Objective: To determine the feasibility and effectiveness of text messages as an educational tool to reduce the prevalence of nonurgent emergency department (ED) visits among a population with high levels of low health literacy.
Methods: This prospective, randomized experiment conducted in a large, urban, academic pediatric primary care practice enrolled 231 caregivers of infants into 2 groups: enhanced standard of care materials at well-child visits through 6 months (n = 99 completing), and enhanced standard of care and 4 text messages a week through 6 months (n = 108 completing). Use of the ED and visit urgency were compared between groups via chart review at 1 year of age.
Results: Of the 230 included in the analysis, 84.2% (n = 194 of 230) were racial or ethnic minorities, 69.7% (n = 142 of 204) reported yearly incomes of less than $20,000 per year, and 70.4% (n = 142 of 204) were identified as having likely or probable limited health literacy. Participants who received text messages had fewer visits to the ED in their first year (2.14 visits in the control group to 1.47 visits in the intervention group who received text messages; P < .05).
Conclusions: Sending educational text messages to caregivers is effective in reducing the number of visits to the ED. Given the accessibility and small expense of sending text messages, these findings have direct implications on the cost of health care, in addition to improving continuity and quality of care for pediatric patients.
Keywords: emergency department use; health care utilization; health literacy; primary care; text messaging.
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