In New Orleans, rates of heart disease, stroke, and diabetes are higher than the national average, and about 30 percent of residents are obese and physically inactive.
Many New Orleans residents, moreover, aren’t getting the regular checkups they need to keep their health on track, manage chronic conditions and screen for more serious illnesses. Among the 60,000 New Orleans residents eligible for free checkups through Medicaid, for example, 41 percent were not taking advantage of this benefit, according to local nonprofit 504HealthNet.
One group of researchers decided to try an innovative way to increase the number of residents getting an annual checkup: sending texts.
The Behavioral Insights Team (BIT) at What Works Cities, an initiative of Bloomberg Philanthropies, partnered with 504HealthNet and the city of New Orleans to send SMS text messages to more than 21,000 Medicaid beneficiaries to encourage them to make an appointment. None of these recipients had seen a primary care physician in two years, according to the health department’s data.
Elizabeth Linos, vice president of BIT North America, said the researchers chose text messages over email because they had access to residents’ phone numbers through the health department, but not email addresses. She said robo-calls were an option, but the team didn’t believe them to be effective because people “hang up all the time.”
The team also decided to test what kinds of text messages were more likely to elicit a response. Recipient received one of three different types of messages, which researchers called “simplicity,” “ego,” or “social motivation,” based on what they thought the motivation behind a response would be. All three types of texts included a greeting and instructions to text “YES” to be contacted by a health care representative to make an appointment, or “STOP” to unsubscribe.
The “simplicity” message aimed to be just that – simple. It read: “Txt YES to be contacted to set up a FREE doctor’s appt.” Linos said clear, straightforward messages are easier for people to understand, which they thought would make people more likely to respond.
The “ego” message, on the other hand, aimed to make people feel special. It read: “You have been selected for a FREE doctor’s appt.”
Finally, the “social motivation” message aimed to remind recipients of their friends and family. It read: “Take care of yourself so you can care for the ones you love.” Linos said hospitals often use this type of pro-social messaging, and it was hypothesized to be the most effective of the three.
However, results showed that the “ego” message was most likely to result in a “YES” response, and “social motivation” came in last. Twice as many recipients responded affirmatively to the”ego” message.
Linos said the “ego” message may have performed better because it made recipients feel that resources were scarce, providing a sense of urgency. She also said that the persuasive power of making people feel special is often underestimated.
The next step for researchers will be to see how many of these “yeses” translate into actual appointments.
If this experiment results in more people, especially low-income individuals in an area with high rates of health problems, getting regular checkups, texts could be just the nudge communities need to improve their health. According to the Pew Research Center, 90 percent of the adult population owns a cell phone, including 84 percent of people with incomes of less than $30,000 per year.
While texting isn’t yet a standard component of the health care industry’s practices, experiments such as these could make it an important piece of preventive medicine in the future.