Texting our way to health equity
How SMS can be used to bridge the digital divide in healthcare.
The Covid-19 pandemic made us all take a closer look at digital health communications and what we found were blaring inequalities. During the heart of the pandemic the economic and educational elite tended to have computers, smart-phones, broadband and internet, allowing for access to vital mobile health services. At the same time, millions of disadvantaged yet deserving humans couldn’t book appointments or access the most basic health communications. The more affluent among us took advantage of subscription apps that granted those with resources to pay, access to telehealth appointments and Covid-19 testing.
What we’re talking about here is a major digital divide in America. It is between the “haves” when it comes to hardware, broadband and digital literacy and the “have nots.” The consequences of this divide permeate throughout society creating inequity in educational and civic arenas. The Covid-19 pandemic did an excellent job of highlighting how the divide is widening on digitized healthcare systems, creating barriers to health services for entire communities.
According to a 2021 report by the FCC, 19 million Americans are still without broadband. That’s millions of Americans who may find it difficult or nearly impossible to schedule broadband dependent vaccine and telehealth appointments. For 19 million people this is both detrimental and demoralizing, especially in a crisis situation such as a global pandemic.
While we await the results of President Biden’s plan to deliver a $65 billion (down from $100 billion due to GOP opposition) to get broadband and high-speed internet access to more Americans, it is pragmatic to look for technologies that can bridge the widening digital health divide right now. The great news is that such technology is already literally in the hands of the people.
Short Messaging Services (SMS), better known as text messaging, is widely adopted and even preferred by underserved populations such as minority youth. This is because texting is accessible via cell phone, is typically free or very low cost based on service plans, and doesn’t require broadband, a computer, or an expensive smartphone.
While smartphone adoption is on the rise in the U.S., with 85% of adults owning one, there are still 11% of U.S. adults relying solely on non-broadband devices that can’t run advanced mobile apps. In 2019, according to Pew Research, 76% of adults in advanced economies owned a smartphone while only 45% of adults in emerging economies owned one. Thankfully, with SMS, living without a smartphone doesn’t have to mean living without vital digital health communications and services. What we need is health communicators to consider using SMS. Here are a few proven reasons why SMS health communications work:
1. SMS appointment reminders are highly effective: When SMS reminders for colonoscopy appointments were sent to an at-risk, minority population a majority (72.7%) got a colonoscopy within three months.
2. SMS communications increase vaccination rates: At-risk pregnant mothers in New York City were 30% more likely to be vaccinated for influenza after receiving SMS influenza awareness communications and appointment reminders.
3. SMS platforms as health education tools are well received by marginalized populations: A research team developed a successful SMS platform with input from at-risk youth in Peru. Crafted in plain, adolescent friendly language, the platform taught sex education to rural and hard-to-reach youth.
It is important to note that SMS communications aren’t perfect, for example, there are some security concerns that need to be addressed and it can be glitchy, although this seems to be the case with many digital and telecommunications. The truth is, we’re still generally figuring privacy and security out. In the meantime I do believe that the benefits of SMS currently outweigh the risks.
During the COVID-19 pandemic, vaccination appointments meant for the Latinx community of Washington Heights in New York City totally missed the mark. Appointments went to more affluent, more digitally savvy, white New Yorkers who traveled from outside of the target community. In this case, obtaining vaccination eligibility required that one spoke English, was digitally savvy and had access to a computer. If this outreach utilized SMS in addition to other communication methods recommended for targeting Latinx communities, the efforts may have been more successful in reaching actual residents of Washington Heights, who had been disparately hit by the pandemic.
SMS just makes so much sense because everyone is already using it and so SMS interventions have high compatibility and ease of use. If you’re a multi-tasking mom like myself then you know that there is something to be said about receiving a convenient SMS appointment reminder or health update without having to log into a website or download and open an app.
I am looking forward to exciting developments in SMS that will make this old technology cutting edge. We can expect to see more intelligent SMS chatbots and platforms that incorporate more personalizations and automations such as enhanced conversational capabilities, which will lead to more effective and affordable health communications for everyone, whether they are broadband connected or not.
Imani Razat is a writer and communications consultant. She holds a Master’s in Communication from Johns Hopkins University.
