Study Finds Text Messaging More Effective for Healthcare Surveys than Phone Calls

From collecting patient data to conducting clinical trials, a well-run survey can make a big difference in how efficient and effective your health organization is run. A new study published in PLos One suggests that health surveys conducted over text messages gather higher quality data than surveys conducted over phone calls.

Comparing survey responses from text messages and phone calls

The study, titled Precision and Disclosure in Text and Voice Interviews on Smartphones, was a joint collaboration with several researchers from the New School in New York, The University Of Maryland, the University of Michigan and other institutions. The researchers wanted to find whether people who participated in a survey over text message answered the questions with greater precision and fuller disclosure than they did over a phone call.

Over 600 randomized participants were asked to fill out a survey delivered in one of four ways: automated text messages, manually sent text messages, automated voice calls, and manually placed voice calls. After participants filled out the surveys, researchers gauged the quality of the data by measuring the extent to which responses were both careful and conscientious. For example, researchers measured the extent to which respondents might round up or round down their answers instead of carefully thinking through a question, or by responding with the same answer for multiple questions in a row instead of varying their responses. They also determined how willing people were to disclose sensitive information via text message as opposed to over the phone.

Study participants answered survey questions more conscientiously and honestly over SMS

The study found that not only did people who answered the survey via text messages answer more conscientiously, but that they also answered more honestly. Patients who took the survey over text messaging, for instance, had greater disclosure level of sensitive information – such as their number of sexual partners or the amount of alcohol they drank. Text message respondents also reported a preference for text message surveys, thereby suggesting that text messaging could quite possibly be the best way to collect data from patients.

Why text messaging works better than phone calls for collecting Client responses

Text messaging is the better option than phone calls for conducting health surveys for several reasons. First, since participants can answer survey questions while carrying out their daily routines, it gives participants more freedom to answer questions thoughtfully on their own schedule. Indeed, the ability to answer questions within one’s own time frame grants participants a more relaxed attitude towards the survey in general, meaning that they are less likely to rush through the questions than they would with a telephone conversation.

Second, text messaging lends better results to data collection is because it grants the participant more anonymity than a phone call. People are more likely to be honest when they don’t have hear their own words or address a person on the other end of the phone line. The phenomenon of "satisficing" or giving answers that are perceived to be desired by the person conducting the survey in order to end the call, irregardless of whether it's an honest answer) plagues phone surveys, whereas, clients tend not to do so during text surveys.

Lastly, a text messaging platform like PreventionPays has the ability to store all the data collected in text message surveys, which is an invaluable feature for researchers because it compiles all the answers into a single, organized database. No need to spend time transcribing the survey results from a voice recording or hardcopy survey into a database!

How text messaging surveys can contribute to the healthcare industry

Using text messaging to collect data can be useful in a variety of ways in the healthcare industry. For example, you can use text messaging to:

• Find and organize participants for a clinical trial: Text messaging can be used to attract and retain potential participants, guide participants through the trial, as well as determine their eligibility based on a short survey.
• Gather feedback on patient care after their discharge: Text messaging allows you to poll your patients using both multiple choice questions and open-ended questions about their quality of stay at your hospital or clinic.
• Improve employee satisfaction: Text messaging can be used internally as well as externally, and it could greatly behoove your organization to conduct an SMS survey with your employees that guarantees anonymity and (as this study suggests) encourages full and honest disclosure.

Regardless of the data that you’re collecting, the ability to collect honest and carefully considered answers and compile all the information on a single platform makes it a lot easier to analyze your data and make improvements to your organization. Text messaging is a great way to make your organization run smoother and achieve better results – and it can start today.

Want to activate a survey? Easy! Already a client? Email or call us so we can pick a time to assess your unique needs and deploy a solution! Want more info on how PreventionPays Text can help you? Email "info@preventionpaystext.com" or text DEMO to 85511

Responding while on-the-go can be as simple as 1, 2, 3!

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citation: University of Michigan, New York New School, U of Maryland Co-Researchers Schober MF, Conrad FG, Antoun C, Ehlen P, Fail S, Hupp AL, et al. (2015) Precision and Disclosure in Text and Voice Interviews on Smartphones. PLoS ONE 10(6): e0128337. doi:10.1371/journal.pone.0128337

Tackling the Opioid Crisis with the Simplicity of SMS Text!

