Intervention with SMS: What’s Next?

November 17, 2013

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.

So 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.