Table 4.

Lessons learned from the formative research conducted to develop Texting for Relapse Prevention

Focus groups

Text messaging behavior

1. Text messaging was a mode that equalized the ability for all patients with phones to take part in the intervention.

2. There was very little concern that symptoms would get in the way of texting.

3. Providers thought it would be likely that phone numbers might be unstable / change frequently.

Program idea

1. Even though the amount of text messaging that people engaged in varied, there was general agreement that 2-4 program messages a day was an acceptable number.

2. Patients and providers agreed that receiving messages would feel supportive and positive.

3. The proposed content (symptom queries, coping skills, medication psychoeducation) was acceptable to both patients and providers. Inspiration quotes were strongly suggested by patients.

4. Providers were not concerned about how the program would affect clinic flow, but they were concerned that it might impact provider-patient communication if patients thought the program messages were being sent from them.

Content Advisory Teams

1. Although some providers voiced concern that the messages might be too ‘corny’ or sound like a real person, the patients especially appreciated the positive tone of the messages and liked that they felt familiar (e.g., using the first-person).

2. Providers worried that some of the coping skills would encourage sedentary behavior (e.g., watching TV); and that some messages seemed to promise that the coping skill would work for everyone. Both issues needed to be addressed in the messages.

3. Longer messages needed to be shortened for readability.

4. Content needed to acknowledge that not everyone has friends/family available and to provide other ideas (e.g., community centers).

5. Messages also needed to acknowledge that not everyone is mobile and able to do exercise beyond what they can do in a chair.