Table 1.

Care Manager text messaging content themes, categories, definitions and examples

Themes	Categories	Definition	Examples
Appointments	Reminder	Reminder of upcoming appointment	“Just a reminder we are scheduled to meet at 9 am today. Let me know if anything comes up. Otherwise I will see you soon”
	Check-in	Schedule general “check in” other than appointment /medication / depression	“Checking in to see how you are doing. Would it be okay if I call you on Friday morning to see how things are going with your medication and to do the depression screen?”
Treatment	Depression	Changes in symptoms of depression (sadness, fatigue, sleep, appetite, lack of interest, suicidal ideation) since starting therapy	“How is your sleep? How many hours are you getting a night.”
	Medication	Checking on compliance (taking the medication) Instructions on how to pick up prescription Information on medication	“The doctor said you can definitely try Wellbutrin and it can increase energy but it is important to know that Wellbutrin can also increase anxiety.”
	Problem Solving Therapy	Behavioral activation Homework Steps, goals	“If you can do something for yourself each day that brings you joy, it will help to break the downward spiral of depression. Even something small, whatever that may be for you, taking a walk, having time with a friend.”
Support	Behavioral modifications	Any recommendations for improving depression that is not medication and not part of a recognized psychotherapy like PST. Eg–practice self-affirmations, do the things that bring you joy.	“NEST: nutrition, exercise, sleep, time to self!”
	Validation	Acknowledging the patients feelings or actions or experience “It can be hard”	“I know this is hard for you and you are doing a good job helping yourself through this. I support you trying this without medication. I'll check in on you again tomorrow”
	Encouragement	“Keep doing it” “keep it up”	“Great job for doing it even though you are sick!” (referring to a patient doing their PST homework)
Information	Depression information	Information about depression symptoms	“Sleep and emotional health are so closely intertwined - try your best to get good rest!” “How are you feeling? I hope you have been able to enjoy some of the sunshine we've had in these last few days. Exposure to bright light is so helpful for mood.”
	Parenting	Anything related to parenting–classes, sibling rivalry.	“They will give you a list of childcare options that fit your criteria (area you want, take newborns, and any other preferences you have). When you call, let them know you are looking for child care for your newborn. they will probably ask you some questions. If you have any more questions, or problems with it when you call. Let me know and I'll help if I can.”
	Obstetric information	Anything related to pregnancy–breastfeeding, premature labor, pelvic rest, pre-eclampsia	“How did everything go with the birth? Breastfeeding? Let me know how I can support you.”
	Other information		“Yes, the prenatal yoga classes are at that same location and are taught by the greatest teacher. I think you would like it! And it's a great way to connect with other pregnant moms.”
Affect / Emotion Probes		Descriptive verbiage that goes beyond response to “check in”. Gives detail regarding mood or feeling	“The steps you came up with sound like they were successful in those days you accomplished your goal. So kudos to you! Glad to hear you have been feeling better! Have you been able to reflect on what has led to an improved mood?”
Other	Gratitude	Expressing thanks	N/A
	Self-reported PHQ-9 scores	Completing and sending itemized PHQ-9 scores	N/A
	Side effects	Anything related to a medication side effect	“Are you still having zingy feeling? If so does it come and go or is it constant? Any weakness in face with ziny feeling? Or do you just feel it on tongue?”
	Suicidal ideation	Expresses thoughts or concerns about suicide	N/A
	Other miscellaneous comment	Not meeting any themes and categories	N/A