How to...use text messages for public health research

This is the first of the “How to…” series, a collaboration between [email protected] and the SRA blog. We will be catching up with researchers who have appeared on the [email protected] YouTube channel to introduce a research design or method. We have picked out some methods that address the unique research challenges that 2020 has brought with it, and hope that this series offers inspiration to those looking for new approaches. The first post is written by Dr George Kitsaras, a research associate in behaviour change and digital health technologies at the University of Manchester..  

What are interactive text surveys? 

Text messages, despite being one of the most basic and well-known mobile phone functions, offer a wide range of benefits for public health research and interventions. I have been using text messages in research with families and young children where I explored repetitive family activities (bedtime routines) and their implications for child health and wellbeing. Through the use of text surveys and text messages I was able to greatly increase retention (90% across my studies) and response rates (85% across all studies) - an area where traditional, paper-based measures struggle. The dynamic nature of text messages and the ability to collect real (or nearly real) time data allowed me to explore how routines change over time and map those changes more easily. 

Why are text message surveys useful in the current research climate? 

With low-cost per unit, agile design, familiarity and ease of use, text message surveys have a wide range of extremely useful qualities. 

  • Text message surveys  can accommodate different types of data collection, from standardized questionnaires to open-ended surveys in order to fit the specific requirements of a particular project.. 
  • Text message surveys can be adapted to accommodate different question formats, from Likert Scales to open-ended boxes and multiple choice questions. 
  • Text messages can be used to convey succinct information and tailored interventions for a target behaviour or outcome. 
  • Text message surveys allow for remote data collection and provision of interventions that are especially important in times of social-distancing measures. 
  • Through the use of secure software applications and data storage solutions, text message surveys can maximize data confidentiality and privacy for participants. 
  • Text message surveys allow for speedy data coding since all data can be easily extracted in different formats that are compatible with widely used applications like Excel. This feature can both speed up  the process of coding data and make codingmore standardised and less open to mistakes (since data is easy to arrange, clean and code). 

For my studies, text message surveys allowed for quick ethical approval since we could demonstrate  how they had been used in other research areas and the extensive security and privacy features these studies had used. Most importantly, and contrary to other communication options, text message surveys, at least the ones we used, had clear GDPR policies in place and utilised full UK-based servers. The platform we used (TextIt.In) is free for someone to use to develop a survey but it requires credits in order to send-receive text messages and replies. All these features reassured both the ethics committee (leading to speedy approvals) and our participants (leading to high retention and response rates). 

When to use text surveys and when not to 
Text message surveys can be used for almost any research project, in deprived and better off population settings, and in clinical, public health and behavioural research. Text messages have an unparalleled flexibility and agility that allows for quick adaptations to meet specific research challenges. Also, text messages offer a sense of familiarity due to their long existence and they also overcome digital literacy barriers since they require minimum effort and digital skills from the receiver/sender in order to engage with them. 

Text messages are not a silver-bullet solution for all survey research problems and environments. Despite a larger percentage of the general public owning and using mobile phones, there is still a small part of the public that lacks access to such devices and will be therefore excluded from using/receiving text messages. However, existing statistics show that there is a record-high access to mobile phones within the UK and much of the world with similar access rates for most demographics. Text messages do not require smartphone or internet capabilities and therefore could still remain a more equitable choice when considering different formats for data collection or intervention delivery. 


How to conduct text surveys 

When considering using text messages for a particular research project it is important to consider the following. 

(A) Are text messages the best data collection tool  for this type of research? Are they safe to use and will participants feel happy to use them? A quick literature review will shine some light and a quick Public and Patient Involvement (PPI) exploration can be used to confim if text messages are a good option (a process where members of the public and patients are asked for their feedback and opinions on a specific research matter) 

(B) How can we help participants understand questions and use the text messages in an appropriate manner? For these questions, additional PPI work with a small sample that will receive the surveys will help to refine the content, duration, timing etc. of the text messages. This is crucial in order to ensure acceptability and practicability from the end users perspective. 

(C) What application should we use? A wealth of text messaging applications exist that harvest secure software and storage solutions (we used TextIt.In). Some of them offer development support too, but for most types of research it will be quite straightforward to develop the text messages yourself.

Any updates on this method? 
I introduced this method and my research on the [email protected] youtube channel in 2018..  Since then, I have completed my PhD and I also secured a Medical Research Council grant (under their Public Health Intervention Development scheme). I am exploring the use of text messages as an intervention for repetitive family activities (bedtime routines) for children’s health and wellbeing. 

AUTHOR BIO: Dr George Kitsaras PhD, MSc, MPH, CPsychol is a chartered psychologist and research associate in behaviour change and digital health technologies at the University of Manchester. He is also the co-lead of the Behaviour Change in Public Health module, part of the MPH Public Health programme and he is involved in undergraduate dental teaching at Manchester. George is currently working on a Medical Research Council project on the development of an interactive, text-message intervention for first time parents around their bedtime routines.

Link to video: To learn more about this method, watch the following video on the [email protected] YouTube channel: