Conditional Branch Conditional branch logic is a software feature that allows for keyword and automated
Logic responses based on a predefined algorithm. It recognizes incoming response types and
sends appropriate messages according to what is indicated in the logic. This feature
requires a moderate amount of customization.
 Tailoring by Group Recipients may be divided into groups, and tailored messages can be sent to each of
those groups. Recipients might be grouped according to sex, location, demographics, or
other characteristics. A moderate amount of customization is needed for this feature.
 Message Out-going messages may be scheduled to be sent at specified times or time increments.
Scheduling/ This feature is valuable for reminders and behavior modification programs and usually
Staggering requires a small amount of customizability.
 Multimedia Messages sent via MMS may include photos or videos, graphics, and texts longer than
Message Service the standard 160-character limit of normal SMS messages. However, MMS is not
(MMS) compatible with all cell phones, and costs for sending MMS messages is higher than for
sending SMS messages.

6
  Active Links URL links that direct recipients to a website may be included in the text. This can be used
to minimize the inclusion of protected health information in a text message, direct
people to a survey or personal health record, or provide access to information in
addition to what can be sent in a text message.
 Voting and Polling Polls can be created and sent via text message. Recipients may respond to multiple-
choice answers either by numeric or alphabetic response. Polling can be useful for
collecting qualitative or quantitative data, and for gathering general information about a
group of people. This feature requires minimal customization.
 Automatic Stop This feature allows end users to opt-out by sending the keyword “STOP” if they wish to
Function stop receiving text messages from the sender.
 Message Queuing Messages may be sent in a predetermined order, with verification that a message was
completed before sending a subsequent message. This requires minimal customizability.
 Unicode Support This feature accommodates messages in any language using proper characters and
formatting, such as French (Français), Japanese (日本語), English (English), or Arabic
(‫)ال عرب ية‬.

Database and Group Management Features

Required Features Description
 Opt-out/Opt-in Text messaging lists require updating to include new subscribers and delete subscribers
(subscription) who wish to opt out and not receive future text messages. Different text messaging
Management platforms may offer varying capabilities and options for the updating of recipient lists.
Researchers may choose between an opt-out or an opt-in system based on their project
goals, institutional policies, and institutional review board guidelines.
 Ability for Multiple Most text messaging platforms offer unlimited recipient lists and the creation of
Groups multiple recipient groups to assist with messaging management. This feature requires
minimal customizability.
 End User Web Portal access for recipients allowing the ability to subscribe to text messaging
Portal Access campaigns or programs via a webpage with any standard browser.
 Integration with Text messaging platforms generally have the ability to upload lists of names, cell phone
Other Information numbers, and other data from outside programs such as Excel or Outlook. Some text
Systems messaging platforms can integrate with EHRs, but this is relatively new and is best
discussed with EHR vendors. Integration with programs such as Excel requires only
minimal customization, while interface with EHRs requires a high degree of
customization and security measures.
 Backup System It is important to have a back-up system for stored data. Data may be backed up on a
vendor server or on an internal server.

 Master Account Some systems offer user accounts under a master account to allow for multiple projects
With Sub-Accounts or message administrators.

Reporting and Administrative Features

Required Features Description
 Text Message Many text messaging systems provide data such as audit logs of messages sent,
Statistic Recording declined or undeliverable (bounce) reports, opt-out reports, and demographics and
behavioral data regarding use. This type of information can be important to
researchers who need to track the results of text messaging interventions. This feature
requires minimal customization.
 Exportability of Data and message statistics may be exported to outside applications such as Excel.
Data More complex systems may have advanced software and security measures for
research data capture, storage, and interface with databases or analysis software. The
amount of customization required for this feature will vary according to the type of
system you wish to interface with.
 Usage Metering Usage metering provides convenient information regarding important usage data,
which may be valuable for designing and monitoring systems.

7
 Application and Hosting Options

The amount of resources you have available and the

level of customization necessary for your text Text messaging application and gateway providers
messaging intervention will determine how you
We do not endorse any particular vendors, but rather we
approach the SMS system set-up and the storage of
recommend researching several companies. Below is a
your data. The main decisions will be your choice of 1) partial list of text messaging companies to serve as a
text messaging application, 2) SMS gateway, and 3) starting point. For more information about choosing a
hosting locations for the software and data necessary vendor, see the Selecting a Text Application Vendor Section.
for your system. Many vendors can provide all of the Application vendors
components, often acting as a reseller and providing Sumo text
professional development and support services. Callpointe
Mobile commons
Message-Media
Participant data and message content may be stored, Televox
or hosted either in a vendor’s database or cloud, or in Ex Texting
an internal database. The advantages of storing Trumpia
information with a vendor are minimal effort and cost
SMS gateway providers
for initial set up, and less required database integration Twillio
capability. However, vendors usually charge service Clickatell
fees, and their systems may not meet your security
requirement, so care must be taken to ensure that
protected health information is only stored on a secure
server. Hosting messages internally requires more
database capability and initial set up, but service fees
Helpful links
are lower and the system has more flexibility and
control over the security. Seattle and King County Public Health – Should you be your
own SMS vendor?
http://www.kingcounty.gov/healthservices/health/prepare
Options for SMS platforms include off-the-shelf
dness/texting/~/media/health/publichealth/documents/tex
applications for simple text messaging interventions, ting/CostAnalysisSummary.ashx
customizable existing platforms for somewhat
complex interventions, and completely customized Top Ten Reviews – 2013 Best Text Message Marketing
Service Comparisons and Reviews: http://text-message-
systems for interventions requiring sophisticated
marketing-review.toptenreviews.com
integration with other health information technology
systems such as electronic health records (EHR). In
this section we describe several common system
solutions categorized into three levels of
customization: 1) none to minimal customization, 2)
moderate customization, and 3) advanced
customization.

8
 Level 1: None to Minimal Customization
Solution for one-way or standard response interventions

Case study 1 Interventions sending non-interactive, one-way messages will usually

require only a simple off-the-shelf application. There are many
Simple, one-way messages: SMS
companies that offer a ready-to-go Internet interface in which you
reminders were used in a 2009
behavioral change campaign to simply enter the message and a list of recipients’ numbers. The only in-
increase adherence to sunscreen house technical requirement is access to the Internet (see figure
application recommendations. below). Therefore, there is little or no set up involved and the fees are
Researchers measured the
generally very low. Check with individual vendors for details about the
effectiveness of sending a daily weather
report followed by a motivational features and customizability options they offer.
reminder to apply sunscreen to a group
of 70 participants via SMS. This study
indicated that even simple, untailored Vendor server/cloud
text messaging is a viable, cost- In-house and gateway Outside cellular service
effective solution that could be
effective in large-scale public health
interventions.

Source:
Armstrong AW, Watson AJ, Makredes M,
Frangos JE, KimballAB, Kvedar JC. Text-
message reminders to improve sunscreen
use: a randomized, controlled trial using Elements in a vendor-hosted system
electronic monitoring. Arch Dermatol
2009;145(11):12301236.

Commercial off-the-shelf application

Description  An vendor application is used to send and receive text messages; includes support
service, limited professional services
Common uses  Public health education campaigns
 Emergency/risk notifications
 Reminders
Features and customizability  Low customizability
 One-way outbound or simple two-way messaging
 Often non-interactive to inbound text messages
 Bulk messaging
Hosting/data storage  Data typically stored on vendor database or cloud, but could be stored on internal
server
Cost considerations  Low up-front development costs
 Low to medium service fees
Advantages  Easy set-up
 Low maintenance
 Adequate for simple projects

