Community-Level Text Messaging for 2009 H1N1 Prevention in China


      Although patients worldwide increasingly are using mobile phone text messaging (SMS) for clinical care, quality data are sparse on the community-level effectiveness of SMS to prevent and control disease.


      To determine SMS effectiveness in improving 2009 H1N1 knowledge, attitudes, behaviors, and self-reported outcomes and to assess community SMS acceptability.


      A program evaluation of Shanghai, China's SMS system using a single-blinded, randomized-controlled method was conducted in 2010 and results were analyzed in 2010–2011. Randomly selected community residents who agreed to participate were assigned to receive 3 weeks of either 2009 H1N1 prevention and control or tobacco-cessation messages. Assessments were made of 2009 H1N1 knowledge, attitudes, behaviors, and self-reported influenza-like illness before and after sending messages to participants. Acceptability of SMS also was assessed.


      Of 1992 respondents, those receiving 2009 H1N1 messages had higher scores measuring 2009 H1N1 knowledge (4.2% higher) and desired attitudes (9.4% higher) (p<0.001); 1.77 times greater odds of new 2009 H1N1 vaccination (p<0.001); and 0.12 times smaller odds of reporting influenza-like illness (p<0.001) than those receiving tobacco messages. More than 95% of participants found the SMS program useful and trustworthy; nearly 90% would use it again.


      SMS can improve self-reported uptake of short-term behaviors, such as vaccination, that can result in long-term prevention and control of disease. SMS can improve knowledge and influence attitudes about infection prevention and control and self-reported health outcomes. In Shanghai, health-based SMS is acceptable to users.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • International Telecommunication Union
        The World in 2011: information and communication technologies facts and figures.
        International Telecommunication Union, Geneva2011
      1. ABI Research. Press release: more than seven trillion SMS messages will be sent in 2011. 2010.

        • Randrianasolo L.
        • Raoelina Y.
        • Ratsitorahina M.
        • et al.
        Sentinel surveillance system for early outbreak detection in Madagascar.
        BMC Public Health. 2010; 10: 31
        • Hoffman J.A.
        • Cunningham J.R.
        • Suleh A.J.
        • et al.
        Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya.
        Am J Prev Med. 2010; 39: 78-80
        • Lester R.T.
        • Ritvo P.
        • Mills E.J.
        • et al.
        Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial.
        Lancet. 2010; 376: 1838-1845
        • Strandbygaard U.
        • Thomsen S.F.
        • Backer V.
        A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study.
        Respir Med. 2010; 104: 166-171
        • Haapala I.
        • Barengo N.C.
        • Biggs S.
        • Surakka L.
        • Manninen P.
        Weight loss by mobile phone: a 1-year effectiveness study.
        Public Health Nutr. 2009; 12: 2382-2391
        • Hanauer D.A.
        • Wentzell K.
        • Laffel N.
        • Laffel L.M.
        Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management.
        Diabetes Technol Ther. 2009; 11: 99-106
        • Kim C.S.
        • Park S.Y.
        • Kang J.G.
        • et al.
        Insulin dose titration system in diabetes patients using a short messaging service automatically produced by a knowledge matrix.
        Diabetes Technol Ther. 2010; 12: 663-669
        • Patrick K.
        • Raab F.
        • Adams M.A.
        • et al.
        A text message-based intervention for weight loss: randomized controlled trial.
        J Med Internet Res. 2009; 11: e1
        • Rodgers A.
        • Corbett T.
        • Bramley D.
        • et al.
        Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging.
        Tob Control. 2005; 14: 255-261
        • Stockwell M.S.
        • Kharbanda E.O.
        • Martinez R.A.
        • Vargas C.Y.
        • Vawdrey D.K.
        • Camargo S.
        Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial.
        JAMA. 2012; 307: 1702-1708
        • Leong K.C.
        • Chen W.S.
        • Leong K.W.
        • et al.
        The use of text messaging to improve attendance in primary care: a randomized controlled trial.
        Fam Pract. 2006; 23: 699-705
        • Liew S.M.
        • Tong S.F.
        • Lee V.K.
        • Ng C.J.
        • Leong K.C.
        • Teng C.L.
        Text messaging reminders to reduce non-attendance in chronic disease follow-up: a clinical trial.
        Br J Gen Pract. 2009; 59: 916-920
        • Perron N.J.
        • Dao M.D.
        • Kossovsky M.P.
        • et al.
        Reduction of missed appointments at an urban primary care clinic: a randomised controlled study.
        BMC Fam Pract. 2010; 11: 79
        • Wei J.
        • Hollin I.
        • Kachnowski S.
        A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions.
        J Telemed Telecare. 2011; 17: 41-48
        • Cole-Lewis H.
        • Kershaw T.
        Text messaging as a tool for behavior change in disease prevention and management.
        Epidemiol Rev. 2010; 32: 56-69
        • Fjeldsoe B.S.
        • Marshall A.L.
        • Miller Y.D.
        Behavior change interventions delivered by mobile telephone short-message service.
        Am J Prev Med. 2009; 36: 165-173
        • Krishna S.
        • Boren S.A.
        • Balas E.A.
        Healthcare via cell phones: a systematic review.
        Telemed J E Health. 2009; 15: 231-240
      2. Chinese Ministry of Industry and Information Technology. Operational situation of China's communication industry in January 2011.

