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Short Messaging Service (SMS)

​Audience Preferences and Legal Rights


Consideration of your audience's needs and preferences using direct input or relevant published studies is important when developing a text messaging intervention. You will want to consider how many messages to send and how often, as well as the most effective message content. We recommend designing messages carefully according to the desired outcomes using a theory-driven, and using an evidence-based approach to text messaging intervention development. You can learn more about communication theory and developing message content by referring to the Develop a Communication Strategy​ section and other sources listed in the Useful Links and Resources section. 

Another factor to consider is maintaining participants’ privacy. Laws and regulations regarding patient privacy apply to text messaging in healthcare. Although text messages are encrypted during transfer, a message that displays on a screen may be visible to people close by and accessible to people who have access to a user’s phone. Researchers can protect patient privacy by restricting the amount of information in messages or advising research participants to protect their cellphones with passwords and settings that restrict the amount of information delivered with a text message receipt notification. Additionally, participants can use antitheft applications that allow them to remotely lock their phone and wipe it clear of sensitive information.  

The public has a choice in what messages they receive. SMS applications allow for people to either opt-in or to opt-out. The universal method of opting out of a program is to respond with the keyword "STOP." Opt-in options require active acceptance by texting a code word, such as "EATWELL" for a program to deliver daily nutrition tips, to a predetermined short code.  Opt-in programs require advertising or outreach to the target audience that would also include the short code and the code keyword so they know how to opt-in. If you are sending messages to a predetermined list, an opt-out feature may be the best option. See the Security and Privacy section for a complete list of applicable regulations and best practices.

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