9
 Level 2: Moderate Customization
Solution for two-way intervention with tailoring

For interventions intending to use tailored, two-way messaging, a

Case study 2
system with a customized, in-house text messaging application and
A recent study used text messaging in an external SMS gateway provider may be the best choice (see figure
combination with social media to below). This type of program will allow for more customizability in
deliver a weight loss program to scheduling, reporting, tailoring, and personalizing of messages. They
college students. Researchers sent 3 have greater flexibility interfacing with other health it systems and
types of text messages at random can incorporate conditional branching logic. Outgoing responses can
intervals. The first was a prompt to be tailored to the recipient’s response. Application customization
monitor weight, calorie intake, and usually requires the assistance of a programmer, or application
activity level and text back nightly the
developer. Many application vendors provide this service. There is
usually some set-up expense and fees for sending messages. Check
information. After responding, the
with individual vendors and developers to get specific costs.
participants received a general
response. The second type was sent 2 In-house
days per week and included a software External SMS
gateway Outside cellular service
motivational message along with a
request for information. Upon receipt
of the data, immediate feedback was
sent to the participants based on
their response. The third type (also
sent 2 times per week) offered tips
tailored to participant’s previously
identified risk behaviors and Elements in a customizable application with external gateway
situations. All data received from text
messages were then compiled into
personalized feedback reports for Customizable application
participants on a weekly basis. Description  Application with greater customization
capability (professional services available from
The text messages sent to the vendor)
participants in this study were  External SMS gateway provider
created and managed using in-house Common uses  Disease management and monitoring
customized text messaging software.  Personalized reminders and responses
The data that supported the  Data collection
application (e.g. participant Facebook  Personalized notifications
Features and  Moderate to high customizability
URL address and mobile phone
customizability  Two-way interactive text messaging
numbers) were stored on an external
 Supports multi-channel (voice, text) messaging
server. The system used an external  Some flexibility in integration with other
SMS gateway provider (Twilio). programs
Hosting/data  Data usually stored internally, but pass
Source:
storage through an SMS gateway
Napolitano MA, Hayes S, Bennett GG, Ives
AK, Foster GD. (2013). “Using Facebook Cost considerations  Some up-front development costs
and text messaging to deliver a weight  Low service fees
loss program to college students”. Advantages  Easy to moderate set-up
Obesity (1):25-31.  Opportunity to add customized features and
tailor or personalize messages

10
 Level 3: Advanced Customization
Solution for interventions involving secure information or electronic health record (EHR) interface

Interventions that require interfacing with patient electronic

Case study 3 health records or other health IT systems may need to be
A large vertically-integrated safety-net completely customized or built from the ground up to ensure
health care system in Denver, Colorado compatibility and security. These systems can be extremely
tested an intervention to remind adult expensive and time consuming to build, but offer the benefit of
patients with diabetes to monitor their being able to draw upon and add to patient electronic health
blood sugar levels and attend medical records. Storing all data on internal servers may also provide
appointments. Blood sugar testing
assurance regarding security. It is possible to have an internal
reminders were sent 3 times per week and
appointment reminders were sent 7,3, and 1
gateway server; however, they will usually be external. Most
day(s) prior to appointments. The text agencies that use this type of system have in-house IT personnel
message interactions were integrated with that can help build a text messaging application and implement
the facilities electronic health information the system.
systems.
In this scenario, the goal was not only to test In-house External SMS
the intervention but also to develop a software gateway Outside cellular service
patient outreach platform that was
integrated with clinical and administrative
IT systems and supported text messaging
in addition to other methods of
communication. The text messaging
application was an integrated feature of
Microsoft’s Customer Relationship Manager
application (Microsoft Dynamics CRM),
which was rebranded as a “Patient Elements in a custom integrated system
Relationship Manager” (PRM) application for
healthcare-specific applications. The text
message application supported 2-way text
messaging with customization of delivery
scheduling to an individual’s preferences, as Completely customized, integrated system
well as basic branch logic capability. The Description  Completely in-house system built from the
PRM database was integrated with clinical ground up; requires programming
and administrative datasets to enable resources; highly customizable
automated triggering of outreach (such as Common uses  Integrated with electronic health records,
texting appointment reminders) as well as personal health records
the flow of patient-generated data collected Features and  High customizability
at home into the clinical database. The customizability  Allows complex conditional branch logic
entity currently contracts with an outside design of interactive messages for highly
SMS gateway vendor, Twillio. Data and personalized and tailored messages (aka
software are hosted internally. dynamic application logic)
Source: Hosting/data storage  Data are stored internally, and may pass
Fischer HH, Moore SL, Ginosar D, Davidson AJ, through an SMS gateway or may be sent
Rice-Peterson CM Durfee MH, Mackenzie TD, directly to a cell service provider
Estacio RO, Steele AW. (2012). "Care by cell Cost considerations  High up-front development
phone: text messaging for chronic disease  In-house maintenance costs
management". The American journal of managed
Advantages  Opportunity to add customized features
care (1088-0224), 18 (2), p. e42.
 Allows greatest flexibility for integration
with other systems

11
 Selecting a Text Messaging Vendor

Selecting a Text Messaging Questions for application vendors

Application  What are the set-up and service costs?
If after assessing your needs for a  Is 2-way texting available?
text messaging system you decide  What level of customization and other functions are available?
to use an off-the-shelf application,  What is the interfacing compatibility with other data systems?
you will need to select a product  What is the Interfacing compatibility with gateway providers?
and vendor to work with. The  What message tracking ability and audit recording is available?
services that SMS vendors offer  What is the security of data stored on the vendor’s system?
 Can the system accommodate multiple users?
vary, so researching different
 How is the system backed up?
options will help you find the right
 What is the availability and cost of technical support services?
company for your project.
Information on specific vendors
can be found on company websites.

Questions for SMS gateway providers

Selecting an SMS Gateway  What is the cost per message sent?
Provider  Are there any other costs?
Using an SMS Gateway provider is  What are the payment options?
usually very simple. Providers  What is the availability and cost of technical support services?
generally offer either a credit-  Is there a monthly minimum credit purchase requirement?
based program, requiring  Is there an expiration period for credits purchased?
 Can you test the system at no charge?
prepayment for a set number of
 What is the quality of the SMS gateway’s network coverage?
messages or a pay-per-use  Is the SMS gateway compatible with the application or interface you
program, which charges per are using?
message sent.  Where will the data be stored?
 How are the accounts and availability of remaining credits managed?

Finding a Programmer
If your text messaging program requires custom development, you will need to employ a programmer. Larger
research institutions typically have in-house resources; however, you can also find services on the Internet at
sites such as the Mobile Marketing Association Industry Directory.

Helpful links
Top Ten Reviews – 2013 Best Text Message Marketing Service Comparisons and Reviews: http://text-message-
marketing-review.toptenreviews.com

Seattle and King County Public Health - Considerations when selecting a text messaging vendor:
http://www.kingcounty.gov/healthservices/health/preparedness/texting/costs.aspx#vendors

Developer’s Home – How to Choose an SMS Service Provider:

http://www.developershome.com/sms/howToChooseSMSGateway.asp

CSCA- Find a SMS Marketing Partner: https://www.usshortcodes.com/partners/find-a-sms-marketing-partner.php#application-tab

Mobile Marketing Association Industry Directory (http://www.mmaglobal.com/resources/directory).

12
 Develop a Communication Strategy

When developing a text messaging program, messages

should be designed in a way that will have an impact
on the target audience. Messages are more effective
when they are carefully composed considering the
target audience characteristics and motivators, and the
program’s desired outcomes. Additionally, messages
can be tailored and personalized for each individual.
This guide is not a review of those theories. Sources
with further information on designing SMS
communication campaigns are located in the Text
Messaging Bibliography (p. 24). This section will discuss
how to analyze and engage your audience, and create a
theory-based text message intervention.

Engage the Audience in the Intervention Design

A successful text messaging intervention will work with
members of the target audience to learn their
preferences. Audience members can offer feedback
and input on the program idea, how many text
messages they prefer, and times of the day or week
they would like to receive messages. This feedback can
be obtained iteratively, to gather input regarding
specific messages and then tested as a system
prototype. Researchers should be sure to test an entire
system with as many users as necessary to reach
information saturation prior to deployment.

Use Communication Theory to Target and Tailor Messages

There is a substantial body of literature on message design within health communication that can be used to
inform message content and intervention design. Messages are more likely to be compelling and evoke a
behavioral response if they are grounded in communication and behavioral change theory, and are linked to
specific desired outcomes.

For example, message design that complies with gain frame or loss frame appeals may be more effective.
Research shows that patients are more willing to undergo an unpleasant task or procedure—such as a
mammogram or colonoscopy—if they are presented with the positive rewards (gain frame appeal) for that
behavior, such as peace of mind. Conversely, people are more likely to take action to avoid risks when they are
reminded of potential negative outcomes (loss frame appeal)1—applying sunscreen to prevent skin cancer, for
instance. Thoughtful and deliberate framing of messages will improve the likelihood that your intervention is
effective.

Using a message library to explicate and link every message to a specific desired outcome and communication
theory or evidence can help researchers design a stronger intervention. The following table illustrates use of a
message library.

13
Example of a text messaging library matrix
Message Type/ Character Theoretical
Outcome Message Content Count Date Time Tailoring Construct
Reminder: 30 minutes of exercise 130 4/8 8am Women Gain frame
regular exercise each day can improve ages 35- Risk: Exercise
for increased your mood, increase your 50 Gain: mood,
fitness and energy, and help you get energy, and
weight loss back into your favorite appearance
pair of jeans!

Two other forms of message tailoring are personalization and feedback. Personalized messages contain
information specific to the recipient, such as a name, and can solicit attention and be a motivating factor.
Depending on your intervention and desired outcomes, you may decide to use a 2-way texting system that
provides feedback to information sent to you from the user. You may, for example, send a message saying,
“You are only eating an average of 2 servings of vegetables per day. According to the FDA, you should be eating
an additional 2.” Providing specific feedback and instructions can be an effective way of promoting behavior
change.2

Text messaging best practices

 Keep messages short and concise. Each message should be less than 160 characters including spaces,
punctuation, and any branding or links to additional information.
 Make messages engaging. Write relevant, timely, clear, and actionable messages. Try to begin each
message with an interesting fact or question so that users will be more likely to open the text message
and read all the information.
 Make content readable. Content should not exceed an 8th grade reading level or contain difficult to
understand terminology.
 Use abbreviations sparingly. Because text messages have a character limit, it is acceptable to use
abbreviations, but only when they are easily understood and do not change the meaning of the message.
 Limit non-Latin characters. Depending on the mobile carrier, non-Latin or accented letters do not always
work.

Source:
Centers for Disease Control and Prevention. (2012). Guide to Writing for Social Media. Retrieved from:
http://www.cdc.gov/socialmedia/Tools/guidelines/pdf/GuidetoWritingforSocialMedia.pdf

14
 Sources

(1) Rothman A, Bartels R, Wlaschin J, Salovey P. The strategic use of gain and loss framed messages to promote
health behavior: how theory can inform practice. Journal of Communication 2006; 56:S202-S220.

(2) Hawkins, R P, Kreuter M, Resnicow K, Fishbein M & Dijkstra A. (2008). Understanding tailoring in
communicating about health. Health Education Research, 23(3), 454-466. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171505/

Helpful links and other sources

Petty R, Barden J, Wheeler S. The Elaboration Likelihood Model of Persuasion. Ch 4 In: DiClemente, Crosby R.,
Kegeler M. (Eds.), Emerging Theories in Health Promotion Practice and Research. San Francisco: Jossey-Bass; 2002.

Atkin C. Theory and principles of media health campaigns. Ch 3 In: Rice R, and Atkins C. (Eds.) Public
Communication Campaigns. 3rd Edition. Sage Publications, Thousand Oaks CA.

Center for Disease Control and Prevention. (2010). Social media guidelines and best practices. Retrieved from
http://www.cdc.gov/SocialMedia/Tools/Mobile.html.

Finnegan J, Viswanath K. Communication theory and health behavior change. Ch 16 In: Glanz K, Rimer B,
Viswanath K. (Eds.), Health Behavior and Health Education. San Francisco: Jossey-Bass; 2008.

15
 Security and Privacy Considerations

The main privacy concern regarding text information sent is vulnerable to exposure. It is
messaging in healthcare is the transmission and important to consider that any information
storage of protected health information (PHI). indicating past, present or future medical
Unfortunately, it is currently not possible to conditions or care is considered PHI. For example,
encrypt SMS messages end-to-end when they are a reminder to return for a second immunization or
sent between different cellular networks. an inquiry about a patient’s current pain level is
Therefore, individually identifiable health subject to regulation. Therefore, it is advisable to
information is subject to exposure when not include any identifying information via text
transmitted via text message. Some vendors and message. Using coded language to communicate
platforms such as Apple iPhone now provide health information can render it incomprehensible
secure, encrypted text messaging services for in- to outside parties. Patients can create their own
network messaging, and there are some recently code to serve as a reminder; for example, “down
available applications that allow messages to be the hatch” could cue a patient to take medication.
sent with password protection (Text Fortress).
However, these solutions are viable only if your Know the Laws and Regulations
intervention uses person-to-person or in-network HIPAA
text messaging. The Health Insurance Portability and Accountability
Act of 1996 (HIPAA) was established to regulate the
Another concern is that messages may be visible use and disclosure of PHI, which consists of
to those other than the phone’s owner, either “individually identifiable health information.”
because the phone is not password protected or HIPAA describes this information as any
because incoming text messages are displayed on demographic information relating to past or
a screen preview feature. Study participants can present health conditions, healthcare received, and
be advised to protect their phone and turn off payments for healthcare, along with any identifiers
preview features that allow a preview of the such as name, address, birth date, and social
message to be automatically displayed on the security number.1 HIPAA’s security rule includes
screen. specific security standards for the disclosure and
storage of electronic health information and
Because information transmitted in a text requires safeguarding of PHI. Text messaging is
message is stored on a non-secure server, a SIM regulated under this rule when it involves the
card, or by a third party, any protected health transmission and/or storage of PHI. The security
16
rule requires covered entities to conduct a technology in healthcare and ensure compliance to
thorough risk analysis to determine threats to the HIPAA rules. The HITECH Act increases the U.S.
safety of PHI. Some texting platform companies Department of Health and Human Service’s ability
advertise that they are HIPAA compliant, but they to impose penalties for violations of HIPAA rules.
provide secure communication only within a closed Under the HITECH Act, penalties for violations have
network. a maximum of $1.5 million, and penalties cannot be
barred for unknown violations unless corrections
FTC’s CAN-SPAM Act of 2003 are made within 30 days.2
The Federal Trade Commission (FTC) enacted the
CAN-SPAM law to protect the privacy of FDA regulations on medical devices
consumers. This law applies to text messaging The FDA regulates only mHealth applications that
campaigns and requires that recipients are told are associated with or serve as a platform for a
how to opt-out of receiving text messages and that medical device. The FDA allows for the exemption
those opt-out requests are honored in a timely of “safe” devices, including cellphones, used for
manner. Penalties for non-compliance can reach up investigational and clinical data collection purposes
to $16,000. from regulation. For more information refer to the
FDA guidance document found at
HITECH Act http://www.fda.gov/downloads/MedicalDevices/D
The American Recovery and Reinvestment Act of eviceRegulationandGuidance/GuidanceDocuments
2009 includes the Health Information Technology /UCM263366.pdf
for Economic and Clinical Health (HITECH) Act,
which was written to promote the use of

Security and privacy best practices

 Conduct a risk analysis and manage the risks
Conducting a thorough analysis of all potential risks to the privacy of PHI will help you understand the specific measures
you should take to safeguard information. These measures may be at the administrative level, the physical level, or the
technical level. At the administrative level, covered entities must create policies and procedures for the prevention of
security violations, and a continual monitoring process to ensure the continued protection of PHI. Physical access to PHI
must also be secured, including access to facilities and systems on which health information is stored. Additionally, the
disposal of storage systems and data must be controlled. At the technical level, controls should protect the access to PHI,
such as the use of passwords or encryption. An excellent example of a comprehensive risk assessment done for the Project
Health Design, Breath Easy research study can be found at http://www.projecthealthdesign.org/media/file/BreathEasy-
Privacy-and-Security-Analysis-lisa Memo-080210.pdf
 Exclude protected health information from messages
Sending private health-related messages to an individual cell phone is complicated because the owner of the phone is
identifiable. In other words, if the owner of the phone can be identified, anything sent to that phone is also identifiable.
One option for avoiding HIPAA compliance issues is to exclude individually identifiable health information from all text
message communication. You might send out generic, “unidentifiable” text messages or messages may be sent in a code
pre-established by the two communicating parties.
 Verify the user’s identity
Verifying the recipient of a text message can protect PHI from being disclosed to the wrong person. You may direct the
recipient to access a secure website where they enter a password to see their message or direct the recipient to call in
directly and speak with a member of the research team, or their personal physician, as warranted for your scenario.
 Use only secure vendors
If your text messaging system is physically located within your organization, your organization is responsible for all security
measures to protect stored PHI. However, you may choose to use a third party vendor to distribute and manage your text
messaging. Many vendors have built-in security features that will protect information.

