Design Principles for Therapuetic Text Message Interventions

A peer-reviewed research article, published on PubMed, analyzed the efficacy of 9 text message interventions across 8 studies to determine which approaches yielded the most favorable results.

Background

The authors of the study, Finitsis et al., sought to determine the effectiveness of text-messaging interventions to promote adherence to antiretroviral therapy given: 

  1. the failure of many patients to adhere at high enough rates to maintain health and reduce the risk of transmission, and
  2. the global growth of mobile phone use. 

Methods

The paper, Text Message Intervention Designs to Promote Adherence to AntiRetroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials, complied and analyzed studies that: 

  1. targeted antiretroviral therapy adherence in a sample of people living with HIV, 
  2. used a randomized-controlled trial design to examine a text messaging intervention, and 
  3. reported at least one adherence measurement or clinical outcome.

Findings

Their analyses found that interventions are most successful when: 

  1. they were sent less frequently than daily,
  2. they supported bidirectional communication
  3. included personalized message content, and
  4. were matched to participants' treatment schedules.

Applying these Principles

These principles not only highlight best practices in mobile intervention design, but TextIt's core functionality as well. Our campaigns feature, a product of our participation in a study conducted by Odeny et al., enables anyone to apply these principles using TextIt, while our array of channel options allows for instant deployment at any scale. 

Send us a note at support@textit.in to learn more, or sign-up for a free account to put these principles to action. 

Integrating your TextIt Workflows with Slack

A number of our users have identified bridging the gap between automated and direct communication (directly communicating with a client after collecting information through an automated workflow) as a point of interest. While TextIt offers some powerful actions to facilitate such a process, such as forwarding information collected within a workflow through SMS & email, we'd like to bring attention to an integration that makes more sense each passing day:  TextIt + Slack.

An increasing amount of teams across every sector are coordinating their projects with Slack. Slack provides a messaging platform that integrates with and unifies a wide range of communications services such as Twitter, Dropbox, Google Docs, Jira, GitHub, MailChimp, Trello, and Stripe. We use it, and for the most part love it. We're not the only ones - organizations ranging from The New York Times to Nasa's Jet Propulsion Laboratory to the University of Wisconsin-Madison's IceCube Collaboration use it every day. 

Why it Makes Sense

Slack allows teams to create a number of channels, from #general to #socialmedia to #support - the latter of which this article will focus on. Dealing with people is a challenge every outward-facing organization encounters, especially if it's selling a product or providing a service. Support interactions can be automated by various workflow products like TextIt, but situations will arise in which direct communication is more appropriate. The challenge then becomes building a workflow that brings clients to support at the appropriate time - an easy proposition for TextIt's flow logic. If your team uses Slack, you've got a perfect environment for receiving and managing these requests. 

Integrating TextIt with Slack

Build your Pipeline

Build a workflow that culminates in a Send an Email action. You'll probably want to triage requests, or give the client a choice as we've done in the example below: 


Insert the information you'd like each support email sent by your workflow to contain. In the example below, we've included the clients' 

Enabling Email Notifications

Adding the email integration to your team is simple: just pick the channel to which you’d like to send the email messages and you’ll be given a secret email address that will route directly to that Slack channel. That’s it—repeat as necessary.

How To:

  1. Choose the Email option shown on your Slack Integrations page.
  2. Select a channel the email will post to, give it a label, name and an icon, then click Save Integration.
  3. Copy the generated unique Slack email address (tip: post it to the channel itself as a Pinned Message if you’d like others to use it too), and add that email to any service you’d like to send emails into your channel, and you’re done.
  4. Repeat the process on as many channels as you’d like to send messages into, letting each instance generate a new special email address.

If you haven't already signed-up for TextIt, you can try this integration and others for free at textit.in :)

Add Contacts to your Account from your Phone

TextIt now allows you to create new contacts by submitting their information to a messaging workflow. This pathway is new, but it's already getting use in some interesting contexts. For example, we're learning that this configuration is a convenient way for medical professionals to register new patients. 

