How to create an effective text messaging protocol

A text messaging protocol outlines the rules and strategies for sending SMS messages to achieve specific goals within an organization. The necessary components of creating an effective text messaging protocol include understanding the audience's preferences and needs, and tailoring the content and timing of messages according to what patients want and need. 

Understanding your audience

Organizations need to identify and understand the key audiences to target the text messaging campaign. This involves a detailed assessment of their language preferences, ensuring the messages are crafted in the most comfortable languages. It's equally necessary to consider the literacy levels within the audience; for those with lower literacy, simplifying the text and using clear, straightforward language is essential. 

Something else that should be considered is acknowledging the cultural backgrounds of the audience. According to an HHS Author Manuscript, “Racial/ethnic minority and immigrant populations experience gaps in information. Prior studies demonstrate that immigrants, lower socioeconomic status (SES) populations, or those who are uninsured, are are less likely to seek health information.” Total equity in a communication protocol includes understanding cultural nuances, values, and norms to provide care that is culturally sensitive and resonates well with the recipients.

Characteristics of an inclusive text messaging protocol

1. Plain language use: Ensures all messages are written in plain language, avoiding medical jargon to make them understandable to people with varying levels of health literacy.
2. Language variety: Offers messages in multiple languages, catering to the diverse linguistic backgrounds of patients, including offering dialect-specific options where relevant.
3. Disability accommodations: Supports accessibility features for disabled patients, such as messages compatible with screen readers and options for voice responses.
4. Cultural relevance: Customizes messages to reflect cultural nuances and sensitivities, ensuring that content is linguistically and culturally appropriate.
5. Age consideration: Tailors messages to be age-appropriate, with different framing for children, adults, and the elderly, acknowledging their unique healthcare needs and comprehension levels.
6. Timed delivery: Schedules messages based on optimal times for different groups, considering work schedules, time zones, and typical daily routines.
7. Two-way communication: Facilitates two-way interactions, allowing patients to respond to messages for more information or to ask questions, thereby improving engagement.
8. Emergency instructions: Includes clear, concise emergency health instructions or warnings, ensuring that all patients, regardless of their background, understand how to react in urgent situations.
   
   

Choosing communication objectives and behavioral techniques

Based on a JACC Case Reports study, “Communication is the foundation for obtaining medical history, as well as conveying a diagnosis and treatment plan.” Communication objectives follow this directive and define an organization's goals through its messaging, such as informing, persuading, or motivating action. By setting clear communication objectives, organizations can measure the success of their efforts, and adjust strategies as needed.

Here are the main objectives that a good text messaging protocol should have:

• Clarity
• Timeliness
• Relevance
• Engagement
• Action orientation
• Compliance
• Accessibility

Behavioral techniques are strategies used to influence and change people's behaviors. When applied to text messaging, these techniques can be particularly effective. For instance, text messages can be timed to prompt actions at moments when people are most likely to respond positively. They can also be personalized to increase relevance and engagement. 

Some behavioral techniques that can be effectively applied to text messaging include

• Personalization involve tailoring messages to individual preferences and history to increase relevance and engagement.
• Prompting uses timely reminders to encourage immediate action, such as taking medication or confirming appointments.
• Reinforcement sends positive feedback or rewards via text for desired behaviors to encourage repetition of those actions.
• Framing shapes how information is presented in texts, emphasizing benefits or consequences to influence decision-making.
• Gradual engagement gradually increases the complexity or commitment required in messages, building up to more significant actions.
• Social proof includes messages about others' successful actions or behaviors to motivate similar behaviors by the recipient.
• Commitment devices ask recipients to commit to future actions via text, which can increase the likelihood of follow-through.

Personalization and timing

Research shows that 71 percent of consumers expect companies to deliver personalized interactions, and 76 percent get frustrated when this doesn’t happen. Personalization tailors the content of text messages to align with the individual's specific interests, past behaviors, and demographic details, making the communication feel more directly relevant and engaging. For instance, using a recipient's name or referencing their previous interactions can significantly increase the likelihood of a positive response. 

On the timing front, delivering messages at strategic moments is essential. The timing of a message can greatly influence its impact and effectiveness. For example, sending health-related reminders just before meals or exercise routines can prompt more immediate and relevant action. Similarly, scheduling payment reminders a few days before a due date can improve the chances of timely payments.

See also: Improve patient engagement with HIPAA compliant text messages

How to monitor the efficacy of protocols 

1. Delivery rate: Measures the percentage of messages successfully delivered to recipients' devices. This helps identify potential issues with message delivery.
2. Open rate: Tracks how many recipients open the messages. This is crucial for gauging the initial level of engagement with the content.
3. Response rate: Measures how many recipients respond to the messages. High response rates typically show that the content is engaging and prompts action.
4. Click-through rate (CTR): For messages that include links (e.g., to a survey, website, or appointment confirmation page), CTR measures how many recipients clicked on the link. This metric assesses the effectiveness of call-to-action elements.
5. Opt-out rate: Tracks how many recipients unsubscribe from receiving further messages. A high opt-out rate might indicate issues with message relevancy, frequency, or content.
6. Conversion rate: Measures the percentage of recipients who take a desired action beyond just clicking a link, such as completing a health assessment form or scheduling an appointment. This is a direct indicator of the protocol’s effectiveness in achieving specific objectives.
7. Patient satisfaction scores: Gauges patient satisfaction with the messaging service through surveys or feedback forms. High satisfaction scores can reveal the protocol’s success in terms of usefulness and user-friendliness.
   
   

Creating an effective text messaging protocol

Understand your audience

• Assess language and literacy needs: Determine the language preferences of your audience and assess their literacy levels to ensure messages are understandable. For patients with lower literacy, use simple, direct language without medical jargon.
• Consider cultural and socioeconomic backgrounds: Acknowledge the cultural, social, and economic contexts of your audience. Understand that certain groups may have less access to healthcare information and tailor your approach to bridge these gaps.

Set clear communication objectives

• Define goals: Establish what you want to achieve with your text messaging, such as improving appointment attendance, enhancing medication adherence, or educating patients about health management.
• Measure success: Set measurable targets for each objective to evaluate the effectiveness of your messages, like tracking the rate of missed appointments or responses to medication reminders.

Apply behavioral techniques

• Personalization: Customize messages to reflect individual patient data such as their name, previous interactions, and specific health conditions to make messages more relevant and engaging.
• Prompting: Use timely reminders to nudge patients towards necessary health actions, such as taking medication at the correct times or preparing for upcoming medical tests.
• Reinforcement: Send follow-up texts to reinforce positive behavior, such as congratulating a patient on completing a health milestone.
• Framing and social proof: Frame messages to highlight the benefits or consequences of specific health behaviors and include testimonials or statistics that demonstrate the positive outcomes of others who have followed similar advice.

Personalization and timing

• Tailor content: Dynamically adjust the content based on ongoing patient interactions and feedback to continuously refine message relevance.
• Optimize timing: Analyze patient routines and behaviors to send messages at times when they are most likely to be effective, such as before meals for dietary advice or early in the day for day-long reminders.

See also: Top 12 HIPAA compliant email services

FAQs

How do I determine the best time to send text messages to my audience?

Analyze your audience’s behavior patterns, such as when they are most active on their phones, and schedule messages accordingly to maximize engagement.

What should be included in a text message to make it effective?

A direct call to action, clear and concise information, and a personal touch when appropriate to make the message feel relevant and engaging.

Why is audience segmentation important in text messaging?

Segmentation allows you to tailor messages to meet the specific needs and preferences of different groups within your audience, improving relevance and response rates.