17
Institutional review boards Sources
Institutional Review Boards (IRB) oversee the use of
human subjects in research projects. We 1. U. S. Department of Health and Human Services
recommend consulting with the IRB at your – Summary of HIPAA:
institution. IRBs must comply with the U.S. http://www.hhs.gov/ocr/privacy/hipaa/understa
Department of Health and Human Services nding/summary/privacysummary.pdf
requirements regarding the use of human subjects
2. U. S. Department of Health and Human Servicesl
in research regarding the risks to, and the selection,
(2009) HHS Strengthens HIPAA Enforcement
consent, privacy, and protection of human subjects. Retrieved from
A list of regulations is available at the U.S. http://www.hhs.gov/news/press/2009pres/
Department of Health and Human Services Office 10/20091030a.html
for Human Research Protections website listed
under Helpful Links on this page. Helpful links
Karasz H, Elden A, Bogan S. – Text Messaging to
Communicate With Public Health Audiences: How the
HIPAA Security Rule Affects Practice. American
Journal of Public Health, 103(4):999-1005:
http://www.ncbi.nlm.nih.gov/pubmed/23409902

Mobile Commons – HIPAA and Text Messaging

Security Whitepaper:
http://www.mobilecommons.com/wp-
content/uploads/Mobile-Commons-HIPAA-Text-
Messaging-Security-White-Paper.pdf

*More security and privacy resources in the Useful

Links and Resources: Security/HIPAA section

U.S. Departmetn of Health and Human Services.

Office for Human Research Protections (OHRP)
http://www.hhs.gov/ohrp/

18
 Appendix A
Health Text Messaging Glossary of Terms
API (Application Programming Interface): A set of routines, protocols, and tools for building
software applications. An API makes it easier to develop a program by providing all the building
blocks. A programmer then puts the blocks together. Many text messaging applications are
considered APIs, and the building blocks allow for the needed customizability.

CSC (Common Short Codes): Shorter numbers, usually 5-6 digits, from which a text message can be
sent or received; short codes can be leased for a fee from the Common Short Code Administration
(CSCA).

Encryption: The encoding of a message by digitally scrambling the information to prevent

interception of messages by third parties.

SMS (Short Messaging Service): A simple, limited character (140-160) text message format that is
compatible with any type of cellular phone.

mHealth (Mobile Health): Refers to the overall use of mobile devices in healthcare, which includes
text messaging, cellular applications, internet applications and interfacing with electronic health
records, and other types of data transmission.

MMS (Multimedia Messaging Service): A message format used in smart phones that can include
media content.

Server: Computer software and hardware that facilitates network service.

Platform: Computer software/hardware frameworks that allow software programs to run.

SMS gateway: Translates messages between different carriers’ protocols A gateway user sends SMS
messages to a gateway, which then routes the messages to either a mobile phone, another SMS
gateway or a SMSC (short message service center which delivers the message to the recipient. A
gateway allows users/applications to send messages from a web browser.

SMSC (Short Message Service Center): is the portion of the wireless network that handles routing,
forwarding, and storing of incoming text messages. SMSCs are connected via SMS gateways.
Different carriers have different SMSC message protocols and most often an SMSC is dedicated to
handle the traffic of a single wireless carrier.

End user: Refers to the party who is the primary recipient of messages in a text message program.

Opt in: The option of a recipient to start participation by sending a text message of a dedicated opt-
in key word to the program’s short code.

Opt out: The option of a recipient to end participation in the text message program and stop
receiving further messages.

Conditional branch logic: coding that allows software to match a specific feedback response to an
incoming message (e.g. If A then respond with B).

19
 Appendix B
Tool 1: Checklist for Assessing Functionality Needs
This tool can be used along with the SMS System Feature Checklist and Guide and will help you
identify what features you will need in your text messaging platform.

1. What type of system will you be interfacing with?

 None
 Spreadsheet/data application such as Excel
 Electronic Health Records (EHR)

2. What type of messaging will you be using?

 One way, outgoing messages only
 Outgoing and incoming, 2-way messaging
 2-way with customized responses
o Tailored responses requiring branching
o Personalized responses

3. What are your needs regarding timing of messages?

 None
 Requires scheduling
 Requires message staggering
 Requires message queuing

4. What type of data will you be collecting?

 Messaging statistics
o Number of messages sent/received
o Times sent
o Number of messages bounced
o Other__________________________________
 Responses
o Closed ended
o Text typed by respondent

5. How will you manage your groups?

 Opt-in: Participants will initiate a text to join
 Opt-out: Participants will be added from a list and given the option to stop

6. What type of number will the message be sent from?

 Short code (shared or dedicated)
 Long code

7. Level of security will you need in your system?

 Minimal: the program will not transmit protected health information
 Requires secure system: the program will transmit protected health information

20
Tool 2: Platform Type Decision Making Checklist
This checklist is intended to provide a starting point to determine what type of system your
project requires. Customizability and functionality vary among different platforms, so available
vendor and API options should also be considered. Therefore, this tool can be used in
combination with the Platform Comparison Matrix to determine customizability needs.

Less customizable More customizable

Off-the-shelf Customized Completely

Application Application Customized or Home-
Built System
What resources
are available for  Low  Low to moderate  High
this project?
(Funding, time,
expertise)

What are my  Low  Moderate  High customizability:

needs for customizability: customizability: Will accommodate
customizability Simple, one-way or Requires customized most functions
and required two-way with responses and
functions? limited scheduling, statistics
(Varies—check customizability tracking, and list
vendor and API management
options)
What control do I
need over security  Externally, on a  Internally, but  Internally, may or may
of data and where vendor’s database; passes through an not pass through an
will I store lowest control over external gateway; external gateway;
protected health security low to moderate most control over
information? control over security security

What types of
data need to be  Message statistics:  Message statistics,  Message statistics, all
collected? when and how all types of types of responses,
many messages responses including data to go
were sent, number into EHRs
of bounced, some
response data

What type of  May interface with  Allows for interface  Allows for interface
system will I need spreadsheet with more complex with any larger
to interface with? programs such as database systems system, including EHRs
Excel

21
Tool 3: SMS System Implementation Planning Tool
This worksheet was designed to assist with SMS system planning. It offers questions to guide
you through the assessment and decision making process, and can be completed as you read
through each of the sections in this toolkit.

•What are your desired project outcomes?

•What data will you need to gather?

Identify
Purpose and
Target
Audience •What are the needs and preferences of your audience?

•How much customizability will your project require?

•What resources do you have available (funding, time, expertise)?

Conduct a
Needs
Assessment •What privacy & security issues do you need to consider?

•Will you use an off-the-shelf, customizable, or a ground-up system?

•Will your system be hosted internally or externally?

Develop a
Plan •How will you protect patient privacy and confidentiality?

22
 Tool 4: SMS Application Vendor Comparison Matrix
This matrix can be used for the comparison of SMS service providers and platforms to help with
the decision making process. It can be adapted and customized according to your list of required
features and implementation plan.

Platform / Message Auto- Scheduling Conditional Data Short / Opt-in / Cost Contact
provider personalization reply branch logic collection long code opt-out
function / tracking
Vendor A No Yes, No, Yes Yes Messages Short code Opt-in .10 per John
sent / message 800-555-
received / 1212
bounced

23
 Appendix C
Text Messaging Bibliography
Systematic Reviews (Annotated)
Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and
management. Epidemiol Rev. 2010;32:56-69. PM:20354039
This systematic review provides an overview of behavior change interventions for disease
management and prevention delivered through text messaging.

Deglise C, Suggs LS, Odermatt P. Short message service (SMS) applications for disease
prevention in developing countries. J Med Internet Res. 2012;14:e3. PM:22262730
The objective of this study was to examine SMS-supported interventions for prevention of
communicable and noncommunicable diseases in developing countries. It assessed the
effectiveness of SMS-based interventions and identified drivers and inhibitors to adoption.

Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile
telephone short-message service. Am J Prev Med. 2009;36:165-173. PM:19135907
This review analyzes the application of SMS for delivering health behavior change
interventions to establish what can be learned from research conducted to date and make
recommendations for future research. SMS-delivered interventions have positive short-term
behavioral outcomes.

Holtz B, Lauckner C. Diabetes Management via Mobile Phones: A Systematic Review. Telemed J
E Health. 2012;18:175-184. PM:22356525
This study sought to examine the types of mobile phone-based interventions implemented
among people with diabetes and the potential effect of these interventions on patient
outcomes.

Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting
adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev.
2012;3:CD009756. PM:22419345
The objective of the study was to determine whether mobile phone text-messaging is
efficacious in enhancing adherence to ART in patients with HIV infection. The study found
that there is high-quality evidence from the two RCTs that mobile phone text-messaging at
weekly intervals is efficacious in enhancing adherence to ART, compared to standard care.

Krishna S, Boren SA. Diabetes self-management care via cell phone: a systematic review. J
Diabetes Sci Technol. 2008;2:509-517. PM:19885219
The objective of this study was to evaluate the evidence on the impact of cell phone
interventions for persons with diabetes and/or obesity in improving health outcomes and/or
processes of care for persons with diabetes and/or obesity. Providing care and support with
cell phones and text message interventions can improve clinically relevant diabetes-related
health outcomes by increasing knowledge and self-efficacy to carry out self-management
behaviors.

Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E
Health. 2009;15:231-240. PM:19382860

24
 Systematically reviewed published studies to evaluate the contribution of cell phones and
text messaging in improving the process and outcomes of care.

Lau PW, Lau EY, Wong dP, Ransdell L. A systematic review of information and communication
technology-based interventions for promoting physical activity behavior change in children and
adolescents. J Med Internet Res. 2011;13:e48. PM:21749967
The present review systematically evaluated the efficacy and methodological quality of ICT-
based interventions that applied Internet and/or SMS as a delivery mode for PA behavior
change in children and adolescents based on the evidence of randomized controlled trials
during the past 12 years (1997-2009)

Lim MS, Hocking JS, Hellard ME, Aitken CK. SMS STI: a review of the uses of mobile phone text
messaging in sexual health. Int J STD AIDS. 2008;19:287-290. PM:18482956
This paper reviews the current published and grey literature and discusses applications of
SMS in sexual health and the evidence base for their effectiveness

Militello LK, Kelly SA, Melnyk BM. Systematic review of text-messaging interventions to promote
healthy behaviors in pediatric and adolescent populations: implications for clinical practice and
research. Worldviews Evid Based Nurs. 2012;9:66-77. PM:22268959
The purpose of this paper is to review the evidence using text messaging as a tool to deliver
healthy lifestyle behavior intervention programs in pediatric and adolescent populations.

Vervloet M, Linn AJ, van Weert JC, de Bakker DH, Bouvy ML, van DL. The effectiveness of
interventions using electronic reminders to improve adherence to chronic medication: a
systematic review of the literature. J Am Med Inform Assoc. 2012. PM:22534082
This review examines the effectiveness of interventions using reminders in improving
patients’ adherence to chronic medication. The review providers evidence for the short-
term effectiveness of electronic reminders, especially SMS.

Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and
healthy behaviour interventions. J Telemed Telecare. 2011;17:41-48. PM:21097565
This article reviews the literature on the use of text messaging for clinical and healthy
behavior interventions.

Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based

interventions for smoking cessation. Cochrane Database Syst Rev. 2009;CD006611.
PM:19821377
Systematic review to determine whether mobile phone-based interventions are effective at
helping people quit smoking. Short term results are possible but the current evidence shows
no effect on long-term outcomes.

General Information
Adler, R. Health care unplugged: The evolving role of wireless technology. California HealthCare
Foundation. 2007
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/H/PDF%20HealthCareUnplugge
dTheRoleOfWireless.pdf

Center for Disease Control and Prevention. Social media guidelines and best practices. 2010.
http://www.cdc.gov/SocialMedia/Tools/Mobile.html.
25
Center for Disease Control and Prevention. The Health Communicator’s Social Media Toolkit.
2011. http://www.cdc.gov/socialmedia/tools/guidelines/pdf/socialmediatoolkit_bm.pdf

Fogg, BJ, Adler, R. Texting 4 health: A simple, powerful way to change lives. Stanford University.
2009. http://www.texting4health.org/

Frontline SMS, Text to Change. Communications for change: How to use text messaging as an
effective behavior change campaigning tool. http://www.frontlinesms.com/wp-
content/uploads/2012/03/TTC_Online_Final.pdf

Labrique, et al. H pe for mHealth: More “y” or “o” on the horizon? Int. J. Med. Inform. 2012.
http://www.ghdonline.org/uploads/2013_Labrique_HypeHope.pdf

Loudon, Melissa. How to set up an SMS system. MobileActive.org. 2009.

http://mobileactive.org/howtos/how-set-sms-system

Loudon, Melissa. Mobile phones for data collection. MobileActive.org. 2009. Retrieved from
http://mobileactive.org/howtos/mobile-phones-data-collection

MobileActive.org. Lessons from mHealth projects: The tech is the easy part. 2011.
http://www.mobileactive.org/lessons-mhealth-what-you-should-know-and-do-launching-
project

PLOS Medicine Editors. A Reality Checkpoint for Mobile Health: Three Challenges to Overcome.
PLoS Med 2013;10(2): e1001395. doi:10.1371/journal.pmed.1001395.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001395

Schweitzer, J., Synowiec, C., Results for Development Institute. The Economics of eHealth.
mHealth Alliance. 2010. http://www.ncbi.nlm.nih.gov/pubmed/22548602

Umapathy, S., G.A. O’Sullivan, and S. Rahaim. mBCC Field Guide: A Resource for Developing
Mobile Behavior Change Communication Programs. Abt Associates Inc. 2012.
http://www.mbccfieldguide.com/

U.S. Department of Health and Human Services (HHS) Text4Health Task Force. Health Text
Messaging Recommendations to the Secretary.
http://www.hhs.gov/open/initiatives/mhealth/recommendations.html

Whittaker, R. Issues in mHealth: Findings from key informant interviews. Journal of Medicine
Internet Res., 14(5):e129 2012. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510768/

Security/HIPAA
Federal Trade Commission Bureau of Consumer Protection. CAN-SPAM Act: A compliance guide
for Business. 2009.
http://www.business.ftc.gov/documents/bus61-can-spam-act-compliance-guide-business

26
Karasz, H., Elden, A., Bogan, S. Text Messaging to Communicate With Public Health Audiences:
How the HIPAA Security Rule Affects Practice. American Journal of Public Health, 103(4):999-
1005. 2013.
http://www.ncbi.nlm.nih.gov/pubmed/23409902

Merrill, M. Five steps docs can take to avoid ‘social media missteps’. mHiMSS.org. 2011.
http://www.mhimss.org/news/five-steps-docs-can-take-avoid-social-media-missteps

mHiMSS.org. Privacy and Security. mHIMSS roadmap. http://www.mhimss.org/road-

map/privacy-security

Stein, Benjamin. Mobile Commons. HIPAA & text messaging security white
paper. 2012. http://www.mobilecommons.com/wp-content/uploads/Mobile-Commons-HIPAA-
Text-Messaging-Security-White-Paper.pdf

Mobile Commons. HIPAA and Text Messaging Security Whitepaper. 2012.

http://www.mobilecommons.com/wp-content/uploads/Mobile-Commons-HIPAA-Text-
Messaging-Security-White-Paper.pdf

TigerText pro. Mobile Communication in a HIPAA-Compliant Environment. White Paper.

http://www.tigertext.com/wp-content/uploads/TigerTextPRO_HIPAA-ExecutiveWhitePaper_5-
12%20(1).pdf?h=329057413612320008958

U. S. Department of Health and Human Services. Standards for privacy of individually identifiable
health information. 2001. Retrieved from http://aspe.hhs.gov/admnsimp/final/pvcguide1.html

U. S. Department of Health and Human Services. Summary of HIPAA. 2003.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf

U. S. Department of Health and Human Services. HIPAA security rule. 2003.

http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/securityrulepdf.pdf

U. S. Department of Health and Human Services. HITECH Act Enforcement Interim Final Rule.
2009. http://www.hhs.gov/news/press/2009pres/10/20091030a.html

U.S. Department of Health and Human Services. Guidance on IRB Approval of Research. 2010.
http://www.hhs.gov/ohrp/policy/conditionalapproval2010.html

U.S. Food and Drug Administration. Overview of Device Regulation. 2013.

http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/default.htm

Technical, Set-up, and Cost Information

Common short code administration website: http://www.usshortcodes.com/index.php

Krarasz, H., Bogan, S. Investing in a text messaging system: A comparison of three solutions.
nwpublichealth.org. 2012. http://www.nwpublichealth.org/archives/s2012/investing-in-a-text-
messaging-system-a-comparison-of-three-solutions

