Intervention with SMS: What’s Next?

Short Message Service (SMS) or text messaging, is a simple way to communicate: it allows people to send text from one mobile device to another, most typically cell phones. The advantage of SMS is that it can work with any cell phone, smart phones are not required. It allows people to “talk” when they might not be able to do so easily by talking on phone (e.g., a public place, or a hospital). The major disadvantages of SMS are that it doesn’t lend itself to complex or nuanced conversations. While some “non-verbals” can be communicated via text emoticons, the non-verbal communication is limited. It’s important to recognize there will be times when a dialogue needs to shift to another platform for certain types of interactions.

I’ve been intrigued for a while by the potential of SMS groups to bring people together. So when I read a recent blog post by Susannah Fox, a member of the Pew Internet team, on the power of SMS to convey human kindness, that is, social support, for people confronting chronic disease, I shared her excitement about the potential of this form of mobile communication. Fox described two projects, one in Kenya and one with teens in the United States, where the SMS Support intervention condition (SMS as one key component of staying connected with people) demonstrated positive health outcomes.

Beyond the projects mentioned in Fox’s article, I’ve seen reports of success with managing pediatric asthma with SMS and a Social Work Today article reporting on an initiative to improve medication adherence among older adults through SMS. All of these are just a small sampling of what is going on a people explore this form of intervention..just try a Google search on “SMS intervention with youth” to get a taste of what’s happening on this topic.

Beyond being a tool for clinical outreach and intervention, I think that SMS can be a very powerful tool to organize group support among people with a shared concern or goal. I’ve had two personal experiences using such groups that have proved to be very powerful.

Helping A Family Confront a Health Crisis

Almost three years ago my dad had a stroke. My mother, my four siblings and I needed to stay connected frequently. My mom decided that I was the one she would relay updates to, and then she asked me to keep everyone else informed. Four siblings, with one in another time zone, could make for lots of phone calls back and forth. So I decided we needed another way to stay in touch fast. But we needed something relatively low-tech, since my mom and some of my siblings had “old style” cell phones, not smart phones. I finally decided on a text messaging group via GroupMe: you get one phone number to send text messages to and it will send the text message to everyone in the group.  It turned out to be the perfect way to stayed connected–even the least “tech” of us used the group and found it valuable, and even though we were all well over age 40.

After my dad recovered, we all continued to use the group to stay in touch, including my mom. On more than one occasion she thanked me for setting up the group — it was used much more often than the family listserv we had set up years before.

Link to image of 5 cell phones connected to a globe through messagesSo two months ago, when my mother’s knee replacement surgery sent her into a medical crisis, the family text group, again, proved a good way to stay connected. It was even the way that my brother let me know that my mother had died — he was sitting by her bedside and texted the rest of us –we were hours away and headed back to the hospital — know that she had died. And surprisingly, that felt fine to me, maybe because I knew he was talking to all of us. And by that time we were so used to communicating that way that  hearing from him felt like a caring connection. It didn’t replace coming together at the hospital person-to-person–it allowed us to feel some connection with each other at a painful time when we were all separated by distance. SMS formed a connection bridge that linked the five of us in our pain.

Since my mom’s death, our family texting group has been a great support as we deal with our grief together, as well as our concerns in caregiving for our dad. At times, we have shifted to phone calls and phone conference calls. But the texting group is still the core that keeps us in touch daily.

A Community Supports a Member in Crisis

In a virtual world called Second Life, I live in a community of people who have our homes based in a group of adjacent islands. There is one member who is our leader — he manages the community for us — and he is is the one who brings us together, comes up with ideas for shared projects, and keeps us all laughing. I’ll call him E.  A year ago E was in a serious bike accident on a weekend when his entire local support system was out of town. He got word to us over our listserv that he was being admitted to the hospital with only his iPhone (and no charger). Our community then mobilized to help him — we were scattered all over the U.S. and the world — but we still managed to make sure he was delivered an iPhone charger in the hospital. And then we set up a GroupMe SMS group which became an active support group for him for the next few days. It was the easiest way for him to maintain a connection with us–easier to follow and post to than email– throughout his hospital stay. We supported him through the pain, the bureaucratic hassles of the hospital, his recovery from surgery, and the loneliness of being there with no visitors. But once he was discharged and connected to the local social support in his life our text group shut down. The crisis was over and we had other ways to maintain our regular community communications.  After his discharge E credited the texting group support as key to helping him get through a very rough time in the hospital. It also had a side benefit of allowing group members to better get to know each other and develop more of a shared sense of community.

The Many Faces of SMS Connection

So SMS can be a method of outreach and engagement for clinicians to use to help people manage health conditions. Similarly, a therapist could use it to remind clients to use coping skills. And an SMS group can bring people together in a crisis or allow people who are already a group (or in a family) to stay connected.  Susannah Fox is interested in the potential of SMS to support peer-to-peer connections. I could easily see people with a shared chronic health condition use a GroupMe SMS group for support, especially at times when people might have a harder time getting access to their regular technology (e.g., when someone is hospitalized or traveling). I am starting to wonder if SMS might have potential for more general group work — both for clinician-facilitated and mutual-aid groups.

I would love to hear others’ experiences or ideas for how SMS might be used for the next frontier of human connection.

Photo credits: Click on the photos to see photo sources.

12 thoughts on “Intervention with SMS: What’s Next?

