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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Childhood Vaccination with MMR, Flu, and HPV.

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Strategy. Text Message-Based Health Interventions

Approach. Implement text message based health intervention to parents of children in need of vaccinations to increase the number of children vaccinated.

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Overview. Text message-based health interventions provide patients with reminders, education, or self-management assistance for a broad spectrum of health conditions. Interventions are most frequently used as a part of broader health promotion efforts or to help individuals manage chronic diseases.[1] Text messages may be standardized or tailored to specific patients and sent at varied frequencies based on the intervention.[2] Text messaging can be combined with other approaches or delivered as part of a stepped care or progressive intervention that is tailored to patients’ needs, beginning with the least intensive treatment and moving to more intensive, and often expensive, treatments as needed.[1] Text message software and smartphone apps can be integrated into electronic health records. (EHRs) to send alerts and reminders to patients.[3]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Text message program engagement data
  • Parental self-reported challenges survey data
  • Healthcare provider/clinic feedback on appointment scheduling Electronic Medical Records Report

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Social Marketing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of text messages sent to parents with information, reminders, and support related to childhood vaccinations. (Shows the volume and frequency of the approach delivery)
  • Number of vaccination appointments scheduled or completed as a result of parents receiving text message prompts through the approach. (Indicates the direct response and action taken by parents)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of parents who report the text messages to be clear, informative, and motivating in promoting childhood vaccinations. (Shows the perceived quality and usefulness of the approach content)
  • Percent of parents who receive additional personalized support or resources through interactive features of the text message platform (e.g., two-way communication, links to online resources). (Indicates the customization and responsiveness of the approach to individual needs)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of language translations and adaptations made to the text message content to ensure usability and relevance for parent populations. (Shows the efforts to improve the approach's reach)
  • Number of data sharing agreements and referral protocols established between the text message platform organized by Title V and healthcare providers to facilitate care coordination and follow-up. (Indicates the integration of the approach with the healthcare infrastructure)
  • Number of healthcare visits or costs averted due to improved childhood vaccination rates and reduced vaccine-preventable illnesses resulting from the text message approach. (Shows the approach's potential for healthcare savings and cost-effectiveness)
  • Number of public health policies or programs that adopt or scale up text message-based approaches as a standard component of childhood vaccination promotion strategies. (Indicates the approach's influence on shaping public health practice and priorities)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of parents from communities facing challenges to access who are successfully enrolled and engaged in the text message vaccination approach and report improvements to overall health as a result of participating in the text message program. (Shows the approach's penetration)
  • Percent of implementation costs for the text message approach that are covered by sustainable funding streams (e.g., health plan reimbursement, public health grants). (Indicates the long-term feasibility and financial viability of the approach)
  • Percent increase in parental awareness, support, and social norms supporting childhood vaccinations in communities exposed to the text message approach. (Shows the approach's spillover effect on building vaccine confidence)
  • Percent of immunization partners (e.g., healthcare administrators, policymakers, payers) who view text message-based approaches as a cost-effective and scalable strategy for improving childhood vaccination rates. (Indicates the approach's perceived value and potential for widespread adoption)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Tofighi 2017 - Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature. Drug and Alcohol Review. 2017;36(4):477-491.

2 Orr 2015 - Orr JA, King RJ. Mobile phone SMS messages can enhance healthy behaviour: A meta-analysis of randomised controlled trials. Health Psychology Review. 2015;9(4):397-416.

3 Perri-Moore 2016 - Perri-Moore S, Kapsandoy S, Doyon K, et al. Automated alerts and reminders targeting patients: A review of the literature. Patient Education and Counseling. 2016;99(6):953-959.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.