27
Mehta, V. Healthy-TXT. Text messaging in health care: Improving outcomes. Changing behavior.
Saving money. http://www.healthy-txt.com/whitepaper.pdf

Movius. Mobile instant messaging: Delivering the next ‘must have’ application. White paper.
2008. http://mobilechatproviders.wordpress.com/2012/10/04/mobile-instant-messaging-
delivering-the-next-must-have-application/

Mobile Marketing Association Industry Directory:

http://www.mmaglobal.com/resources/directory

Developer’s Home. Short Message Service / SMS Tutorial. 2013.

http://www.rapidsms.org/code/reference/guides/

Seattle and King County Public Health. Considerations when selecting a text messaging vendor.
2011.
http://www.kingcounty.gov/healthservices/health/preparedness/texting/costs.aspx#vendors

Seattle and King County Public Health. Should you be your own SMS vendor? 2011.
http://www.kingcounty.gov/healthservices/health/preparedness/texting/~/media/health/publi
chealth/documents/texting/CostAnalysisSummary.ashx

Seattle King County Public Health. Life of a text message. 2012.

http://www.kingcounty.gov/healthservices/health/preparedness/texting/costs.aspx#life

Top Ten Reviews. Best Text Message Marketing Service Comparisons and Reviews. 2013.
http://text-message-marketing-review.toptenreviews.com/

Designing Health Text Message Campaigns

Atkin C. Theory and principles of media health campaigns. In: Rice R, and Atkins C. (Eds.) Public
Communication Campaigns. 3rd Edition. Sage Publications, Thousand Oaks CA. 2000. Ch 3.
Finnegan J., Viswanath K. Communication theory and health behavior change.

Center for Disease Control and Prevention. Guide to Writing for Social Media. 2012.
http://www.cdc.gov/socialmedia/tools/guidelines/pdf/guidetowritingforsocialmedia.pdf

Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M. & Dijkstra, A. Understanding tailoring in
communicating about health. Health Education Research, 2008; 23(3), 454-466.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171505/

K4Health.org. Planning for mHealth for BCC: Questions to ask. mHealth Toolkit by Knowledge 4
Health. http://www.k4health.org/toolkits/mhealth/planning-mhealth-bcc-questions-ask

Keller, P. A. & Lehmann, D. R. Designing effective health communications: A meta-analysis.

Journal of Public Policy & Marketing, 2008;27(2), 1-26. (abstract only)
http://www.biz.colostate.edu/MPPCWorkshop/Documents/Readings/Scammon/designingeffect
ivehealthcommPunamKelleretal2008.pdf

28
Petty R., Barden J., Wheeler S. The Elaboration Likelihood Model of Persuasion. DiClemente, R,
Crosby R., Kegeler M. (Eds.) Emerging Theories in Health Promotion Practice and Research. 2nd
Edition. San Francisco: Wiley. 2009. Ch 7.

Rothman A., Bartels R., Wlaschin J., Salovey P. The strategic use of gain and loss framed
messages to promote health behavior: how theory can inform practice. Journal of
Communication, 2006;56:S202-S220.

Text Messaging in Global Health

Gold, J., Andrews, H., Appleford, G., Ramanantsoa, B., Hanitriniaina, O., Deiparine, R., Corby, N.
Using mobile phone text messages (SMS) to collect health service data: Lessons learned from
social franchises in Kenya, Madagascar, and the Philippines. Journal of health informatics in
developing countries 2012;6 p. 467-479.
www.jhidc.org/index.php/jhidc/article/download/87/123

Gurman, T.A., Rubin, S.E., Roess, A.A. Effectiveness of mHealth behavior change communication
interventions in developing countries: A systematic review of the literature. Journal of Health
Communicaiton, 2012;17, 82-104

Interactive Research and Development. mHealth to improve TB care. 2012.

http://www.stoptb.org/assets/documents/resources/publications/acsm/mHealth%20to%20Imp
rove%20TB%20Care.pdf

Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A., Goldberger, A., Fu, L., &
Ossman, J. Earth Institute, Columbia University and mHealth Alliance. Barriers and gaps
affecting mHealth in low and middle income countries: policy white paper. 2010.
http://cghed.ei.columbia.edu/sitefiles/file/mHealthBarriersWhitePaperFINAL.pdf

Philbrick, W., mHealth Alliance, UN Foundation, Leveraging mobile technologies to promote

maternal and newborn health: The current landscape & opportunities for advancement in low-
resource settings. 2012. http://www.mhealthalliance.org/images/content/leveraging_
mobile_technologies_to_promote_maternal_newborn_health.pdf

World Health Organization. mHealth: New horizons for health through

mobile technologyies: second global survey on eHealth. Global Observatory for eHealth Series (vol.
3). Geneva, Switzerland. 2011. http://www.who.int/goe/publications/ehealth_series_vol3/en/

29
 Appendix D
Table of Text Messaging Studies
Purpose of Text Disease/Condition of Setting Population
Communication Focus
Lifestyle (diet, Obesity1-10 Public health2, 5, 6, 6, 7, 11-14, Children1, 4-6, 26
exercise) Smoking cessation11-16 16, 20, 23, 24, 26
Adolescents3, 4, 6, 6, 8, 9, 11-13,
Cardiovascular disease17, 18 Dietician25 17, 20, 26

Postnatal inactivity19 Young adults11-13, 20

Nutrition6, 20 Women5, 18, 19
Diabetes21 Adults2, 7, 10
COPD22
Exercise23-25
Disease self- HIV/AIDS27-31 Global health27-30 Women27, 39
management/ Athsma32-36 Primary care27, 29, 30, 32, 34, 36, Adults28
adherence Brain Injury37 37, 40, 43, 44
Children36
Inflammatory bowel Psychiatry41 Adolescents35, 36
disease38 Low income/minority35
Prenatal support39
Hypertension40
Schizophrenia41
Diabetes42
Prevention/ HIV/AIDS28 Public health28, 31, 45-50, 52 General45
Education Disease prevention45 Military51 Adolescents/ young
Sexual health46-48 adults33, 46, 47
Sun safety47, 49 Adults33, 49
Cancer50 Children52
Malaria reminder51 Latino youth48
Dental52
Reminders Immunizations53, 54 Primary care33, 36-38, 44, 53-55, Children6, 36, 53, 61
Athsma36, 55 58-60, 62-65, 67, 68
Adolescents36, 38, 56
Family planning56, 57 Family planning center56, 57 Young women56
Appointment attendance37, Health promotion center44 General58, 68
44, 58-63
Health insurance66 Adults44
Acne64 Dental61 Women66
HIV/AIDS29, 65 Military51
Mammogram66
Malaria prevention51
Medication67, 68
Monitoring/ Back Pain69-71 Primary care70-72, 77 Young adults73, 74
collecting General72 Public health75, 75, 76 Adolescents74
research data Alcohol use73, 74 New mothers75
Infant feeding75
Disease outbreaks76

30
Disease Eating disorders43 Primary care34, 43, 78
maintenance/ Diabetes78, 79
communication Activity level80
between patient Athsma34
and provider
Useability Prenatal support39 Clinical practice (general) 34 Women39
studies Activity level80, 81 Adults80
Athsma35
Smoking cessation16

Reference List

(1) de NJ, Timman R, Bauer S et al. The effect of a short message service maintenance
treatment on body mass index and psychological well-being in overweight and obese
children: a randomized controlled trial. Pediatr Obes 2012;7(3):205-219.

(2) Haapala I, Barengo NC, Biggs S, Surakka L, Manninen P. Weight loss by mobile phone: a
1-year effectiveness study. Public Health Nutr 2009;12(12):2382-2391.

(3) Kornman KP, Shrewsbury VA, Chou AC et al. Electronic therapeutic contact for
adolescent weight management: the Loozit study. Telemed J E Health 2010;16(6):678-
685.

(4) Lau PW, Lau EY, Wong dP, Ransdell L. A systematic review of information and
communication technology-based interventions for promoting physical activity behavior
change in children and adolescents. J Med Internet Res 2011;13(3):e48.

(5) Lombard C, Deeks A, Jolley D, Ball K, Teede H. A low intensity, community based lifestyle
programme to prevent weight gain in women with young children: cluster randomised
controlled trial. BMJ 2010;341:c3215.