This project (in many forms) is being piloted at various health and human service agencies (211, I&R and community impact programs) and we're very excited about how much impact this can/will have!  This project was fundamentally designed to offer the very best of PreventionPays including options for live, two-way support, and integration with your CRM (Client Resource Management Solution), so that, as referrals are identified within your CRM, they can be automatically extracted from there and sent to the end user's mobile device and this is completely seamless to the end user!  If you don't use a CRM and simply want to partner with agencies that do, please reach out! We want to hear from you! There are many layers to this work and will require partnerships across all sectors of the help-seeking ecosystem.  This project will provide addresses/links to the most current, vetted resources in closest proximity to the individual's mobile device! 

Are you interested in partnering with an agency from your local community? Email info@preventionpaystext.com and in the subject line, send "Opioid Text Project"!

GOALS:

1. Reduce harm/death from opioid/drug addiction!

Outcomes will be tracked and self-evident through the follow-up work with individuals that text the service.

AIMS

10% of the population in the target zone text the helpline.

50% of those that seek help, will follow through with the resources/help.

50% of those that follow through with the help will report they continue to receive ongoing support with meetings and other suggestions (as identified by the partner agencies and content curators).

The project is two-fold: marketing website updates/banners/messages/PSAs/Press Release/Local News and the text message program/sms mapping and opt-in protocols

Marketing:

Web banners for partner, community agency websites

School-based programs work really well; posters, brochures, take-away cards strategically placed in public/private spaces will encourage use of the text program.

Add posters and take-away cards in schools and community venues at little to no cost!

Text Module:

End user texts keyword to short code to begin automated Q&A to obtain end users' risk level and then provide end user with recs for treatment/support. (support also available for friends and family so that everyone in the community can gain something from texting the service! We are all impacted by addiction.

End user will get an automated survey querying for zip, county, age of individual that is seeking help.

End user will select whether they need long-term care w/ detox or short term care w/ detox or detox only.

This will trigger referrals to resources that are closest to them according to their need.

After the referrals are delivered, there is a follow-up text letting them know they can call 211 or text their zip code for more support.

5-7 days later:  You requested help with “short-term care w/ detox” for yourself or a loved one. Did you find the information helpful? 

Did you or your loved one enter treatment?

Please remember, 211 (or named agency) is here for you! if you need more assistance or would like to talk with someone at 211, please call 211 or text your zip code at any time.

Then, one week later: We’re thinking about you! We know seeking help for yourself is an emotional and difficult matter. We want to help. 

If you want someone to talk to, call us or just text us and you’ll get a live response from one of our call specialists!

Then, 1-2 weeks later survey:

Did you make contact with the help you were given?

yes responses

Would you like a list of AA meetings for your area?  Per request send additional tips/resources and statements of encouragement/hope etc. 

no responses

Are you still looking for help with short-term care plus detox?

yes responses

Set a time to call or text with a Specialist

no responses

Please make sure to check with us. We realize there are several barriers to getting help. Please call us or text us so we can help you.

Evaluation:

The survey data and outcome data will be prepared in a formal document to be shared with participating agencies and funders. 

Project aims and protocols will be published for replication/uses in other regions/states.

Goal:  Reduce harm and cultivate better health outcomes! Present this project at conferences!

Interested in learning more about this project and others like it? email opioidtext@ustxt211.org

Want to partner? email opioidtext@ustxt211.org

Why the Gray Routes and Digital Long Codes are Bad

You don’t have to understand the mechanics of SMS to be able to send SMS, but having some basic understanding under your belt is valuable; it is much like car ownership, understanding the basics makes you an informed consumer.

A white route is a legitimate route, fully sanctioned by the operator on which the subscriber you are sending to is served by. As an example, sending a message to a Sprint subscriber through a connection directly to Sprint would be regarded as a white route. Here, Sprint gets paid either by the subscriber or by the sender of the message (or both) and everyone is happy.

A black route is the complete opposite; this is a route that attempts to defraud a 3rd party in its attempt to deliver a message. As the name suggests these routes should never be used, as they are usually operated by suppliers who cannot be trusted, are illegal and inferior in quality. An example here would be sending a message to a Sprint subscriber from a network in some remote and distant country but pretending to be Vodafone. Here, Sprint sends the bill to Vodafone who will most likely not pay it (because they have no record of sending it), so no one gets paid and everyone is unhappy.

The third type is the grey route. These routes take advantage of the fact that in the early days of mobile telephony (before SMS was a thing) there was a rule between operators, that the sender of the message would keep all of the revenue, i.e. the receiving operator does not get paid to deliver a message to its own subscriber. In the early days this worked well, but as the volume of A2P messages grew and operators became savvy to the fact that they could make money from SMS, they began trying to monetize it by signing agreements with other operators to get them to pay for delivering a message to one of their subscribers (for those who want to know more, lookup AA19 or AA60 agreements).

