The Powerful Simplicity of Well-Crafted Text Messages in Healthcare

As healthcare systems adjust to virtual models of care, one key challenge is the digital divide, largely impacting communities already underserved by healthcare. Health technology companies and healthcare organizations are teaming up to bridge this gap. One method for text messaging is short message service, known as SMS. Given that a considerably larger segment of the population has access to cell phones than smartphones or broadband, this type of patient engagement solution has the power to bring communication and care to those that need it most, including multicultural and low-income populations. The power of SMS engagement lies in the fact that it is an effective means of patient outreach – with an estimated open rate of 98% – and has been shown to be a significant driver of behavior change in patient populations. What’s more, response rates to SMS marketing are 7.5x higher than email, and the average SMS response time is 90 seconds, as opposed to 90 minutes for email. We live in a notification-based culture, which is why SMS is a great tool to nudge behavior, especially when the average person spends 55 minutes per day texting. The communication channel itself is only part of reaching communities. Few patient engagement solutions leverage data for true precision and thus lose impact. For example, mass-text campaigns barrage entire databases with identical messaging regardless of needs and preferences. While many patients may open these messages, it is unlikely that the majority will act on them or absorb the information in a meaningful way. This is because true behavior change can only occur when patients are contacted at the right time, in the right way and with a relevant message. Finding a balance between large-scale outreach and direct messaging is essential; tailored campaigns can account for demographics as well as social determinants of health.

Patients have varying levels of trust, behaviors and motivations. One patient may respond well to the positive message framed as a gain, “Take time for yourself to reduce stress and your risk of depression and anxiety.” Another might ignore such a nudge, but find themselves motivated by a negative message reading, “If you don't take time for yourself, you could suffer from stress-related illnesses like depression and anxiety.” Some patients may want frequent messages throughout the day while others less often and in the evening. There are several communication preferences that can be identified and leveraged through an iterative design approach. Communications tailored to individual preferences and behavioral profiles can effect real change. How do you write an SMS message that influences behavior? To optimize a text message, there several key components:

1. Keep it pithy: Messages should be short and concise. Most messages should be below 300 characters, requiring each message to be direct and simple.

2. Make it easy-to-read: Messages should be no higher than a 6th grade reading level, ideally closer to a 3rd grade reading level, which is critical for accessibility. Default to the simplest words and sentence structure, and then verify with a tool like the Flesch Kincaid readability test.

3. Use common vernacular: Opt for common words and vernacular used by the population you are messaging. Avoid jargon and medical terms or acronyms when possible. If required to use a medical term, provide a short definition or description thereafter.

4. Translate carefully & offer options to switch languages: It is essential to provide messages in someone’s preferred language. There can be inaccuracies in data and someone’s language preference may vary for oral and written contexts. Check on the first message and occasionally thereafter if someone wants to switch languages. Translations should be verified for clinical and cultural accuracy.

5. Include a call to action: Inform patients what to do next and provide additional information.

Calls to action can consist of simple yet informative phrases that drive an additional action on the part of the user, such as “Learn more,” “Read more,” “Call us today,” or “Schedule a visit.” Include an easy way for patients to complete this action, such as providing a phone number or shortened hyperlink which can be used directly by smartphones and many feature phones (non-smartphones). Increasingly, many basic feature phones also have the ability to receive multi-media content (MMS) such as images and links to short videos. Multimedia can support literacy and impact but can also deplete data. We are assessing the differential impacts across populations. When it comes to driving behavior change with SMS, the final piece of the puzzle is building the right flow of communications. Generally, begin with a greeting and introduction on what to expect in the SMS campaign. Then build trust with highly relevant messages to keep people engaged. As you gain insights into the patients, tailor the approach and messages to best fit their behavioral profile and any stated needs. Well-timed and individualized communications create more meaningful interactions, allowing healthcare providers and organizations to forge remote connections with patients.