Health on the go: Can we use mobile telephone SMS to change health behaviors?

Using SMS to change health behaviors

The reach of SMS makes it a useful method for communicating with individuals about healthy behaviors. In the United States there are more mobile telephone subscribers than landline users, and approximately seven billion SMS are sent every month. More importantly, in developed countries SMS use transcends age groups, cultures and socio-economic backgrounds.

Cell phones are used by all age groups, cultures and socio-economic backgrounds

So far, the exploration of using SMS to influence health behaviors has been limited, but the potential is huge due to the specific capabilities of SMS. SMS allows for instantaneous delivery of short messages (maximum 160 characters) directly to individuals at any time, and in any place. Although SMS can be sent en masse, they can also be personally tailored to each individual recipient, thereby circumventing the likelihood of the message being dismissed as irrelevant (as it is often the case with mass media messages). Additionally, SMS can be read at a time suitable for each individual recipient, overcoming some of the inconvenience associated with receiving telephone calls.

Using SMS reminders for health care

We recently published a review of research examining the application of SMS for health behavior change interventions4. We discovered that there were a large number of studies published last year (2008) that reported on developmental work of SMS programs or on SMS trials that were in progress, which indicates that research into behavior change via SMS is increasing. We examined 14 SMS-delivered behavior change interventions in our review. We found that most studies conducted to date (10/14 studies) had focused on the management of chronic diseases, predominantly using SMS as a reminder service to increase adherence to treatment programs among sick individuals (i.e. blood glucose monitoring among diabetic patients). Less than half of the studies (4/14 studies) had focused on promoting preventive behaviors to healthy individuals (i.e. smoking cessation or healthy nutrition). We found statistically significant, positive changes in behavior in more than half of the studies (8/14 studies). A further five studies demonstrated positive behavioral trends but did not have sufficient statistical power to demonstrate statistical significance, and just one study showed no change in behavior. These are promising results for the future of SMS in health behavior change research.

However, it is important at this early stage of research to acknowledge the limited number of high quality SMS intervention trials. The broad range of study designs used and the varying use of SMS characteristics in interventions (i.e. degree of tailoring, SMS dialogue initiation), limited the conclusions we could draw from our review, and highlights the need to improve the quality and rigor of future research in this area. The following methodological improvements will allow for future research to learn valuable lessons from the first generation of SMS trials:

The need for post-intervention follow-up

Technology is developing at a rapid pace and there are many new mobile devices such as Personal Digital Assistants (PDA’s) and devices with Global Positioning Systems (GPS) and video calling capabilities. However, based on the principles of public health promotion it is important to examine the potential of technologies that are used by the masses as methods to disseminate health behavior programs. The widespread use of mobile telephones and the capabilities of SMS have great potential for delivering health behavior interventions. However, we are not sure yet how great that potential is.

Authors :Brianna Fjeldsoe, Ph.D. Associate Lecturer School of Population Health The University of Queensland

Alison Marshall, Ph.D. Public Health Subject Area Coordinator School of Public Health Queensland University of Technology

Yvette Miller, Ph.D. Research Fellow School of Psychology The University of Queensland


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