Create your Contact Creation Flow

In the sample flow below we've created a questionnaire that asks for the contact's default attributes - their name and phone number: 

After the active contact enters those values for the new contact they're creating, they reach a Start Someone Else in a Flow action. This action is unique in that it allows you to start the yet-to-be-created contact - represented by their phone number (the @flow.phone variable) - in the next flow, which we'll modify to update their name. Once they exit the flow, they're added to your account: 

Creating the New Contact

We've placed an Update the Contact action in the next flow, Create New Patient, which will update the new contacts' names with the values we collected in the previous flow (@flow.name).

Because this flow is connected to the previous flow through a Start Someone Else in a Flow action, we're able to call the flow variables collected by the previous flow by giving them the @parent prefix, e.g. @parent.name:

That's all there is to it. Once the new contact's default phone field (URN) is given a value, they're added to your account. 

Leveraging SMS Messaging for Government Service Reform

In 2013, a handful of Code for America fellows presented the ambitious, compelling realities they're working to create for government services across the United States. The following article details a giant step in that direction, powered by industry-leading products Twilio, TextItFront and Slack.

This week, we’re eager to bring attention to one of many ground-breaking civic reform initiatives taking place around the United States, GetCalFresh, and the outstanding organization behind it, Code for America (CFA).

A Timely Approach 

CFA's overarching mission is to build a 21st century government, and they’re doing so by evangelizing an approach characteristic of some of the most successful, ubiquitous tech products and services available today: user-centered design. This is the first step in a proprietary process that includes such goodies as community engagement, iterative development, data-driven decision making, open government, team building, and informed procurement.

An Antiquated Program

The CalFresh program, federally known as the Supplemental Nutrition Assistance Program (SNAP), issues monthly electronic benefits that can be used to buy most foods at most markets and food stores. Its impact cannot be understated; it distributed $631,249,251 among 2,380,169 Californians (~80% of which are in families with children) in September 2015. It’s state economic impact in 2014 was $7.4 billion in the green, producing $1.74 of economic activity for every $1 issued. In addition, SNAP’s national error rate - comprising of an overpayment and underpayment rate - is lower than it’s been in 25 years. These stats represent a program on the rise, of great benefit to those participate, but they fail to address a monumental issue: after dogfooding the service, CFA found that obtaining food stamps is an arduous process weighted by poor design. In fact, 40% of people eligible for CalFresh aren’t receiving benefits (the second-worst participation rate in the country). You can view their annotated teardown of the CalWIN application portal here - it’s as educational and demonstrative as it is entertaining.

A Mobile Mission

CFA recognized that like most user-centric products today, GetCalFresh needed to be mobile. This is particularly important for those whose income is less than $30,000 per year, as they’re becoming increasingly reliant on smartphones as (1) their primary internet access touchpoint and (2) their primary method of communication.

After identifying the many pain points, they created a suite of tools to remedy them: 

(1) GetCalFresh.org, an easy to use mobile-friendly website that lets people apply for CalFresh in 10 minutes.  

(2) A Twilio/Front stack that allows CFA to track and send applications to CalFresh sourced from SMS interactions.

(3) A TextIt DRIP campaign that text messages CalFresh applicants:

  • 1 minute after application, confirming their application, letting them know what to expect, and providing a communication channel in case they have questions.

  • 10 days after application, asking if they’ve had an opportunity to complete the necessary steps.

  • 20 days after application, following up on their previous message and providing assistance if needed.

  • 25 days after application, asking if they’ve been approved, and soliciting a feedback call to fuel their next iteration.  

This approach meets applicants on the channel they prefer, mobile messaging, serving as both a user feedback pipeline and a measurement of the effectiveness of the application process they’ve designed.

The Utility of DRIP Communication

DRIP communication is a communication strategy that sends, or "drips," a pre-written set of messages to customers or prospects over time. Each of the following is true in a DRIP communication model:

(1) the timing of the messages follow a pre-determined course.