A grey route is not a recognized route by the carriers. Due to the desire for the subscriber operator to make some money from this message, grey routes are discouraged by the carriers and are liable to be blocked without notice and can be filtered by carrier firewalls. And, as such, if you care about your messages getting delivered, we recommend avoiding the grey routes completely. 

Why are grey routes in use? Pure and simple: for perceived cost savings. Sanctioned, legitimate routes have a higher cost associated with them as these are legally recognized between the operating partners and regulatory bodies and include an agreed upon financial arrangement, including fees and tariffs. Grey routes are legal but typically unsanctioned routes and though they may have upfront cost savings, they come with risks that can result in higher costs, for example, spam lawsuits are now $1,000 per infraction (up from $500 per MT in 2013).  Also, most people don't realize (while the up front costs may be low) the per message fees are often very high, upwards of 10 cents per MT (mobile terminated) whereas, we don't charge for MTs and providers of short codes will often charge no more than 1 cent per MT. Providers of long codes will also charge for MOs (mobile originated) which never carry a charge in the short code model.

What additional risks are their with the Grey Routes?  First is the constant risk of being shut down without notice.  Our clients simply can't afford to take the risk. The second is the high uncertainty of delivery.  Since the operator does not legitimately recognize the route, there is no guarantee of delivery or latency. And this too is a risk our clients cannot afford to take.  And finally performance is affected.  So as not to draw attention to the usage of the unsanctioned route, the message provider will significantly reduce the throughput or traffic flow through the route, so as not to raise the suspicion of the operator, ultimately resulting in slow delivery.

Though the mobile operators know grey routes are used, and up to now have accepted a revenue leakage from this activity between 5%-10%, recent studies have shown message providers who use grey routes to bypass paying fees are affecting revenue leakage in much higher percentages.

So what’s being done to shut down the use of grey routes? Mobile operators are aggressively making changes to their networks to prevent as well as detect and shut down grey routes on their networks. More and more networks are being locked down, but there is another way to combat this and that is establishing fair upfront costs, to make it economical so message providers are not looking to circumvent the system but instead are agreeable participants in the marketplace. The consortium of mobile operators are aware that to be effective in removing grey routes, they need to work closely together and establish prices that are amenable to all parties to move traffic 100% to “on-net” delivery. This will result in better service overall including message delivery and reducing spam.

Here's what our clients and partners have to say about Gray Routes and Digital Long Codes:

“Our system was not giving us positive message tracking and we were not ever certain if our referrals got through, then ultimately we found out that a whole part of our state had been unbound by the mobile carriers…no texts were getting through.”

— 211 Indiana

“Long codes do not let you opt out automatically. This is a very unsafe practice.”

— Heart of Florida United Way

“We were using a long code system and were unable to trust any of the information coming into us. We tried to pass along information to our emergency management associates to enable a rescue but they were not able to use the information and said that it was impossible to trace. This created a barrier and damaged our relationships with local authorities. We have since replaced that system with short code texting and repaired those damaged relationships.”

— CrisisLink Virginia

“We were using the old system (long code) and many of our clients were calling us up and telling us they didn’t get the text. We started using the short code with PreventionPays and everything goes through instantly. It’s so easy. The best part is, no more complaints!”

— United Way 211 Atlanta

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— Claire C.

“We had to put in the phone number and the carrier. We thought that was strange. With PreventionPays you just need the mobile number. We really like how easy it is to send texts to callers on 898211! ”

— United Way Central Iowa 211

“We tested the system that did not use a certified short code that is carrier provisioned and instead used a 10 digit long code. We got spammed almost immediately. We have since switched all our clients to short code texting.”

— ReferNet

Do you want to learn more? Do you have a personal experience with the gray routes? Spam texting?  We want to hear from you!  Text "longcodehorror" to 85511 or email "info@preventionpaystext.com" and include in the subject line "long code horror story". 

Would you like a demo of how short codes use white routes? How PreventionPays Text Carrier Grade Message Tracking/Reporting works? Text DEMO to 85511 or email us! Demos run about 30 mins! Thank you for reading! 

Happy texting from the EMS Team!

Standard msg&data rates may apply. Text STOP to opt-out. For end user privacy and our terms and conditions of texting with 85511 (all PreventionPays Text short codes)