  1. What a wonderful post. I love the combination of the personal and the academic. I’ve never heard about We Group – sounds like it was wonderful. My family has certainly shared some very funny and connecting moments using a family group on WhatsApp (we all have smartphones). I had two thoughts about SMS after reading your post. 1) I would imagine that during both life & death crises you and your family members were motivated to make the technology work for the greater purpose of connecting – something you were very motivated to connect. Even if SMS does not lend itself to nuance, people can still emote, debate, and process. 2) The subtlties that get lost using SMS are probably less important when communicating with people you know so well. I wonder if the quality of SMS communication is highest for folks who already have well-established intimate relationships OR people who have no relationship (because they would be the most careful about what they said and how they responded). I wonder if it would be the worst for folks who sort of know each other, but not really.

    Clearly you got me thinking! Thanks.

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    • Jonathan, I agree completely about crisis providing a reason to participate — I think that operated, for sure, with some of my family members. There is a chance that someone might feel overwhelmed in a crisis and not up to learning something new — it’s a balancing act, I think. I also agree with you about the context of the relationships playing a role with subtleties in communication. As I think about relationships I wonder if it really comes down to how much trust you have in the person. When trust is high, you cut people more slack in communication…when it’s low (or just unknown/new) you take a lot more care in communication.. Thanks for your comments, because you have me thinking more about other aspects of this!

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  2. Hi Nancy,

    Thanks for reaching out and I’m so glad you covered this topic. I’ve been using sms in my macro social work practice in public housing for an academic medical center in a number of ways.

    -Most of the families I serve do not have smartphones or limited minutes and sms is an effective way to correspond.
    -I use it for instantaneous data collection on programming and community outreach and to take the temperature of community needs. Questions like:

    Have you or someone you know witnessed a violent act in the last 48 hours.

    Would you be interested in more info on asthma treatment for your kids

    -Going forward, I’m wondering how sms could be used for community organizing, phone and text trees to help neighbors bond with each other in a close geographic location, and a way to vent and/or express gratitude..

    You shared tons of resources I never heard of that are particularly relevant to more work on health disparities. Thank you!

    My favorite site so far for #mhealth is: http://mhealthalliance.org/

    and frontline is a great opensource and affordable product:
    http://www.frontlinesms.com/

    Please continue to share!
    ..

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    • I love all the examples of the macro work that you are doing with SMS, Mozart — very innovative. And those are terrific resources, thanks for sharing them. I’m impressed with the digital infrastructure that has developed around using SMS for work with diverse populations.

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  3. Public health is really leading a charge in this arena.. Text4Baby is a very well regarded pre-natal support and care text service that has been up and running for a few years. You can read more about it here: https://text4baby.org/ There is also a new service getting off the group in the North East called Crisis Text Line that is backed by the Do Something people. http://www.crisistextline.org/ I have suggested to them that they use social work interns as the counselors behind the phones.. it would be an incredible training ground for new social workers to be involved in this type of engagement strategies..

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  4. Nancy, after reading your post, I wondered what my days as a mental health case manager in the late 1990s would have been like if SMS had been around. I could have sent a text to clients about appointments, when I might arrive at their home to pick them up for an appointment or even to ask how their day was going. I think it could have been an invaluable way for me communicate with clients in between regular face-to-face visits. Today, I communicate frequently with students in my social work courses with SMS. I started doing this about five years ago when working with a student who had difficulty hearing. The student suggested that we use SMS when a translator was not available, and it worked great. Since then, I give students the option of sending me a text message to reach me, but always provide them with some ground rules and expectations about how and when to text me. It has been a great tool to engage students between classes. Thanks for another great post, Nancy!

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    • Laurel, I’ve had the same thought about past work that I’ve done before we had all these new technologies to draw on.

      Thanks for sharing what you’re doing with your students. I’m curious about the “ground rules” that you set for your students when you use SMS. Would you be willing to say more about those?

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      • Nancy, yes, I am happy to share how I use SMS with students, and the “ground rules” for the students are simple:

        1. The Who: When texting, please Identify who you are and the class. I don’t respond to texts from unidentified persons.

        2. The What: Please be professional and brief in the message by using close-ended questions and keeping jargon, acronyms and emoticons to a minimum.

        3. The When: During normal business hours, I typically respond to texts within minutes, but it can take longer. I rarely respond to a text between 10 PM and 6 AM.

        I provide my cellphone number on the course syllabus and then discuss these ground rules during the first day of class. Frequently, I find that I am often the first professional that students have ever considered sending a text message. This give me a good opportunity to open a discussion with students about professional communication, and we talk about how to pick the best method for the message (i.e. email vs. phone call), communication etiquette, and the importance of good writing, even with SMS.

        Also, I work to model good professional communication with students throughout the semester, and I have my own set of “ground rules” for using SMS:

        1. I only respond to text messages from students. I never initiate a conversation via texting. If I need to reach a student outside of class, I will email or call as these methods give me more space to explain the reason for my communication.

        2. When responding to a student’s text, if my response is too long or complicated to text back, I ask the student to call me or set up an appointment with me. I have not yet found a way to explain how to calculate a standard deviation via SMS.

        3. I follow all of the ground rules that I set for my students. For example, I sign all of my text messages with my initials and try not to use jargon.

        This is what works for me, but I can imagine these “rules” may change in the future as the technology changes. I would be very interested to know how other educators are using SMS. Also, do you know if any social work text books on professional writing and communication are addressing best practices for texting?

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  5. Thanks for posting the ground rules for how you use SMS with students. I am not aware of any social work writing books that address this issue — would love to know of any if any one else know them.

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  6. Pingback: The Liebster Award | Virtual Connections

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