(2) the messages are dripped in a series applicable to a specific behavior or status of the recipient.

Building a DRIP Campaign with TextIt

Putting together a TextIt DRIP Campaign is a simple process comprising only two components: 

Create a Campaign 


A campaign requires a title as well as a contact group to send events to. Each campaign may only operate on one group; a new campaign is required for each group you'd like to interact with. 

Add Campaign Events


A campaign event represents an action that is performed at a time relative to a datetime value stored within a contact field (in the CFA's case, the date each applicant applied for CalFresh). As such, a campaign event must define the contact field it's relative to, the offset to that field (the amount of minutes, hours, days, weeks before or after the contact field value), as well as the action to perform (send a message or start a flow).

Code for America

Check out this video to learn more about the process behind GetCalFresh:

You can view Code for America’s areas of interest, and their corresponding projects, here.

Sign-up for a free account to apply TextIt to your cause. 

Engaging Low-Income Communities through SMS Polls

SMS-Sourced Feedback

An increasing number of organizations are turning to SMS as their preferred polling channel given its high engagement potential and low-touch nature. SMS is a particularly important channel for organizations who wish to engage low-income communities in the US, as 84% of adults with an income lower than $30,000 own a cell phone - 81% of which send and receive text messages (Pew Research Center).

Street Chat

A Great Nonprofits initiative, Citizen Insight’s Street Chat uses TextIt’s flow engine to build dynamic, automated, conversational surveys that engage low-income communities via SMS, providing actionable feedback for policy makers and nonprofits. Specifically, Street Chat seeks to give the underserved a voice, allowing change-makers to stay informed, identify trends, improve participation and ultimately improve social programs. This was the first social-media survey evaluating health insurance in California.

Affordable Care Act Case Study

Street Chat’s inaugural study, conducted earlier this year by Stanford’s Social Psychological Answers to Real-World Questions (SPARQ) program in conjunction with Great Nonprofit’s Citizen Insights initiative, gave voice to low-income people of color who are impacted by the Affordable Care Act. The chat-based mobile survey, designed using TextIt, was completed by 824 participants in metropolitan areas around Los Angeles, San Francisco and San Jose, who comprise 90% of those engaged.

Results

Results from those with insurance:  

  • Access to care was not a barrier, with 86% of respondents saying it was "easy" or "very easy" to get an appointment

  • About 69% used their insurance to see a doctor

  • About three-fourths of respondents (77%) said insurance was affordable for them

  • 93% said their co-pay charge was affordable

  • 84% of respondents liked their provider

Results from those without insurance:

  • 57% tried and failed to get health insurance

  • Another 28% were still waiting to hear about their insurance status

  • Of those uninsured respondents who applied online, 63% reported failure

  • 87% of uninsured people who applied by phone reported failure 

The results indicate that those who have insurance are largely satisfied with its cost and quality, but also revealed that phone and online application touchpoints might require improvement. 

Feedback

Nearly 100% of participants agreed to take future surveys, having the completed the survey within 2 hours of receiving the initial message.

Click here to learn about the study and get in touch with Citizen Insights.

Build Your Own

Click here to sign up for a free TextIt account to build and deploy your own chat-based mobile survey.

Introducing the TextIt Surveyor Mobile App

We're excited to announce that you can now use TextIt's Workflow Engine to collect data in areas where internet and cellular connections aren't reliable or even available.

Introducing Surveyor

Our Surveyor Android application is a rugged compliment to our web application, allowing you to author, field, and manage mobile chat-based data collection workflows anywhere in the world - all you need is an Android device and a charge. Specifically, it provides an out-of-box solution for users to:
  • Initiate polls or surveys that mimic the flow of live, chat-based communication.

  • Collect data on an Android device and send it to a TextIt account when a connection is available.

  • Aggregate the collected data on our servers and extract it for further analysis.

