JMIR Publications

ABSTRACT

Background:

Short message service (SMS) reminders are among the most widely implemented mobile health (mHealth) interventions used to improve outpatient appointment adherence and optimize healthcare service delivery. Although substantial evidence demonstrates their effectiveness in reducing missed appointments, limited research has examined how the design and framing of SMS reminder messages are evaluated within healthcare systems, particularly by personnel responsible for implementing these communication tools in routine clinical workflows.

Objective:

This study investigated healthcare service personnel’s preferences for SMS appointment reminder content and examined structural and experiential factors associated with message evaluation in a high-volume outpatient care system.

Methods:

A cross-sectional questionnaire study was conducted at a tertiary medical center in Taiwan with more than 1.2 million outpatient visits annually. Healthcare personnel involved in appointment coordination, diagnostic scheduling, and telehealth follow-up workflows evaluated six SMS reminder message formats representing distinct communication framings. Among 410 distributed questionnaires, 356 responses were returned and 322 complete responses were included in the analysis. Descriptive statistics, bivariate analyses, and multivariable logistic regression models were performed. To control for multiple comparisons, the Benjamini–Hochberg false discovery rate procedure was applied.

Results:

Informational SMS reminders were the most preferred format (52.2%), followed by reminders referencing prior missed appointment behavior (25.8%). Empathy-oriented messages were substantially less preferred, including patient-focused (7.6%) and provider-focused (5.3%) approaches, while physician follow-up (4.8%) and supportive reminders (4.2%) were least selected. After false discovery rate adjustment, age, education level, occupational category, and outpatient visit frequency remained significant in bivariate analyses. In multivariable models, age emerged as the only consistent predictor of SMS preference across specifications. Healthcare utilization indicators, including prior missed appointments, were not stable predictors. Model explanatory power was modest (Nagelkerke R²≈0.02–0.12).

Conclusions:

Preferences for SMS reminder message design among healthcare personnel are heterogeneous and only partially explained by observable structural characteristics. These findings suggest that SMS reminder systems should be conceptualized not merely as behavioral tools but as implementation-embedded communication processes within healthcare delivery systems. Optimizing SMS reminder strategies may therefore require context-sensitive message framing and workflow-compatible communication design in high-volume outpatient environments. Clinical Trial: not Applicable