JMIR Publications

ABSTRACT

Background:

Digital healthcare is one strategy to improve health service accessibility and reduce costs. Digital health care requires a significant self-management component and this generates information and support needs. Text messaging is an important strategy to meet these needs. There have been no evaluations of the use of SMS support to help within online self-management when delivered at scale

Objective:

The aim of this study was to understand the quantity and quality of SMS support needed to facilitate use of an online sexual health service in order to inform service planning and staff training.

Methods:

The content of all text messages received by SH:24, a large online sexual health provider based in the UK, were analysed from 4th April 2018 to 5th July 2018. Messages were classified as being either administrative or clinical in nature, and service user or online support staff initiated. For those messages that were both clinical and user generated, a qualitative thematic analysis was completed in order to fully describe the content of the interactions.

Results:

267 messages were generated per 1000 service user requests, of which 63.6% were administrative and 36.4% required clinical advice. Of the clinical messages, 31.1% required specialist clinical advice. Fifty per cent of the messages responded to service generated queries that reflect the public health and clinical responsibilities of this service and 50% of the messages were service user generated queries, suggesting a willingness to engage with this type of interactions with an online service. User initiated messages comprised 31.1% (968) of SMS communications in the clinical category. These had an informal, conversational tone, shared complex and personal information, were 9 to 965 characters long and included requests for help with the self-testing process, interpretation of results and assessment of risk of infection.

Conclusions:

Text based mobile phone interaction is an effective way to build skills and knowledge for self-management but further work is required to understand the range of clinical problems that can be managed within this medium, and when and how conversations should be transferred to synchronous media such as telephone, video or face to face.