Have a Look


You can download Surveyor for free from the Google Play Store and link it to your TextIt account. Don't have one? Visit our website to create a free account. 

To create a Surveyor workflow, simply create a workflow as you normally would and then elect to run it over an Android phone: 


Note that your credits are applied to each message sent and received within Surveyor once you send your results to your account. 

If you have a question that isn't addressed in this post, you can get in touch with us at support@textit.in

Understanding the Mobile Communication Process

At its core, TextIt is a communication tool. It facilitates the creation and distribution of message-based workflows which you can send through a variety of channels. The importance of effective communication is immeasurable in any context, and it’s become a strong determinant of the success of a product or service in the digital age. Time and again we see that poor communication reduces quality, weakens a brand, and ultimately leads to a lack of trust, thus facilitating user detraction and plummeting completion rates. To that end, we recommend referencing this guide to the mobile communication process when designing your SMS service. 

The Communication Process

The communication process comprises the following components:

  • Sender - You: the person, group or entity that initiates a message. The sender is responsible for the success of the flow, as they directly influence the content thereof.

  • Receiver - Your contacts: the person, group or entity to whom the message is directed; also called the interpreter.

  • Message - Content that must be encoded by the sender and decoded by the receiver.

  • Channel - the medium through which a message is delivered. TextIt supports a variety of channels, including SMS, Voice, Twitter and Email.

  • Context - the situation and setting in which the flow will be sent and delivered.

  • Noise - factors that decrease the chances of successful communication but does not guarantee failure. The type of noise most applicable to mobile communication is semantic noise, which exists when the words that comprise the message are not understood, thus inhibiting the decoding process.

  • Feedback - responses from your contacts indicating whether a message has been received as in intended.

Step 1:  Encoding

The encoding process requires you to condense your objectives into a flow. Are you pushing content, collecting data, directing users to resources, or otherwise complimenting your product or service’s workflow? When designing your flows, it’s just as important to base your content on what you can gather about your contacts’ knowledge and assumptions as it is to consider what information you want your contacts to have.  

Step 2: Transmission

The transmission step requires that you select a channel. The context of the interaction you’re designing and the characteristics of your messages will determine the ideal channel for your service:

  • Is the information you’re conveying best presented in the form of an SMS message, Twitter DM, Email, phone call, or an SMS link?

  • Which channels do your intended audience use most often?

  • Is the content urgent?

  • Is immediate feedback necessary?

  • Is the content complicated, controversial or private?

  • Is your messaging intra or inter-organizational?

  • How literate is your average contact likely to be? What is the extent of your average contact's written communication skills?

Step 3: Decoding

Once you’ve selected the appropriate channel(s) and your messages have been sent to your receivers’ handsets, the decoding process begins. When the message is received and examined, your contacts interpret and assign meaning. The extent to which your contacts comprehend your flows will depend on their familiarity with the purpose of your flows upon receipt, and the extent and nature of the relationship between your organization and your contacts.

Step 4: Feedback

Feedback is a contact’s response - which allows you to evaluate the effectiveness of your flow(s). Are they responding to your flow as intended, or are they consistently responding with uncategorized responses. Are they responding at all? A lack of response qualifies as a response. Feedback provides an opportunity for you to take corrective action to edit a flow - it’s a litmus test of sorts for communication barriers.

Next Steps

In addition to this guide, you may find the following articles helpful in designing and testing your service:

The Importance of Pilot Testing

Improve the Effectiveness of your Flows with A/B Testing

Are your Flows User Friendly? Find out with Usability Testing



The Contact Analysis Checklist

Prior to constructing your flows, it’s a good idea to conduct a contact analysis to learn more about your intended audience. We’ve put together a checklist containing questions to help you analyze your contacts and ensure efficient and pleasant communication. This checklist can be applied at any point in the testing process.

