An exploration of the strengths and weaknesses of using text messaging as a tool for self-report data collection in psychological research 

How is SMS currently being used for research?

Before asking about the possibilities, we should take a look at what's already happening. Note 'currently' here was current as of 2014.

A systematic review of how SMS has been used in the health and psychology literature

Short Message Service (SMS) is one of the most widely used data services world-wide (Kuntsche & Robert, 2009). The profound integration of SMS into people’s daily lives is a rich field receiving extensive research attention (i.e. Battestini, Setlur, & Sohn, 2010; Leung, 2007; Ling, 2010). With a presence in everyday life and the literature, it is unsurprising that health and psychology practitioners have begun to pay attention to SMS, and the opportunities it provides for research, interventions, and support. Though constrained by its text-only nature and a somewhat strict character limit (typically 160 characters), SMS has a number of desirable properties. Its ubiquity can allow the researcher or clinician access to isolated populations (Suwamaru, 2012). Its scalability can make it appropriate for deployment to small or vast numbers of recipients (Kabadi, Mwanyika, & De Savigny, 2013), particularly given the potential to integrate and automate the process of sending and receiving SMS via programmed databases (Ngabo et al., 2012). Using SMS is convenient for both the sender, and the recipient (Leung, 2007; Liu, 2010).

Against the backdrop of rapid SMS uptake for everyday use in the general population (ACMA, 2013), and slow but steady uptake as a tool in the research literature (Conner & Reid, 2012), now is an opportune moment to investigate how psychology and health professionals and researchers are using SMS to develop a guide for future use. Condensing the literature into summary form will allow a birds-eye view of how SMS has been used. The intention is to provide a starting point for those considering using SMS for their research or practise, who may be unaware of the existing methodologically relevant literature. Though there is some overlap, the theoretical content of publications tends to follow topic or domain-specific groupings, for example, the distinction between the health and psychology literatures. Conversely, methodological issues transcend topic and domain. For example, an effective self-report methodology constructed for a particular topic within the health literature may be applicable to other health topics, or even for psychological topics, and vice versa. A timely cross-topic, cross-discipline summary of how SMS has been used alongside clearly grouped citations will afford health and psychology professionals with ideas for possible uses of SMS, and allow further reading into those uses across disciplinary boundaries. This systematic review will provide an overview of how SMS is being used in the health and psychology literature. The relative uptake of SMS in health and psychology domains will be contrasted and discussed.

Method

SMS_Systematic_figure_1.jpg

Figure 1. Flow chart indicating the meta-analysis review process


Sample

On their own or in combination, the key words SMS, text, message, txt, mobile, and telephone were entered as search terms the following databases: ScienceDirect, Ovid, PubMed, ProQuest, PsycInfo, and Google Scholar. The sample included dissertations and conference proceedings, so was not limited to peer-reviewed research. Some papers contained multiple relevant studies, so the counts and percentages discussed will refer to studies rather than papers. An initial pool of 1049 studies published prior to April 2014 were identified.

Criterion for study inclusion

As illustrated in Figure 1, studies were sorted under broad headings of preliminary research (where the use of SMS was discussed, but not employed), data collection, prompt to support other modes, or other health and psychological purposes. Studies on irrelevant topics such as everyday SMS usage, and SMS in advertising, were excluded. This resulted in a final sample of 643 studies.

Results

The literature reflects a relatively low level of engagement with SMS in comparison to other more established tools, such as online surveys, but this will likely change. Since the first publication in 2000, the number of studies where SMS is used in the health and psychology literature has been steadily increasing over time (Figure 2).

 

SMS_Systematic_figure_2.jpg

Figure 2. Studies relating to the usage of SMS for health and psychology purposes over time. Note that data for the 2014 column is only for the first half of the year; columns to the left of the dash line indicate all papers from that year were included.

 

Click here to download table 1. It is a stonkingly huge meta analysis table. You've been warned.

 

Preliminary papers. Across these preliminary papers and reviews, SMS is generally considered in terms of a wider topic (such as telehealth) or intervention (as part of a multi-modal framework), rather than as a single method of contact. This is in line with the growing use of mixed-mode research and multimodal interventions in the wider health and psychology literature, where multiple methods of contact are being used (Dillman, Smyth, & Christian, 2009).

Protocols and attitude surveys. There were 78 studies involving research exploring participant willingness to use SMS for communicating with clinicians or researchers, or outlining how such communication could be done, but did not actually use SMS. Most (88%) of the studies in this category focus on health, rather than psychology topics. For a list of constituent papers, see Table 1.

Reviews. Meta-analyses and review papers were included in this category. Of the 98 studies in this category, the majority (81%) were focussed on health related topics rather than psychology topics. Thirty four percent were focussed specifically on the SMS modality itself, whilst the others covered SMS under the umbrella topics of using mobile phones including SMS (29%). The remaining studies mentioned using SMS incidentally whilst focussing on specific theoretical topics, or discussed it more broadly in terms of data collection methods. For a list of constituent papers, see Table 2.

Data collection. Compared with the vast amount of research using paper, telephone, or online surveys, few studies use SMS as a mode for data collection. However, though the research is relatively sparse, there is considerable variety in the topics, purposes, and properties of health and psychology studies collecting data via SMS. Of the 140 studies using SMS to collect data, most (81%) had a health rather than psychological focus. Four studies collected data via open calls, situations where researchers sent out a call for participation in an open-ended way to a population of unknown size, or in relation to incidence reporting, across a wide range of topics. Fourteen studies collected data via clinical reporting, where health clinics or organisation reported event-contingent information. A relatively new phenomenon (with the earliest literature being published in 2010), clinical reporting tended to involve disease surveillance and management in poorer countries, with a particular focus on malaria reporting and management. SMS was used as a method for self-report data collection in 122 studies. Topics included weight loss, disease management (asthma and diabetes), addiction management (smoking and alcohol use), sexual health, and stress and mood diaries. For a list of constituent papers, see Table 3.

