January 18, 2012
Preparedness Brief
Leading the Way to Prepared and Resilient Communities
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Influenza Pandemic
Managing Antiviral Medication during the 2009 H1N1 Influenza Pandemic: State and Local Public Health Department Responsibilities
Medical Reserve Corps
Order’s Up! DOTMLPF
Preparing Volunteers for a Response: Inclusive Just-in-Time Training for Mass Prophylaxis/POD Operations
Advanced Practice Centers
Chaska, Minnesota, Takes Plan 9 to Camp to Prepare the Community
Story from the Field
What Community Members Want from Public Health Text Messages
Upcoming 2012 Public Health Preparedness Summit
APC Program To Host a Workshop at the 2012 Public Health Preparedness Summit
PPHR Criteria, CDC PHEP Capabilities, and PHAB Standards, Oh My! Sharing Session
Public Health Law and Preparedness Examined at the 2012 Preparedness Summit
Focus Groups on Health Department Use of ICS in EOC Offered at the Summit
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HOSA and MRC Team Up at the Chaska Safety Camp
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The Public Health Associate Program: Apply to Host an Associate from the 2012 Class
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Jack Herrmann, MSEd., NCC, LMHC, Senior Advisor & Chief, Public Health Preparedness at NACCHO

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Story from the Field
What Community Members Want from Public Health Text Messages
Whitney Offenbecher, Research Assistant, Public Health – Seattle & King County

Over two trillion text messages will be sent in the U.S. in 2011, and upwards of 72% of all adult cell phone users text. Unlike the digital divide with online technologies, people of color and low income individuals are even more likely than affluent whites to text.1 With this widespread adoption, texting offers promise for public health departments to make health information accessible using the communication channels widely used by the people they serve.

Before investing in developing texting capabilities, local health departments need to better understand their texting audience. Knowing what attitudes people hold towards receiving text messages from health departments and the types of messages people want to receive, will assist in creating successful text messaging programs. The Public Health–Seattle & King County Health Department, as part of the Northwest Preparedness and Emergency Response Research Center, talked to texters from five target populations to learn more about how they use this potentially powerful technology.

Over 100 in-depth interviews and surveys were conducted with young adult Spanish speakers, young adult Native Americans, urban and rural young adults, and deaf and hard of hearing people of all ages. Participants in these groups were interested in receiving text messages from the health department about customized health behavior tips and emergency alerts. It must be emphasized that participants are not representative of all residents, or even all residents who text.

Emergency Alerts
Interviewees reported that text messages from public health would be particularly effective in emergencies. Survey results revealed that 89% of participants were likely or very likely to sign up for text messages about severe emergencies, such as information about how to respond after an earthquake. One participant explained, “People check their phones more than anything. E-mails are convenient, but if there's an emergency…they'd look at their phone.” Interviewees were less interested in alerts about moderate emergencies such as a flu outbreak or a food recall.

Health Tips
Seventy-two percent of our sample expressed interest in receiving health tips through text messages, such as reminders to exercise or suggestions for healthy recipes. Many specified that they preferred information that is easy to follow. “I like details. If the health department is going to text and say, ‘eat fruit.’ I’m like, okay. What kind of fruit, you know? How much fruit? Tell me more.” Those who suggested that they would not sign up for health tips indicated that they would rather access health information through other channels, such as the Internet, and on their own time. As one participant described, “I wouldn't necessarily go for health tips. If I wanted a tip, I would just look it up. I wouldn't want someone constantly texting me, ‘do this.’ No. That would just be kind of annoying.”

Relevance and Customization
Researchers found that participants were most interested in messages that were relevant to them and targeted to their interests. “I don't necessarily need to know that there's some kind of crisis going on across town if it doesn't impact me,” one participant said, “I mostly want to know about the things that impact me.” There were different perceptions about what information impacted them and what constituted “junk mail.” A mother of young children wanted information about where to find the flu vaccine. A food handler at a fast food restaurant was interested in hand hygiene. To ensure messages are relevant, several participants suggested that public health departments should allow people to customize the topics of messages that they receive.

Credibility and Trust
Participants were asked to share their views about how likely they are to trust text messages from the health department. Twenty-two percent of respondents mentioned concerns about how cell phone information would be used by the government. However, most people interviewed had a high level of trust in health department messages, and would rather receive messages about health and emergencies from the health department (66%) than from their friend or social network (26%). One participant said, “If you got a text message from public health, it's a more reliable source.” There was also a general consensus that using abbreviations in text messages would make the health department less credible. Participants worried that the information is already limited by the 160-character limit for text messages, and further abbreviations may lead to miscommunication.

What does this mean for public health departments?
Public health organizations are continually searching for reliable and timely methods to communicate with target populations and the recent growth in text messaging technologies offers promise. Understanding what audiences want in a texting program is critical, particularly because individuals must opt into a texting program before they can start to receive text messages.

Findings suggest that marketing campaigns should promote text message alerts for severe emergencies. Marketing messages with phrases like “have information at your fingertips in case of a dangerous situation” and “receive texts with critical information for your safety to store right in you phone” will appeal to a wide audience. Marketing efforts should also emphasize that text messages from public health are relevant and timely to the individual. Phrases like “texts will be short and to the point, and you can follow up on the information that interests you” will allay concerns about getting inundated with irrelevant information. Health departments that allow individuals to customize the messages they receive about health and emergency topics will motivate more people to opt-in to the service. For example, an appeal could include “customize your text alerts to receive important health information that matters to you and your close friends and family.”

Health departments have an opportunity to use text messaging as a new tool to increase communication, particularly among communities who may be more challenging to reach through traditional media such as television or radio. These research findings can help position health departments for greater effectiveness when implementing a texting program.

For more information about this research, visit http://www.kingcounty.gov/health/texting or contact Hilary Karasz at hilary.karasz@kingcounty.gov. Research conducted by Hilary Karasz, Sharon Bogan, Meredith Li-Vollmer and Whitney Offenbecher.

This work was supported by the Centers for Disease Control and Prevention, Grant no. 5PO1TP000297. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.


1Smith, A. (2011, April 28). Trends in Mobile Phone Usage: Overview of Pew Internet Project Research. Pew Internet and American Life Project. Retrieved July 23, 2011, from http://www.pewinternet.org/Presentations/2011/Apr/FTC-Debt-Collection-Workshop-Cell-Phone-Trends.aspx.


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