        • Snyder L.B.
        Health communication campaigns and their impact on behavior.
        J Nutr Educ Behav. 2007; 39: S32-S40
      3. People’s Republic of China. Chinese Center for Disease Control and Prevention. Knowledge of influenza A (H1N1) flu’s prevention and control. 2009.

        • Shanghai Municipal Health Bureau (Influenza A H1N1 Prevention and Control Working Group)
        Notification of influenza A (H1N1) flu vaccination and seasonal influenza vaccination for key groups in the year 2009-2010.
        31. SMHB, Shanghai, China2009 (document no 31; 2009)
        • Aiello A.E.
        • Murray G.F.
        • Perez V.
        • et al.
        Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial.
        J Infect Dis. 2010; 201: 491-498
        • Jefferson T.
        • Del Mar C.
        • Dooley L.
        • et al.
        Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review.
        BMJ. 2009; 339: b3675
        • Cowling B.J.
        • Chan K.H.
        • Fang V.J.
        • et al.
        Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial.
        Ann Intern Med. 2009; 151: 437-446
        • Hardelid P.
        • Fleming D.M.
        • McMenamin J.
        • et al.
        Effectiveness of pandemic and seasonal influenza vaccine in preventing pandemic influenza A(H1N1)2009 infection in England and Scotland 2009-2010.
        Euro Surveill. 2011; 16
        • Pelat C.
        • Falchi A.
        • Carrat F.
        • et al.
        Field effectiveness of pandemic and 2009-2010 seasonal vaccines against 2009-2010 A(H1N1) influenza: estimations from surveillance data in France.
        PLoS One. 2011; 6: e19621
      4. People's Republic of China. Shanghai Municipal Health Bureau. Notification of the launch of Shanghai's H1N1 influenza type A vaccination campaign among 6-35 month old children, February, 2010.

        • Marteau T.M.
        • Ogilvie D.
        • Roland M.
        • Suhrcke M.
        • Kelly M.P.
        Judging nudging: can nudging improve population health?.
        BMJ. 2011; 342: d228
        • Denizard-Thompson N.M.
        • Feiereisel K.B.
        • Stevens S.F.
        • Miller D.P.
        • Wofford J.L.
        The digital divide at an urban community health center: implications for quality improvement and health care access.
        J Community Health. 2011; 36: 456-460
        • Junco R.
        • Merson D.
        • Salter D.W.
        The effect of gender, ethnicity, and income on college students' use of communication technologies.
        Cyberpsychol Behav Soc Netw. 2010; 13: 619-627
        • Samal L.
        • Hutton H.E.
        • Erbelding E.J.
        • Brandon E.S.
        • Finkelstein J.
        • Chander G.
        Digital divide: variation in internet and cellular phone use among women attending an urban sexually transmitted infections clinic.
        J Urban Health. 2010; 87: 122-128