Yesterday, in the middle of a meeting, my phone beeped and vibrated, indicating I’d received a text message. After the meeting, I checked my phone and saw the following message:

MINISTRY OF HEALTH ALERT! POLIO IS BACK IN UGANDA. ENSURE CHILDREN UNDER 5 YEARS COMPLETE ALL 4 DOSES OF POLIO PREVENTION VACCINATION. FREE AT HEALTH CENTRES.

The message had been sent on behalf of the Ministry of Health by MTN, one of the big telecommunication companies in Uganda, in some act of corporate social responsibility.

I remember hearing about the idea of using text messaging to send out health messages when I was at Hopkins. And I remember thinking right away, how much information can you convey in 160 characters? What good could a text message do? What can a text message convey or prompt that a billboard, poster, newspaper ad, TV ad, radio ad, or interpersonal communication couldn’t do more effectively?

I subscribe to all these public health, health communication, HIV/AIDS, and FP/RH listservs. A few months ago, I got an email through one of these listervs requesting me to fill out a 5-minute survey on how I get my health information. On one of those mornings where the urge to procrastinate outweighs the urge to tackle an actual to-do list, I clicked on the link to fill out the survey. It asked all kinds of questions about how, as a public health professional, I obtain my health information. A few of the questions centered around text messaging: Have I ever received health information through a text message? How effective, on a scale of 1 to 5, do I think text messages are in passing on health information, etc. I have to admit, I gave it pretty low rankings.

In one of my recent blog posts, I wrote about a project spearheaded by Straight Talk Foundation to answer young people’s health-related text messages sent in to a hotline. This was the first time my ears perked up when I heard about text messaging for public health. Hmmm, okay, sounds interesting. Makes sense. Let’s see how it goes.

Yesterday, when I got the text message about polio, I had to stop and think. Polio is indeed back in Uganda (I blogged about it a couple of weeks ago), and the public does need to be informed of the risk. But is this effective? I certainly don’t think sending the text messages out hurt anyone or anything, but how many people did it prompt into action? Mobile phone use and ownership is relatively widespread in Uganda; you can now buy a brand-new, ready-to-go phone for $15, then load airtime as infrequently as you desire in increments of 25 cents. Amongst mobile phone owners, text messaging is a preferred mode of communication (I picked up my text messaging habit in Uganda, back when no one was texting in the US), and receiving an SMS is free. But did this SMS make it to the people who were most in need of its information? Or were the people who most needed to read it the ones who don’t own phones? The ones who live in communities where the MTN network has no coverage (like many of the communities I work in)? The ones who don’t read English?

Personally, I just couldn’t imagine myself hauling my (hypothetical) children down to the nearest health unit just because of that text message. Maybe if I were already contemplating taking them, the text message would have given me the extra nudge (can anyone say Prochaska and DiClemente’s stages of change model?).

Maybe the allure of text messaging for public health rests in its simultaneous speed and strength in numbers. With the typing of a few characters and the push of the send button, you can get information out to thousands or even millions of people, relatively inexpensively, in seconds.

I’m not saying that this text message was a bad idea. I guess what I’m trying to say is that I, personally, still need to be convinced of the relevance and effectiveness of text messaging in public health.