How to design a useful healthcare SMS experience for patients

If the COVID-19 response has taught us anything design-wise, then it’s that digital communication is now a critical part of delivering public health strategy. Research shows that cyber communication delivers effective healthcare. Furthermore, such comms are now demanded. The design must be mobile-first, including SMS (Short Message Service) outreach.

The SMS healthcare experience. Expected. Demanded. Must be designed. Source: Instasent

SMS design

Effective SMS design enables reaching a broad audience profile, helping reduce health inequalities, and improving patient outcomes. Enabling patient health literacy is a key design consideration, especially with the limited content space afforded on a small screen for a broad audience.

Seen those prescriptions. Shoulda learned Figma!

Here are some thoughts on creating useful, patient-centric SMS content. Perhaps, this musing might trigger a healthcare stakeholder discussion about readable, patient-friendly, and cost-effective content for public health outreach.

Simple SMS writing guidelines

1. Write in plain language that patients understand and use. Refer to the plain language materials from health organizations about how to write.
2. Write in the active voice. (For example, “The Surgeon General requests you to …”, rather than, “It is requested by the Surgeon General that …”).
3. Keep sentences and overall length short (make it easily read on a phone or watch, while on the go!). Remember you may be required to translate your SMS. Translated versions can be longer than the English version.

4. Use patient-friendly words and call-to-actions consistently. Enable this, for example, by:

• Creating a glossary of your top plain language terms to communicate public health guidance online.
• Creating a glossary of those top call-to-action plain language verbs.
• Avoiding medical-domain terms and jargon! Don’t scare people with words like “disease”, “surveillance”, “the virus”, and so on. “We found COVID-19” is a better patient experience than reading “Your COVID-19 swab was positive”.

5. Trim unnecessary words (why use “in order to”, when “to” will do, for example?).

6. Use “you”, and “we”, when possible.

7. Use digits for numbers. Stick with a universal date format, understandable by everyone regardless of origin (for example, a DD-MON-YYYY format, shown to the patient as 23-Feb-2023).

8. Avoid “etc.”, “i.e.”, abbreviations, and special symbols. SMS content uses GSM-7 character encoding when sent — that means 160 single-byte plain text characters (in boring tech-person speak). Did you know that using “smart” (curly) quotes in Microsoft Word in Office 365 or in Google Docs), takes up a lot more character byte space than boring old “straight” quotation marks, for example? Keep it plain text. No emojis.

9. Use punctuation consistently; especially full stops (periods), colons, and commas. Be wary of including full stops at the end of links.

10. Avoid making yourself look suspicious with badly written, and inconsistent content that looks like smishing. Public health is a serious matter, as is data security, but content can still be friendly and polite.

SMS UX design considerations

Here are a few design tips. It’s all about the patient user experience. Remember: “You” are not the “user”.

• Check the content’s readability using a Flesch-Kincaid calculator.
• Show your SMS on a mobile phone interface when designing and reviewing with stakeholders (not on a laptop) — for example, these ones.
• Ask a 12-year-old / older person / non-native, second-language speaker to read the SMS text, click on links, and explain the SMS to you. Do you know what the average reading age on the web is? (Clue: it’s more than 10, but less than 15.)
• Review the feedback from 4–6 users and iterate.
• Do a patient survey for feedback after launch, using SMS.
• Repeat.

Some financial cost considerations

Generally, SMS transmission is paid for by segment per message (not per word). Each segment contains about 160 plain text characters. Trim any extra words to reduce the number of segments, where feasible. Use this Twilio tool to calculate the number of segments.

Can a URL shortener for your links be used instead of the full URL address in your SMS? This saves space for valuable content instead. For example, use “https://www.yourhealth.ie/covid”, instead of “https://www.yourhealth.ie/covid19/virus/health/swabresults/positive”.

Conclusion

I hope this little piece helps your UX design efforts when crafting SMS content for healthcare use. You may have your own ideas and experiences about user-centred design in public healthcare, already. If so, please find the comments!

Some useful sources

• How we write (The National Health Service)
• Lower-Literacy Users: Writing for a Broad Consumer Audience
• Combatting low health literacy that’s affecting a quarter of Irish people
• Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland
• Health literacy in Ireland: Reading between the lines
• 15 Essential Doctor Appointment SMS Templates

Ultan Ó Broin is an art school layabout UX designer. He works in digital healthcare design, and is a patient in Ireland.