(6) Lubans DR, Morgan PJ, Dewar D et al. The Nutrition and Enjoyable Activity for Teen Girls
(NEAT girls) randomized controlled trial for adolescent girls from disadvantaged
secondary schools: rationale, study protocol, and baseline results. BMC Public Health
2010;10:652.

(7) Patrick K, Raab F, Adams MA et al. A text message-based intervention for weight loss:
randomized controlled trial. J Med Internet Res 2009;11(1):e1.

(8) Shrewsbury VA, O'Connor J, Steinbeck KS et al. A randomised controlled trial of a

community-based healthy lifestyle program for overweight and obese adolescents: the
Loozit study protocol. BMC Public Health 2009;9:119.

(9) Sirriyeh R, Lawton R, Ward J. Physical activity and adolescents: an exploratory

randomized controlled trial investigating the influence of affective and instrumental text
messages. Br J Health Psychol 2010;15(Pt 4):825-840.

31
(10) Soureti A, Murray P, Cobain M, Chinapaw M, van MW, Hurling R. Exploratory study of
web-based planning and mobile text reminders in an overweight population. J Med
Internet Res 2011;13(4):e118.

(11) Haug S, Meyer C, Dymalski A, Lippke S, John U. Efficacy of a text messaging (SMS) based
smoking cessation intervention for adolescents and young adults: study protocol of a
cluster randomised controlled trial. BMC Public Health 2012;12:51.

(12) Brendryen H, Drozd F, Kraft P. A digital smoking cessation program delivered through
internet and cell phone without nicotine replacement (happy ending): randomized
controlled trial. J Med Internet Res 2008;10(5):e51.

(13) Brendryen H, Kraft P. Happy ending: a randomized controlled trial of a digital multi-
media smoking cessation intervention. Addiction 2008;103(3):478-484.

(14) Free C, Knight R, Robertson S et al. Smoking cessation support delivered via mobile
phone text messaging (txt2stop): a single-blind, randomised trial. Lancet
2011;378(9785):49-55.

(15) Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based
interventions for smoking cessation. Cochrane Database Syst Rev 2009;(4):CD006611.

(16) Ybarra ML, Holtrop JS, Bagci Bosi AT, Emri S. Design considerations in developing a text
messaging program aimed at smoking cessation. J Med Internet Res 2012;14(4):e103.

(17) Klausen SH, Mikkelsen UR, Hirth A et al. Design and rationale for the PREVAIL study:
effect of e-Health individually tailored encouragements to physical exercise on aerobic
fitness among adolescents with congenital heart disease--a randomized clinical trial. Am
Heart J 2012;163(4):549-556.

(18) Park MJ, Kim HS. Evaluation of mobile phone and Internet intervention on waist
circumference and blood pressure in post-menopausal women with abdominal obesity.
Int J Med Inform 2012;81(6):388-394.

(19) Fjeldsoe BS, Miller YD, Marshall AL. MobileMums: a randomized controlled trial of an
SMS-based physical activity intervention. Ann Behav Med 2010;39(2):101-111.

(20) Kerr DA, Pollard CM, Howat P et al. Connecting Health and Technology (CHAT): protocol
of a randomized controlled trial to improve nutrition behaviours using mobile devices
and tailored text messaging in young adults. BMC Public Health 2012;12:477.

(21) Newton KH, Wiltshire EJ, Elley CR. Pedometers and text messaging to increase physical
activity: randomized controlled trial of adolescents with type 1 diabetes. Diabetes Care
2009;32(5):813-815.

(22) Nguyen HQ, Gill DP, Wolpin S, Steele BG, Benditt JO. Pilot study of a cell phone-based
exercise persistence intervention post-rehabilitation for COPD. Int J Chron Obstruct
Pulmon Dis 2009;4:301-313.

32
(23) Prestwich A, Perugini M, Hurling R. Can the effects of implementation intentions on
exercise be enhanced using text messages? Psychol Health 2009;24(6):677-687.

(24) Prestwich A, Perugini M, Hurling R. Can implementation intentions and text messages
promote brisk walking? A randomized trial. Health Psychol 2010;29(1):40-49.

(25) Rossi MC, Perozzi C, Consorti C et al. An interactive diary for diet management (DAI): a
new telemedicine system able to promote body weight reduction, nutritional education,
and consumption of fresh local produce. Diabetes Technol Ther 2010;12(8):641-647.

(26) Militello LK, Kelly SA, Melnyk BM. Systematic review of text-messaging interventions to
promote healthy behaviors in pediatric and adolescent populations: implications for
clinical practice and research. Worldviews Evid Based Nurs 2012;9(2):66-77.

(27) da Costa TM, Barbosa BJ, Gomes e Costa DA et al. Results of a randomized controlled
trial to assess the effects of a mobile SMS-based intervention on treatment adherence
in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to
incoming messages. Int J Med Inform 2012;81(4):257-269.

(28) de TK, Skinner D, Nembaware V, Benjamin P. Investigation into the use of short message
services to expand uptake of human immunodeficiency virus testing, and whether
content and dosage have impact. Telemed J E Health 2012;18(1):18-23.

(29) Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for
promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane
Database Syst Rev 2012;3:CD009756.

(30) Lester RT, Ritvo P, Mills EJ et al. Effects of a mobile phone short message service on
antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet
2010;376(9755):1838-1845.

(31) Pop-Eleches C, Thirumurthy H, Habyarimana JP et al. Mobile phone technologies

improve adherence to antiretroviral treatment in a resource-limited setting: a
randomized controlled trial of text message reminders. AIDS 2011;25(6):825-834.

(32) Lv Y, Zhao H, Liang Z et al. A mobile phone short message service improves perceived
control of asthma: a randomized controlled trial. Telemed J E Health 2012;18(6):420-
426.

(33) Petrie KJ, Perry K, Broadbent E, Weinman J. A text message programme designed to
modify patients' illness and treatment beliefs improves self-reported adherence to
asthma preventer medication. Br J Health Psychol 2012;17(1):74-84.

(34) Prabhakaran L, Chee WY, Chua KC, Abisheganaden J, Wong WM. The use of text
messaging to improve asthma control: a pilot study using the mobile phone short
messaging service (SMS). J Telemed Telecare 2010;16(5):286-290.

(35) Seid M, D'Amico EJ, Varni JW et al. The in vivo adherence intervention for at risk
adolescents with asthma: report of a randomized pilot trial. J Pediatr Psychol
2012;37(4):390-403.
33
(36) Strandbygaard U, Thomsen SF, Backer V. A daily SMS reminder increases adherence to
asthma treatment: a three-month follow-up study. Respir Med 2010;104(2):166-171.

(37) Culley C, Evans JJ. SMS text messaging as a means of increasing recall of therapy goals in
brain injury rehabilitation: a single-blind within-subjects trial. Neuropsychol Rehabil
2010;20(1):103-119.

(38) Hommel KA, Hente EA, Odell S et al. Evaluation of a group-based behavioral intervention
to promote adherence in adolescents with inflammatory bowel disease. Eur J
Gastroenterol Hepatol 2012;24(1):64-69.

(39) Jareethum R, Titapant V, Chantra T, Sommai V, Chuenwattana P, Jirawan C. Satisfaction

of healthy pregnant women receiving short message service via mobile phone for
prenatal support: A randomized controlled trial. J Med Assoc Thai 2008;91(4):458-463.

(40) Park MJ, Kim HS, Kim KS. Cellular phone and Internet-based individual intervention on
blood pressure and obesity in obese patients with hypertension. Int J Med Inform
2009;78(10):704-710.

(41) Pijnenborg GH, Withaar FK, Brouwer WH, Timmerman ME, van den Bosch RJ, Evans JJ.
The efficacy of SMS text messages to compensate for the effects of cognitive
impairments in schizophrenia. Br J Clin Psychol 2010;49(Pt 2):259-274.

(42) Shetty AS, Chamukuttan S, Nanditha A, Raj RK, Ramachandran A. Reinforcement of

adherence to prescription recommendations in Asian Indian diabetes patients using
short message service (SMS)--a pilot study. J Assoc Physicians India 2011;59:711-714.

(43) Bauer S, Okon E, Meermann R, Kordy H. Technology-enhanced maintenance of

treatment gains in eating disorders: efficacy of an intervention delivered via text
messaging. J Consult Clin Psychol 2012;80(4):700-706.

