Feasibility of a proactive text messaging intervention for smokers in community health centers

Few smokers receive evidence-based cessation services during primary care visits. We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke.

We used electronic health records (EHRs) to identify smokers from two Massachusetts community health centers who had a mobile phone number listed. In March 2014-June 2015 patients were screened by their primary care physician then sent a proactive text message inviting them to enroll by texting back. Patients who opted-in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit.

Among 949 eligible smokers, 88 (9%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (61% vs. 48%, p=0.02) but otherwise did not differ in age, race, insurance status, or comorbidities. Twenty-eight percent of enrollees were not ready to quit in the next 30 days. The median time in the program was 9 days (interquartile range 2-32). Twenty-five percent of current smokers sent one or more keyword requests to the server. These did not differ by readiness to quit.

A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office.