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Preferences for Personalized Text Message Appointment Reminders Among Outpatients in a Universal Health System:

Shih-Huai Hsiao1,2,3, Yu-Chen Chuang4, Shu-Ling Ma5

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Summary

Patient preferences for SMS appointment reminders vary by age. Younger individuals prefer tailored messages, while concise, behavior-focused reminders are generally favored over empathetic ones to reduce missed outpatient appointments.

Keywords:
SMS remindersbehavioral designhealth communicationoutpatient no-showspatient preferencespersonalized messaginguniversal health coverage

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Area of Science:

  • Health Services Research
  • Behavioral Science
  • Health Informatics

Background:

  • Short message service (SMS) text messaging reminders are common for reducing missed outpatient appointments, but evidence on patient content preferences is limited, especially in East Asian universal health systems.
  • Taiwan's healthcare system, with low financial barriers and easy access to hospitals, faces high outpatient visit volumes and persistent no-show rates.
  • Tailored, behaviorally informed reminder strategies are needed, rather than uniform messaging, to address specific patient demographics and healthcare utilization patterns.

Purpose of the Study:

  • To investigate patient preferences for six theory-guided SMS appointment reminder types.
  • To identify demographic and healthcare utilization predictors of reminder preferences.
  • To inform the design of personalized SMS reminders for a future randomized controlled trial aimed at reducing appointment no-shows.

Main Methods:

  • A cross-sectional online survey was administered to adults in Taiwan with prior outpatient experience.
  • Six SMS reminder prototypes, based on behavioral communication principles and expert validation, were presented to participants.
  • Participants selected their preferred reminder type and provided sociodemographic and healthcare utilization data; statistical analyses included chi-square tests, ANOVA, and multinomial logistic regression with false discovery rate correction.

Main Results:

  • A total of 1095 respondents completed the survey.
  • General reminders and those referencing prior missed appointments were most preferred; empathy-based or relational messages were less favored.
  • Age was the only significant independent predictor of SMS reminder preference in the multivariable model; individuals younger than 50 were more likely to prefer alternative message types (aOR=1.64, P=.003). Sex, education, employment, region, visit frequency, and missed appointment history were not significant independent predictors.

Conclusions:

  • SMS reminder content preferences are systematically influenced by age, with younger individuals showing a preference for tailored messages.
  • Concise, behavior-focused reminders are generally preferred over empathy-oriented or relational formats.
  • Findings support age-informed tailoring of SMS reminders and provide validated prototypes for intervention research to reduce outpatient no-shows and improve healthcare efficiency in Taiwan.