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Text message-based health interventions

Health Factors: Access to Care
Decision Makers: Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Text messaging interventions can provide reminders, education, or self-management for health conditions. These interventions are most frequently used in health promotion efforts or to help individuals manage chronic diseases. Technology-based interventions, such as text messaging, can be combined with other approaches or delivered as part of a stepped care/progressive intervention, beginning with the least intensive treatment and moving to more intensive, and often expensive, treatments based on the needs of the individual patient.

Expected Beneficial Outcomes

Increased healthy behaviors
Improved health outcomes
Increased medication adherence

Evidence of Effectiveness

There is some evidence that cell phone-based interventions increase positive health behaviors and improve health outcomes, especially via text message (Buhi 2013, Free 2013Cochrane-de Jongh 2012Cochrane-Horvath 2012, Cochrane-Vodopivec-Jamsek 2012Fjeldsoe 2009, Krishna 2009). However, additional evidence is needed to confirm effects.

Text messaging, alone or with an internet-based component, can change health behaviors in the short-term (Buhi 2013, Head 2013a, Fjeldsoe 2009); additional research is needed to determine long-term effects. These types of interventions have been shown, in some circumstances, to improve blood glucose levels, asthma self-management, and weight loss and obesity prevention efforts, as well as other health behaviors (Buhi 2013), such as smoking cessation (Free 2013Free 2011).

Text messaging interventions have also been shown to increase medication adherence. In two Kenya-based studies, weekly text messages increased HIV patients’ adherence to antiretroviral therapy; one study also found improvements in HIV viral load suppression (Cochrane-Horvath 2012). A Canadian study found text message reminders to take vitamin C increased adherence (Cochrane-Vodopivec-Jamsek 2012). However, in a study of schizophrenic patients, daily text message prompts added to standard care did not appear to increase medication adherence more than standard care alone (Cochrane-Kauppi 2014).

Text messaging appears to be as effective as, and in some cases better than, usual care in the self-management of some long-term illnesses, such as hypertension and diabetes (Cochrane-de Jongh 2012). Text messaging also appears to be as effective as telephone reminders at promoting appointment attendance (Cochrane-Gurol-Urganci 2013).


United States

One example of a text messaging service, Text2 Survive in Illinois, allows minority youth and young adults to receive HIV/AIDS information and testing, including lists of nearby sites offering free services, health events, and health tips (AHRQ HCIE-Halloway).

Another service, txt4health, provides health reminders and information based on national health experts' recommendations (txt4health).

Implementation Resources

Handel 2011* - Handel MJ. mHealth (mobile health)-using apps for health and wellness. EXPLORE: The Journal of Science and Healing. 2011;7(4):256–61. Accessed on January 27, 2016
HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap. Accessed on February 2, 2016

Citations - Evidence

Buhi 2013* - Buhi ER, Trudnak TE, Martinasek MP, et al. Mobile phone-based behavioural interventions for health: A systematic review. Health Education Journal. 2013;72(5):564–83. Accessed on January 27, 2016
Cochrane-de Jongh 2012* - de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database of Systematic Reviews. 2012;(12):CD007459. Accessed on January 28, 2016
Cochrane-Gurol-Urganci 2013* - Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews. 2013;(12):CD007458. Accessed on February 1, 2016
Cochrane-Horvath 2012* - 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 of Systematic Reviews. 2012;(3):CD009756. Accessed on February 1, 2016
Cochrane-Kauppi 2014* - Kauppi K, Välimäki M, Hätönen H, Kuosmanen L, Warwick-Smith K, Adams C. Information and communication technology based prompting for treatment compliance for people with serious mental illness. Cochrane Database of Systematic Reviews. 2014;(6):CD009960. Accessed on February 2, 2016
Cochrane-Vodopivec-Jamsek 2012* - Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database of Systematic Reviews. 2012;(12):CD007457. Accessed on January 28, 2016
Fjeldsoe 2009* - Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine. 2009;36(2):165–73. Accessed on January 28, 2016
Free 2011 - 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. Accessed on February 2, 2016
Free 2013 - Free C, Phillips G, Galli L, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Medicine. 2013;10(1):e1001362. Accessed on January 28, 2016
Head 2013a* - Head KJ, Noar SM, Iannarino NT, Grant Harrington N. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Social Science & Medicine. 2013;97:41-8. Accessed on January 28, 2016
Krishna 2009* - Krishna S, Boren SA, Balas EA. Healthcare via cell phones: A systematic review. Telemedicine Journal and e-Health. 2009;15(3):231–40. Accessed on January 27, 2016

Citations - Implementation

AHRQ HCIE-Halloway - Halloway V. Texting service enhances minority youth access to HIV/AIDS information and testing. Rockville: AHRQ Health Care Innovations Exchange. Accessed on January 26, 2016
txt4health - Voxiva. txt4health: Text your way to a healthier life. Accessed on February 2, 2016

Page Last Updated

September 23, 2014

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