Systematic reviews of telephone and SMS reminders find that they significantly improve attendance to health care providers, with SMS reminders being as effective as phone call reminders and postal reminders (Car et al. 2012; Hasvold, 2011). More broadly, the evidence indicates that SMS messages can change behaviour when aimed at short-term behavioural outcomes (Fjeldsoe et al. 2009). However, the UK Behavioural Insights Team (BIT) has found that the content of the message is also very important.
Early trials have found that adding a person’s name to the a text message increases the likelihood that someone will pay a court fine (Behavioural Insights Team, 2012) and more recent trials have found that emphasizing the costs to the healthcare system can increase attendance rates (Hallsworth et al., in submission). Similarly, personable and personal messages increased attendance substantially (Kirkman et al., in submission). The trials run by the Behavioural Insights Team have also found that bland and impersonal text messages can have no impact on attendance whatsoever.
Text messages are currently used in some New South Wales (NSW) hospitals to encourage people to attend their outpatient appointments. However, these messages are not sent out as routine practice.
In this trial, a NSW hospital will trial the whether 8 text messages will increase the likelihood of people attending their outpatient appointments. Testing various text messages will allow us to further the science on persuasive messages and lead to cost savings for the hospital.
The content of these messages shall focus on: lost revenue to the hospital, lost revenue to other patients, revenue gains to the hospital, revenue gains to patients, aggregated losses to the hospital, a notice that people are free not to attend but they should cancel in advance or that their failure to turn up shall be recorded.
These messages were chosen as they are based on prior work, namely Prospect theory (Kahneman & Tversky, 1979), meta analyses into the use of the phrase "But you are free" (Carpenter, 2013) and some unpublished work by the Behavioural Insights Team. These phrases all have theoretical underpinnings, but this study shall test whether or not these theoretical underpinnings translate into an applied policy setting.
Behavioural Insights Team (2012). Applying behavioural insights to reduce fraud, error and debt. Crown Copyright
Car, N. J., Christen, E. W., Hornbuckle, J. W., & Moore, G. A. (2012). Using a mobile phone Short Messaging Service (SMS) for irrigation scheduling in Australia–Farmers’ participation and utility evaluation. Computers and Electronics in Agriculture, 84, 132-143
Carpenter, C. J. (2013). A meta-analysis of the effectiveness of the “But you are free” compliance-gaining technique. Communication Studies, 64(1), 6-17.
Fjeldsoe, B. S., Marshall, A. L., & Miller, Y. D. (2009). Behavior change interventions delivered by mobile telephone short-message service. American journal of preventive medicine, 36(2), 165-173.
Hasvold, P. E., & Wootton, R. (2011). Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review. Journal of telemedicine and telecare, 17(7), 358-364.
Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica: Journal of the Econometric Society, 263-291.