How the Humble Text Message Can Help Democratize Healthcare

For many Americans living below the poverty line, getting adequate healthcare is nearly impossible, resulting in low-income communities being underserved by the health care system. Understanding how to better serve these neighborhoods is a point of concern for medical researchers and community organizers alike.

Take Parkside, a public housing complex on the eastside of Detroit that houses about 750 people, 90 percent of whom are black. Nearly half of Parkside's residents live below the poverty line. Many of the people who live there can't afford proper health care, and community organizations like Friends of Parkside (FOP), which aims to improve the Parkside community through a variety of services, are looking for effective ways to conduct surveys to find out how they can help.

Researchers from the University of Michigan teamed up with FOP to address the issue using an often overlooked technology: texting.

"Even if people can't afford to pay for their medication or buy things that we perceive as them needing, they will definitely pay for their cell phones and text messaging plans," Tammy Chang, lead author of  the study, told me. "Why are we not using this resource? It's a low-tech, basically ubiquitous technology that we can use to tap into their thoughts and opinions about issues going on in their community."

In the study, published online in BioMed Central Public Health, the researchers subjected 20 Parkside residents, all black and nearly all women, to weeks of mail-in and text message-based surveys about health issues. The surveys asked whether the participants would stay at home or go to the emergency room in the event of a medical emergency like suddenly not being able to walk.

Sadly, and perhaps unsurprisingly, many participants responded that in most cases they would stay home and wait it out. Aspirin is often way cheaper than a hospital trip when you don't have medical insurance.

After the initial round of surveys, the researchers held a focus group to gauge how the subjects felt about receiving and answering surveys via text instead of mail. According to the study, nearly all the participants reported having a positive reaction to the text message-based surveys. Many saw the texted surveys as an improvement over those on paper, because they were simple and could be answered "in their own language."

"Text messaging definitely levels the playing field in terms of the amount of words that can be sent, you can control how complicated the words that you use are," Chang explained. "What text messaging allows people to do is give their feedback in their time, in their own language—in a language they use to communicate in every other aspect of their lives."

Text messaging, in this context, has a democratizing effect in more arenas than just language. For one, it's extremely cheap for both surveyors and survey takers. The University of Michigan researchers estimate that it would cost just $50 for a community organization like FOP to launch a text message-based survey campaign.

"When you work with low-income individuals or people who are more generally underserved, there's a lot of creativity and untapped use of traditional technologies, which I would say text messaging is," Chang said. "This is not just useful for research, it can be used by community organizations, and it's inexpensive. It's exciting."

Text messaging's outdated and inexpensive nature, compared to newer, much-touted technologies, such as wearable fitness trackers, that aim to make people's access to health information easier, makes it a viable, community-based alternative to pricey and individualized technological solutions to health care betterment.

National Nurses United (NNU), a union that represents roughly 30,000 nurses, has levied  a similar charge against wearable health tech, arguing that it puts up more financial barriers to care than it tears down. "You start tiering the medicine—the provision of healthcare—based on your ability to pay," NNU co-president Deborah Burger told me in May.

Although the University of Michigan researchers' findings likely aren't generalizable by dint of their small sample size, at the very least they invite further investigation into the use of stodgy tech like text messaging to eventually improve the access to care for low-income communities. Chang sees the role of texting in garnering feedback about health care expanding in the near future.

"We can start using this as a proof of concept saying we don't really need to [use paper surveys]. We can send 1,000 participants a text message survey," she said. "Even evaluating Medicaid expansion—if we want to get the opinions of a large group of people, this could be a way."

Although that kind of widespread use for text messaging in health care surveys might be somewhat far off and contingent on more research being done, Chang says that her team's approach is ready to be put to use for the good of at least one community: Parkside.