Is SMS the Penicillin of mHealth? Learning about effective mobile health programmes from New Zealand

I was really excited to meet Robyn Whittaker, M.B.Ch.B., in October in San Francisco (Thank you, Commonwealth Fund and HHS, for bringing her to us!), because of her international expertise in using SMS/Texting in mobile health programs.

She’s a physician with a specialty in public health, and her work appeals to my philosophy that (a) if someone is doing something better, I want to learn from them and (b) we should always strive for the simplest solutions to our problems (or as I sometimes say, light a candle with a match, rather than an H-bomb).

Robyn comes from a place, New Zealand, which has an environment conducive to her international expertise in this area – SMS is cheap, data is expensive, so therefore if the desire is to reach and actually help as many people as possible and the most vulnerable, texting is the way to go. In the U.S., we could probably say SMS is not as cheap, data is very cheap, relative to New Zealand. For example, Robyn told me that she doesn’t understand the concept of paying to receive text messages, we apparently have gotten used to it…

There’s a huge industry growing up to tout the value of smartphones and apps. Problem is, there isn’t evidence that apps have greater reach or more effectiveness than simpler solutions in health and health care.

With that in mind, I asked Robyn to present her work to my colleagues at Kaiser Permanente, and she did, and gave me permission to repost her slides above.

Note that she’s the author of the Cochrane review on mobile phone-based interventions for smoking cessation, as well as published RCT and one in press. I’ll let you review the findings – overall there is a picture that SMS may be as effective as telephone quit lines, which results in overall greater cost-effectiveness.

Also, the impact of reach cannot be understated, and there is a distinctive difference in cost/complexity of SMS relative to smartphones and apps, and maybe unfortunately in the visual and emotional appeal, which is the basis of my penicillin analogy above.

We had a very lively discussion at the conclusion of her talk, including issues of what to measure to talk about effectiveness (do we measure the cost-effectiveness of talking to your doctor?), SMS versus Apps (“I’m not anti-Apple” she said, iPad in hand. I followed up with, “She’s pro-health,” with my iPad in hand as well…), and getting this information out there. One of the ways is this blog post.

I loved the advice of my colleague @JanGround , she said, “It’s not enough to just have a twitter handle. You have to tweet, too.” On that note, Robyn is now on Twitter, @rawegd , ready to be followed. She is also now on the United States’ Text4Health Task Force, set up by the Department of Health and Human Services ( I note that it’s not the Apps4Health Task Force ).

Thanks again for your time, interest, and expertise, Robyn, we look forward to benefitting from the experience of the people of New Zealand.

Oh, the short videos in the presentation are below, I think they show the power of the personal story and interaction with the mobile phone. Enjoy.

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Ted Eytan, MD