The Checklist

  1. How many contacts do you anticipate will interact with your service ?

  2. What information do you have regarding the demographic makeup of your contacts (age, gender, education level, ethnicity), and how might you use that information to develop and shape your flows? Will it be necessary to build a multi-language flow?

  3. What personal and professional traits do you have in common with your contacts?

  4. Are there any cultural considerations that may influence how your contacts interact with your flows?

  5. Will you need to targeting certain contacts? If so, what is your criteria?

  6. With regard to your service, how much knowledge or expertise will your contacts possess?

  7. Will your contacts recognize and implicitly trust your credibility or ethos, or will you have to earn their trust by immediately demonstrating value?

  8. What preconceptions or biases regarding your service and/or channel might be held by some of your contacts?

  9. In general, will your contacts have a favorable, unfavorable, or neutral attitude toward the subject and/or nature of your service?

  10. What common misconceptions about the subject of your service will you need to correct during the course of your deployment?

  11. In general, will your contacts recognize the value of your service, or will you need to generate interest and demonstrate value?

  12. What expectations might your contacts have regarding the length of your flows?

  13. What expectations might your contacts have regarding content of your flows?

  14. To complete your flows, how much background information will your contacts need?

  15. What key questions might your contacts have about your service?

  16. Which tone or general attitude do you want to convey to your contacts - objective? authoritative? collaborative? supportive?

  17. What do you want your contacts to know or do as a result of interacting with your flows?

Feature Update - Simplified Expressions

Writing expressions in TextIt just got easier :)

In an effort to simplify the process of adding expressions to flows, we’ve changed the input method from = to @ and added a completion dialogue that lists and explains each function when @( is written in any window:  

1png

Variable substitution remains the same, so @contact and @contact.name are unchanged. 

With these new changes, what was previously written as =UPPER(contact.name) or @contact.name|upper is now written @(UPPER(contact.name))

To escape the variable and function dialogue, simply add an additional @ to the text. For example, @@twitter will evaluate to @twitter when a message is sent. 

Refer to our function glossary for a list of functions you can add to your messages. 

We’re excited to get your feedback; share your thoughts with us at support@textit.in.

All the best,

The TextIt Team


Use TextIt to funnel your users to live support

While automation is useful in a variety of contexts, there may come a point in the interaction when it makes sense to add a human element - to link a user to a team member who can continue the conversation in real time. This would be an obvious win in a customer support context, but extends across any vertical to organizations that want to improve communication with a particular community.

Create an SMS-to-Support Pipeline

The key to this configuration is TextIt’s Send an SMS to somebody else action. You can place this action at any step in a flow, and use it to instantly direct contacts to team members who can respond via SMS, phone or email to continue the thread.

Create an Email-to-Support Pipeline

If your organization has multiple customers or manages multiple members, you’re probably using a customer relationship management platform (CRM). If you’re not, you should be. CRMs allow you to track and manage the people that interact with your product or service, and most offer the ability to link your organization’s email addresses to a feed that each team member can view. CRMs built for customer support, like UserVoice, present these emails as tickets that each team member can respond to and eliminate from the feed.

Another super simple way to connect a contacts’ inquiry with a team member is the Send an Email action. Simply create a flow that asks for a contact’s name, inquiry and preferred response method, and configure TextIt to send an email containing that info off to your support feed. Team members will be able to instantly access the ticket via your CRM and respond accordingly. Easy.

1png

The variable @flow.name references the name of the contact if you collected it at a previous step, while @flow.inquiry and @flow.preferred_channel reference the contact’s inquiry and the way they’d like you to respond (SMS, Call, Email), respectively.

Tiered Support

Perhaps you’re an organization that tiers your support to accommodate low support capacity, or you want to screen a customer or community member before directing them to a team member. No problem. Decide on your requirements, then build a flow that only directs contacts to staff if they follow a certain path in your flow.

Create a Flow, Build a Stream

Support isn’t complicated, but it is vital to the success of an organization. Use TextIt to provide a convenient, mobile support channel, and respond with a human touch.