Using text messaging to facilitate self-management of long-term illness

SMS technology uses mobile phone ownership, which is estimated to be about 3.09 billion users globally, to communicate and provide equitable traditional healthcare delivery. Unlike app-based solutions that require smartphone access or digital literacy, text messaging operates on basic mobile devices, making it inclusive for elderly patients and those in resource-limited settings. With a high-level of accessibility, SMS can be especially beneficial for chronic disease management.

What is mobile health? 

Mobile health, known as mHealth, is when mobile and wireless technologies improve healthcare services, health outcomes, and health research by delivering health information or facilitating data collection. Emerging as a sub-segment of eHealth, mHealth expands healthcare access, particularly in developing countries, by reaching previously underserved populations and improving the capabilities of existing health systems. mHealth offers convenience through continuous health data tracking and facilitates communication between patients and providers. 

Initially driven by the constraints faced by developing nations' healthcare systems and the rapid rise in mobile phone penetration, mHealth has progressed from the early days of pagers to today's powerful smartphones and wearable devices. The introduction of the smartphone marked a turning point, ushering in an era of market-driven mobile health solutions and ecosystems. The evolution includes major milestones such as the launch of the mHealth Alliance in 2009, the rise of wearable technology around 2013, and the surge in telehealth usage during the COVID-19 pandemic. 

Why text messaging is the best option

Studies demonstrate that text messaging effectively integrates behavior change techniques such as reinforcement, goal setting, and real-time feedback, to achieve measurable outcomes, like cholesterol reductions and blood pressure improvements in chronic disease management. Its simplicity aligns with cognitive load theory, delivering bite-sized, actionable prompts that seamlessly integrate into daily routines without requiring active engagement, an advantage over complex apps requiring user initiation.

From a systems perspective, SMS optimizes resource allocation by automating high-frequency tasks (appointment reminders, prescription alerts) while enabling scalable personalized communication through adaptive algorithms. The bidirectional nature fosters patient-provider continuity, allowing symptom tracking and queries that enhance self-efficacy, a factor in chronic illness management. Cost analyses reveal SMS interventions often operate below $100/patient annually, contrasting sharply with expensive telehealth platforms or wearable-dependent systems. While limitations exist, such as 160-character constraints and HIPAA compliant encryption needs, text messaging’s ability to deliver timely, low-intensity nudges positions it as the backbone of sustainable mHealth strategies

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The benefits of text messaging for self management 

1. It is a simple way to improve behavioral risk factors for chronic diseases.
2. Text messages are an affordable way to deliver health messages.
3. It helps remind patients to take their medications, improving medication adherence.
4. Text messaging doubles the odds of patients sticking to their medication programs.
5. It can improve medication adherence for those with HIV, asthma, diabetes, schizophrenia, and heart disease.
6. Text messages can send reminders about appointments.
7. It can send refill reminders.
8. It allows for more focused time on communicating with high-risk patients.
9. Personalized text messages help patients feel that their care team wants them to improve their health status.
10. Texting works well for healthcare workflows such as scheduling, billing, and patient surveys.

The practical application of chronic illness management

HIPAA compliant text messaging can improve communication between caregivers and healthcare providers by establishing a secure and direct channel for exchanging information, asking questions, and receiving updates on a patient's condition. It reduces misunderstandings and improves care coordination, which is especially necessary for patients with chronic conditions requiring input from multiple healthcare professionals.

Secure messaging enables seamless coordination between doctors, nurses, therapists, and caregivers. With HIPAA compliant texting, caregivers can quickly reach healthcare providers for immediate answers about medications, symptoms, or care procedures, reducing the need for unnecessary emergency visits.

How to use text messaging effectively 

1. Tailor text messages to specific patients and send them at varied frequencies.
2. Combine text messaging with other approaches or deliver it as part of a program tailored to patients’ needs.
3. Integrate text message software and smartphone apps into electronic health records (EHRs) to send alerts and reminders to patients.
4. Engage directly with patients one-on-one to provide more personalized care and support.
5. Send messages en masse with educational information, community resources, and screenings, saving staff time.
6. Use an automation process for communication types like appointment reminders, and medication adherence and refill reminders.
7. Respect patient preferences by sending personalized text messages in their native language and accounting for different learning modalities.
8. Incorporate nurse care managers into patient engagement workflows for direct texting to provide educational and community resources.
9. Utilize automated bidirectional messaging that patients can respond to to further engage patients.

Why Paubox Text Messaging is the only choice

Paubox distinguishes itself by offering secure, encrypted messaging without requiring patients to download third-party apps or navigate complex portals, increasing patient engagement for chronic illness management. Paubox allows healthcare providers to enhance patient care, improve communication workflows, and, ultimately, deliver better patient outcomes, by using personalized messaging that includes protected health information (PHI) while adhering to HIPAA.

FAQs

Can healthcare providers text patients about PHI?

Yes, you can text with patients about PHI. If they want to discuss PHI or have a comment/question that would require you to mention PHI in the text, it’s necessary to get their consent first. 

What types of messages require written consent? 

Billing or marketing messages require written consent as they are not considered healthcare messages. Examples include advertisements for new services, solicitations to events, and special offers. If you want to send out a dual-purpose message that includes both a healthcare and a marketing message, the message will be held to the higher marketing message standard and will require express written consent.

What are the key requirements when sending text messages? 

Key requirements include having a clear opt-out option, adhering to the minimum necessary standard for sharing PHI if using a third-party, regularly checking and updating patient contact information.

What should a healthcare provider consider when creating a management plan? 

The healthcare provider, along with the patient, should identify health priorities, actions to manage the condition, other healthcare and community services needed, and desired results from the plan.

What can healthcare providers do to support patients in managing chronic diseases at home? 

Healthcare providers should encourage regular medical check-ups, creation of structured routines, tracking of symptoms, adapting the home environment, collaboration with healthcare professionals, use of assistive devices, effective medication management, and engagement in preventive care. 

What is chronic disease management? 

It is an integrated approach to managing chronic conditions to reduce symptoms, slow disease spread, retain function and ability, and maintain quality of life.