(44) Chen ZW, Fang LZ, Chen LY, Dai HL. Comparison of an SMS text messaging and phone
reminder to improve attendance at a health promotion center: a randomized controlled
trial. J Zhejiang Univ Sci B 2008;9(1):34-38.

(45) Deglise C, Suggs LS, Odermatt P. Short message service (SMS) applications for disease
prevention in developing countries. J Med Internet Res 2012;14(1):e3.

(46) Lim MS, Hocking JS, Aitken CK et al. Impact of text and email messaging on the sexual
health of young people: a randomised controlled trial. J Epidemiol Community Health
2012;66(1):69-74.

(47) Gold J, Aitken CK, Dixon HG et al. A randomised controlled trial using mobile advertising
to promote safer sex and sun safety to young people. Health Educ Res 2011;26(5):782-
794.

(48) Vyas AN, Landry M, Schnider M, Rojas AM, Wood SF. Public health interventions:
reaching Latino adolescents via short message service and social media. J Med Internet
Res 2012;14(4):e99.

34
(49) Armstrong AW, Watson AJ, Makredes M, Frangos JE, Kimball AB, Kvedar JC. Text-
message reminders to improve sunscreen use: a randomized, controlled trial using
electronic monitoring. Arch Dermatol 2009;145(11):1230-1236.

(50) Greaney ML, Puleo E, Sprunck-Harrild K et al. Electronic reminders for cancer
prevention: factors associated with preference for automated voice reminders or text
messages. Prev Med 2012;55(2):151-154.

(51) Ollivier L, Romand O, Marimoutou C et al. Use of short message service (SMS) to
improve malaria chemoprophylaxis compliance after returning from a malaria endemic
area. Malar J 2009;8:236.

(52) Sharma R, Hebbal M, Ankola AV, Murugabupathy V. Mobile-phone text messaging (SMS)
for providing oral health education to mothers of preschool children in Belgaum City. J
Telemed Telecare 2011;17(8):432-436.

(53) Ahlers-Schmidt CR, Chesser AK, Nguyen T et al. Feasibility of a randomized controlled
trial to evaluate Text Reminders for Immunization Compliance in Kids (TRICKs). Vaccine
2012;30(36):5305-5309.

(54) Stockwell MS, Kharbanda EO, Martinez RA et al. Text4Health: impact of text message
reminder-recalls for pediatric and adolescent immunizations. Am J Public Health
2012;102(2):e15-e21.

(55) Britto MT, Munafo JK, Schoettker PJ, Vockell AL, Wimberg JA, Yi MS. Pilot and feasibility
test of adolescent-controlled text messaging reminders. Clin Pediatr (Phila)
2012;51(2):114-121.

(56) Castano PM, Bynum JY, Andres R, Lara M, Westhoff C. Effect of daily text messages on
oral contraceptive continuation: a randomized controlled trial. Obstet Gynecol
2012;119(1):14-20.

(57) Hou MY, Hurwitz S, Kavanagh E, Fortin J, Goldberg AB. Using daily text-message
reminders to improve adherence with oral contraceptives: a randomized controlled
trial. Obstet Gynecol 2010;116(3):633-640.

(58) Guy R, Hocking J, Wand H, Stott S, Ali H, Kaldor J. How effective are short message
service reminders at increasing clinic attendance? A meta-analysis and systematic
review. Health Serv Res 2012;47(2):614-632.

(59) Fairhurst K, Sheikh A. Texting appointment reminders to repeated non-attenders in

primary care: randomised controlled study. Qual Saf Health Care 2008;17(5):373-376.

(60) Liew SM, Tong SF, Lee VK, Ng CJ, Leong KC, Teng CL. Text messaging reminders to reduce
non-attendance in chronic disease follow-up: a clinical trial. Br J Gen Pract
2009;59(569):916-920.

(61) Nelson TM, Berg JH, Bell JF, Leggott PJ, Seminario AL. Assessing the effectiveness of text
messages as appointment reminders in a pediatric dental setting. J Am Dent Assoc
2011;142(4):397-405.
35
(62) Perron NJ, Dao MD, Kossovsky MP et al. Reduction of missed appointments at an urban
primary care clinic: a randomised controlled study. BMC Fam Pract 2010;11:79.

(63) Stubbs ND, Geraci SA, Stephenson PL, Jones DB, Sanders S. Methods to reduce
outpatient non-attendance. Am J Med Sci 2012;344(3):211-219.

(64) Boker A, Feetham HJ, Armstrong A, Purcell P, Jacobe H. Do automated text messages
increase adherence to acne therapy? Results of a randomized, controlled trial. J Am
Acad Dermatol 2012;67(6):1136-1142.

(65) Hardy H, Kumar V, Doros G et al. Randomized controlled trial of a personalized cellular
phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient
Care STDS 2011;25(3):153-161.

(66) Lakkis NA, Atfeh AM, El-Zein YR, Mahmassani DM, Hamadeh GN. The effect of two types
of sms-texts on the uptake of screening mammogram: a randomized controlled trial.
Prev Med 2011;53(4-5):325-327.

(67) Stenner SP, Johnson KB, Denny JC. PASTE: patient-centered SMS text tagging in a
medication management system. J Am Med Inform Assoc 2012;19(3):368-374.

(68) Vervloet M, Linn AJ, van Weert JC, de Bakker DH, Bouvy ML, van DL. The effectiveness of
interventions using electronic reminders to improve adherence to chronic medication: a
systematic review of the literature. J Am Med Inform Assoc 2012;19(5):696-704.

(69) Axen I, Bodin L, Bergstrom G et al. Clustering patients on the basis of their individual
course of low back pain over a six month period. BMC Musculoskelet Disord 2011;12:99.

(70) Axen I, Bodin L, Bergstrom G et al. The use of weekly text messaging over 6 months was
a feasible method for monitoring the clinical course of low back pain in patients seeking
chiropractic care. J Clin Epidemiol 2012;65(4):454-461.

(71) Macedo LG, Maher CG, Latimer J, McAuley JH. Feasibility of using short message service
to collect pain outcomes in a low back pain clinical trial. Spine (Phila Pa 1976 )
2012;37(13):1151-1155.

(72) Haller DM, Sanci LA, Patton GC, Sawyer SM. Text message communication in primary
care research: a randomized controlled trial. Fam Pract 2009;26(4):325-330.

(73) Kuntsche E, Robert B. Short message service (SMS) technology in alcohol research--a
feasibility study. Alcohol Alcohol 2009;44(4):423-428.

(74) Suffoletto B, Callaway C, Kristan J, Kraemer K, Clark DB. Text-message-based drinking

assessments and brief interventions for young adults discharged from the emergency
department. Alcohol Clin Exp Res 2012;36(3):552-560.

(75) Whitford HM, Donnan PT, Symon AG et al. Evaluating the reliability, validity,
acceptability, and practicality of SMS text messaging as a tool to collect research data:
results from the Feeding Your Baby project. J Am Med Inform Assoc 2012;19(5):744-749.

36
(76) Yang C, Yang J, Luo X, Gong P. Use of mobile phones in an emergency reporting system
for infectious disease surveillance after the Sichuan earthquake in China. Bull World
Health Organ 2009;87(8):619-623.

(77) Axen I, Bodin L, Bergstrom G et al. The use of weekly text messaging over 6 months was
a feasible method for monitoring the clinical course of low back pain in patients seeking
chiropractic care. J Clin Epidemiol 2012;65(4):454-461.

(78) Kim HS, Song MS. Technological intervention for obese patients with type 2 diabetes.
Appl Nurs Res 2008;21(2):84-89.

(79) Yoon KH, Kim HS. A short message service by cellular phone in type 2 diabetic patients
for 12 months. Diabetes Res Clin Pract 2008;79(2):256-261.

(80) Lagerros YT, Sandin S, Bexelius C, Litton JE, Lof M. Estimating physical activity using a cell
phone questionnaire sent by means of short message service (SMS): a randomized
population-based study. Eur J Epidemiol 2012;27(7):561-566.

(81) Vandelanotte C, Duncan MJ, Plotnikoff RC, Mummery WK. Do participants' preferences
for mode of delivery (text, video, or both) influence the effectiveness of a Web-based
physical activity intervention? J Med Internet Res 2012;14(1):e37.

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