Texting: It lets you cancel at the last minute, provide TV commentary in real time—and, increasingly, live a healthier life.
Over the past decade or so, text messaging has become a regular fixture in the healthcare industry, accomplishing goals as widespread as reducing no-shows and fighting the opioid epidemic.
And no wonder. Research conducted by the company Dynmark shows that 90% of text messages are read within three minutes of being received, and 98% are read at some point. According to a Gallop poll, texting is the primary way that people under age 50 communicate. And 80% of smartphone owners say that they’d like their healthcare providers to interact with them using their mobile devices, a FICO survey found.
Dr. Yifeng Hu is an associate professor and chair of Communication Studies at The College of New Jersey and a senior lecturer in the Mailman School of Public Health at Columbia University. She says text messaging in healthcare falls into three distinct camps. One is health intervention, where texting is used to provide patients with information, reminders, and support. Another is using texting as a communication tool between patients and healthcare providers or medical offices. And finally, Hu says, texting is playing a growing role in AI, which allows chatbots to have intelligent, and increasingly detailed, conversations with people.
Texting as a health-intervention technique is the best-established use of the form. The first study using texting as a tool to improve patient health was published in 2002. Since then, automated updates (and some manual messaging) have been used to give health and safety information to pregnant women, help patients follow post-op instructions, and check in with people struggling with addictive behaviors—to name a very few examples.
There’s strong evidence that these (primarily automated) messages are an effective way to improve public health. Dr. Mandi Hall, an affiliate assistant professor of Biomedical Informatics and Medical Education at the University of Washington, co-conducted a 2015 review of existing scholarly research on the topic. “We found that there was pretty significant evidence for [texting] interventions being effective when addressing diabetes self management, weight loss, physical activity, smoking cessation, and medication adherence for antiretroviral therapy,” she said.
From patient to provider
Then there’s texting between patients and medical organizations. While automated messages have become a standard feature of doctors’ offices—a recent Medical Group Management association poll found that 68% of healthcare organizations text patients about appointments—Hu says that doctors’ offices are only just beginning to use manual texting to reach out to patients. HIPAA-compliant texting platforms like TigerConnect and OhMD enable doctors to text patients directly and access electronic health records. WELL gives patients the opportunity to connect directly to medical office staff via text, which allows for easier communication and cuts down on individual phone calls and missed appointments.
When patients feel empowered and more in charge of their own health, they will become more motivated and also more informed. The evidence shows that this leads to better doctor-patient relationships.— Dr. Yifeng Hu
Associate Professor and Chair of Communication Studies, The College of New Jersey
Senior Lecturer in the Mailman School of Public Health, Columbia University
According to Hu, this kind of texting is especially good for doctor-patient relationships. It employs what’s called the “transactional model of communication,” a two-way social interaction in which both parties listen and contribute, and both have equal power and control over the situation. “Traditionally, healthcare providers have the upper hand, and patients are in the submissive role, so they feel vulnerable,” Hu said. Patients frequently emerge from the doctor’s office without fully understanding what the doctor has said or what’s required of them.
“In healthcare, some of the biggest problems stem from miscommunications. Miscommunications can be in the form of not understanding my diagnosis, or not understanding how to change a dressing [on a wound] or take my medication,” Hall said. “How do you disseminate that knowledge effectively?”
According to Hu, texting gives patients a comfortable space in which to get the information they need. “That empowers patients,” she said. “And when patients feel empowered and more in charge of their own health, they will become more motivated and also more informed. The evidence shows that this leads to better doctor-patient relationships.”
Hall says there’s also simply a pragmatic benefit to texting: “Text messages are really just this short way to disseminate information quickly and with not much effort.”
And finally, although the newest generation of health-related chatbots rarely use the term “texting,” Hu says that’s precisely what they do. She cites the example of Woebot, which engages users in a text conversation based on cognitive-behavioral principles. The essential idea is to improve your mood—or navigate a high-stress situation—using the chatbot’s cues. There are also chatbots designed to serve as virtual health consultants, like Your.MD and Babylon Health. And lest you think that all chatbots are intended for patient use, the landscape now includes options like Safedrugbot, which gives doctors information about how medications might affect a breastfeeding patient.
Texting is far from a new invention: SMS technology is about 25 years old. And in terms of health intervention, Hu said, like providing motivational information and check-ins to patients, it’s old news. “Ten years ago it was new, but there are so many newer technologies for intervention. I see fewer articles for texting interventions,” she said.
But “a lot of healthcare providers are still way behind in terms of using new media technologies for communication,” Hu said. Healthcare organizations are just beginning to explore the possibilities of texting back and forth with their patients. “It’s a new reinvention of a not-very-new technology,” she said.
As for the future of texting in healthcare, Hu thinks it will “be immersed into more advanced, encompassing technologies, such as AI applications and medical wearables that track personal health data and connect patients with health providers in real time.”
It might not be called “texting” anymore—the term is no longer cutting-edge—but short, back-and-forth messaging will continue to be a part of the healthcare models to come. Nonetheless, Hu says that stand-alone texting will still have some role to play in health interventions, simply because of its convenience and security: “It’s low cost, widely accessible, and very universal.”
Talya Meyers is WELL’s Health Editor. Talya began her career in academia before transitioning to writing full time. She has written for Smithsonian Magazine online, BBC Future, Refinery29, and the Los Angeles Times, among other venues. She is a graduate of U.C. Berkeley and Stanford University.