What Good Can a Phone Do? - How Text Messaging Programs Have Been Used to Improve Education and Healthcare

Wednesday, January 24, 2018

John Horsley

Mobile phones are all around us. As of 2012, 6 billion people around the world have mobile phone subscriptions (1). And while mobile phones might have originally been used solely to make calls while on the go, they have since evolved, providing on-the-go internet access, storage for all of our information, or entertainment from music, videos, and games. However, one of the most popular features worldwide, if not the most popular feature, of mobile phones is text messaging (2). Just in the United States, as of 2011, 61% of adults use the text messaging function on their mobile phone (3).

The overwhelming popularity of mobile phones and text messaging make them an ideal tool for getting in contact with individuals. Here at CEPA Labs, we are doing research on the effectiveness of texting caregivers information about literacy; mathematics; and social and emotional learning and how to teach those skills. The texts are sent weekly and include information about the importance of specific skills and activities, suggestions of specific activities, and encouragement and reinforcement. Our research shows the texts improved parental engagement and early literacy (4). You can find more information at TIPSbyTEXT and Publications.

However, CEPA Labs isn’t the only research organization working on text messaging interventions. Nor is education the sole area where text messaging programs are being used. Extensive research has also been done in the field of mobile health (mHealth) in both behavioral health and medication. These programs in each of their respective fields focus on all different ages and target improvement in many different ways.

In education, the primary goal of any text messaging program is to help the student improve or succeed academically. Kraft and Monti-Nussbaum sent texts to parents/guardians over the summer to help improve their elementary-school-aged child’s literacy (5). Bergman and Chan sent information about both absences and grades weekly to parents/guardians in order to improve student grades and attendance (6). Kraft and Rogers had teachers text parents/guardians weekly messages about their child’s performance and how he or she could improve (7). Castleman and Page have repeatedly looked at how text messaging programs can be used to help high school students apply to college and have their parents/guardians support them by texting the student, their parent/guardian, or both (8, 9, 10). Similarly, Groot et al. sent text messages to a “study supporter” about their college peers’ attendance and progress so that the “supporter” could help their peers succeed (11). Other programs have taken to directly messaging students to help them. Naismith created a program where professors could text college students important information about the class (12). Even still, programs have been written to teach the material through text messages. Kennedy and Levy sent college students taking an Italian language class course materials by text (13).

As previously stated, text message programs have also been used repeatedly in mHealth for over a decade. Multiple text messaging programs have been created to help improve behaviors by promoting smoking cessation (14, 15, 16, 17, 18, 19, 20, 21), physical health and weight management (15, 21, 22, 23, 24, 25), alcoholism and drug intervention (26, 27, 28, 29), pregnancy and baby preparation (17, 28, 30), and affective and mental disorder treatment (27, 31). Text messaging programs have also been used in order to promote medication adherence and appointment attendance (15); specifically for asthma medication (15, 32); acne therapy (33); cardiovascular disease medication (34, 35, 36); diabetes (15, 32, 37, 38); HIV/AIDS antiretroviral therapy (15, 30, 39, 40, 41); and schizophrenia medication treatment (26).

When looking at the results of all of these experiments, quasi-experiments, surveys, and meta-analyses, the overwhelming majority found that texting programs resulted in a significant improvement their desired category: grades, attendance, college applications, health improvement, or medical adherence. There were several occasions that found no improvement or insignificant improvement. For the most part, the research had sample sizes that were too small to determine that their treatment actually wasn’t effective (17, 21, 27, 31, 33, 35, 40). Beyond that reasoning, there were three appointment adherence programs that were as effective as phone calls (15), Kraft and Monti-Nussbaum found that their text messaging program was effective for third and fourth graders, but not first and second (5), and several that hypothesized that texts being sent more frequently would or did decrease the benefits of the program (33, 38, 41). This final reason is of particular interest.

Nearly every paper on text messaging programs have looked specifically at whether or not one particular program works. In doing research for a literature review on the ideal frequency of texts sent in a text messaging program, I not only discovered very little research regarding frequency, but very little research into any other variations on a program except for length of messages (38, 39). In fact, Pop-Eleches et al. were the only people I found who used differing treatments, both different frequencies and message lengths, in testing their text message program. Even in other literature reviews and empirical studies, Pop-Eleches et al. were the only people cited at having compared frequencies (38, 41, 42, 43, 44). There have been some surveys or experiments that provide end surveys asking for user satisfaction and preferences (13, 30, 37, 44, 45), but no past experiments or quasi-experiments I could find. And how many texts per week and the length of the texts aren’t the only ways that a text messaging program can be specifically designed. Should texts be sent as connected sets? Should there be breaks between message sets? Should the texts be sent as bursts? How many texts can be sent per day? What time of day should the texts be sent? Should the number of texts vary throughout the program? Should the user select how many texts to receive? How should the texts be written? What should the tone be? Can there be emojis? Should the text be personalized? Should they include links to more information? Should images or videos be included? Can texts be repeated? As research moves forward with studying the effectiveness of text messaging programs, it’s important to determine the answer to these more intricate questions. By answering these specific questions, programs can be better tailored to the individual setting and its purpose, improving the effectiveness of programs involved in the previously listed fields.

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