SMS and Health: A Systematic Review of the Uses of Mobile Phone Text Messaging in Chronic Disease Management

Theoretical Background and research questions/hypothesis:  Chronic diseases are among the most common, costly, and preventable of all health problems in the United States and suboptimal self-management of these conditions has been identified as a major contributor to the overall healthcare expense burden of these diseases.  Given the pervasiveness, low cost, and convenience of the technology, text messaging may be particularly well suited for supporting the treatment of diseases or conditions that must be managed over an extended period of time.  The United States, however, lags behind many other nations in terms of cell phone penetration and the range of available services. In the U.S., cell phone use is not evenly distributed across the population. Younger adults, socioeconomically disadvantaged populations, less educated young adults, and people who rent or frequently change addresses have been identified as having high rates of cell phone use. Furthermore, higher levels of cell phone use have been associated with lower levels of self-reported health status and participation in health-compromising behaviors. Over the last few years, many health-related applications for cell phones have been developed. However, many were developed and implemented outside of the U.S. where cell phone use is more common and, in general, cell phone networks are more pervasive and advanced than they are in the U.S. The purpose of this literature review is to define the context for the use of SMS interventions to support chronic disease management.  We have classified the research questions to be addressed through this review into three categories: an overview of the technology’s use in support of chronic diseases, technical issues, and implementation issues.

Methods:  For this literature review, our inclusion/exclusion criteria directly linked to the key questions with regard to the populations being studied and the study topics. We excluded studies that were not published in the English language, and did not report research results related to the key questions.  We performed systematic searches of three databases (PubMed, PsycINFO, and the ISI Web of Knowledge) to obtain the articles.  Our search for evidence encompassed the period from 2003 to 2010.

Results: The search resulted in over 160 unduplicated articles.  For those included in our abstraction, we established the rank order of the most common chronic conditions that have been subject to SMS interventions and evaluation, and cataloged research designs, methods, outcomes, and implementation challenges cited.  

Conclusions: Text messaging not only facilitates more frequent communication with patients, but also offers the opportunity to deliver health-related messages at precisely the times and places where they can have the greatest impact (e.g., medication reminders consistent with an individual’s dosing schedule). Messages that focus on increasing self-efficacy and providing a form of social support have been shown to have a positive impact on health behaviors and enhance self-management of long-term diseases.

Implications for research and/or practice: The review of a growing body of work and evaluation of the use of SMS-based interventions for chronic disease management provides reserachers a base from which to consider the benefits and limitations of resarch designs, methods, and challenges associated with implementation.