Prompt to support other modes. There were relatively few instances (n=14) where SMS was used as a prompt to support other modes of communication. Again, over half (66%) of the papers in this category had a health focus. SMS prompts were most commonly used in combination with online surveys (43% of studies had this combination), followed by postal surveys (36%), and apps (21%). In some instances, email was used in combination with SMS and reported under the category of ‘electronic reminder’. For a list of constituent papers, see Table 4.

Interventions and support. Publications using SMS for support and as part of interventions began around 2000, with a drastic increase between 2011 and 2012. Of the 313 papers in this category, the majority (88%) were focussed on health rather than psychology topics. As in the preliminary studies, SMS was often discussed as part of a multimodal framework.  In this category, the most common non-research purpose for using SMS was to provide information to participants (52% of studies), a reminder for appointment attendance (46%) or reminders to carry out some action, such as to take medication (35%). Other uses included SMS being used in medication adherence reporting infrastructure (i.e. a blood glucose monitoring device that sends results to the clinician via SMS directly). For a list of constituent papers, see Table 5.

Discussion

This overview of the health and psychology literature shows that the applications of SMS are widely varied. Against a backdrop of many other communication methods, such as post, email, or voice call, it is perhaps this versatility that underlies the growing literature surrounding using SMS in health and psychology domains. Over fourteen years, the number of publications involving SMS in some way has consistently increased. Its continued application in data collection, interventions, and support, covers the full gamut of health and psychology topics, from individual-level sensitive issues such as sexual health through to population-level disease tracking in rural areas. Accompanying these applications is a large number of preliminary research endeavours, and reviews, demonstrating an interest in the mechanics of how the usefulness of SMS may be further extended.

One persistent trend is a higher comparative volume of papers involving SMS in the health, rather than psychology domain. This may be an artefact of there simply being a greater volume of health-related research[1], or may reflect a different level of openness to new technologies in the literatures. Regardless, it indicates that a psychology clinician or researcher considering integrating SMS into their work would do well to look beyond the psychological literature, and search the health domain for ideas and evaluations of SMS applications. Another recurrent theme is SMS being used as a component in multimodal research, interventions, and support programs. SMS has been applied far more often as a reminder to complete a task in an interventions or support setting than in a research setting. Researchers considering using SMS as a prompt may learn much from the intervention and support literature.

SMS is a ubiquitous communication method that can contribute much to health and psychology domains. As it slowly gains traction as a tool in the clinical and research literature, reflecting on how it has been used so far can inform how it can be used in future. This systematic review has revealed remarkable versatility the role of SMS in the health and psychology literature, and provided citations across topics and disciplines for further reading. This is a valuable starting point for future researchers and professionals that may wish to investigate the potential further applications of SMS in the health and psychology domains.


 

References

ACMA. (2013). ACMA Communications report 2012-2013.

Battestini, A., Setlur, V., & Sohn, T. (2010). A Large Scale Study of Text Messaging Use. 12th international conference on Human computer interaction with mobile devices and services (pp. 1–10). New York: ACM. doi:10.1145/1851600.1851638

Conner, T. S., & Reid, K. A. (2012). Effects of intensive mobile happiness reporting in daily life. Social psychological and personality science, 3(3), 315 – 323.

Dillman, D. A., Smyth, J. D., & Christian, L. M. (2009). Internet, Mail, and Mixed-Mode Surveys (Third.). New Jersey: John Wiley & Sons.

Kabadi, G. S., Mwanyika, H., & De Savigny, D. (2013). Innovations in monitoring vital events: a scalable intervention using mobile phone messaging (SMS) support for vital registration coverage. The Lancet, 381, S69. doi:10.1016/S0140-6736(13)61323-9

Kuntsche, E., & Robert, B. (2009). Short Message Service (SMS) Technology in Alcohol Research - A Feasibility Study. Alcohol and Alcoholism, 44(4), 423–428. doi:10.1093/alcalc/agp033

Leung, L. (2007). Unwillingness-to-communicate and college students’ motives in SMS mobile messaging. Telematics and Informatics, 24(2), 115–129. doi:10.1016/j.tele.2006.01.002

Ling, R. (2010). Texting as a life phase medium. Journal of Computer-Mediated Communication, 15(2), 277–292. doi:10.1111/j.1083-6101.2010.01520.x

Liu, M. T. (2010). The influential factors of SMS usage among youth : an exploratory study to Western exchanging students in Asia. 2010 International Conference on Networking and Digital Society (pp. 148–151).

Ngabo, F., Nguimfack, J., Nwaigwe, F., Mugeni, C., Muhoza, D., Wilson, D. R., Kalach, J., et al. (2012). Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda. The Pan African medical journal, 13, 31. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3542808&tool=pmcentrez&rendertype=abstract

Suwamaru, J. K. (2012). An SMS-based HIV / AIDS Education and Awareness Model for Rural Areas in Papua New Guinea. Global telehealth, 161 – 169. doi:10.3233/978-1-61499-152-6-161



[1] As a general example, at the time of writing, major journal databases had fewer journals categorised as psychology than health, i.e. Elsivier (99 psychology to 125 health) and Ovid (60 psychology to 114 health).