JMIR Publications

ABSTRACT

Since the early studies exploring the use of text messaging for health intervention 25 years ago, text messaging has played a pivotal role in the advancement of mobile health. As an intervention modality, text messaging has provided vital learnings for the design and delivery of interventions particularly in low-resource settings. Despite the advances in technology over the last 25 years, text messaging is still being used in largely the same way to deliver health information, behaviour change interventions and support. The strong consistent evidence for the benefits of this type of intervention has made text messaging a routine part of health interventions around the world. Key to its success is its simplicity alongside the benefit of being arguably the most accessible form of consumer digital health intervention. Text message interventions are well suited for public health interventions due to their low cost, vast reach, frequent use, high read rates and ability to be tailored and personalised. Furthermore, the nature of text messaging interventions makes them ideal for the delivery of multilingual, culturally tailored interventions, which is important in the context of increasing cultural diversity in many countries internationally. Indeed, studies assessing text messaged-based health interventions have shown them to be effective across socio-demographic and ethnic groups and led to their adoption into national-level health promotion programmes. With a growing focus on artificial intelligence (AI), robotics, sensors, and other advances in digital health, there is an opportunity to integrate these technologies into text messaging programs. Simultaneously, it is essential that equity remains at the forefront of digital health researchers, developers and implementers. Ensuring digital health solutions address inequities in health experienced across the world while taking action to maximize digital inclusion will ensure the true potential of digital health is realised. Text messaging has the potential to continue to play a pivotal role in the delivery of equitable digital health tools to communities around the world for many years to come. Further new technologies can build on the humble text message leveraging its success to advance the field of digital health. This viewpoint presents a retrospective of text messaging in health and evidence for the continued relevance of this mHealth modality in 2024 and beyond.