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Our research team is part of the Communications Team at Public Health — Seattle & King County. As public health practitioners, our research questions stem from our experiences in the field. Our research project is one under the Northwest Preparedness and Response Research Center at the University of Washington.

We aim to:

  • Understand why and how certain target populations use texting and what attitudes they hold towards receiving text messages from public health departments.
  • Determine what health departments need to know from a technical and legal standpoint to develop texting programs.
  • Evaluate use of texting for gathering and disseminating emergency information.


  • Hilary Karasz, PhD, Project Director and Co-Investigator
  • Sharon Bogan, MPH, Project Manager
  • Meredith Li-Vollmer, PhD, Co-Investigator
  • Whitney Offenbecher, Research Assistant
  • Jason Madrano, Research Assistant
  • Mark Oberle, MD, MPH, Principal Investigator

For questions about this project, please contact Sharon Bogan at, or Hilary Karasz at

Our research

Research aims:

Developing text messaging programs require a considerable investment in time and resources. Before our department—and any other department—invest in text messaging, we want to know how we can best set it up to succeed.


Researchers are using a variety of methods to understand how and why people use texting. These methods include:

  • In-depth interviews with over 100 individuals using Q-sort, an opinion-ranking method.
  • A phone survey of over 400 people in King County who text.
  • Qualitative interviews with text messaging vendors, legal experts, industry specialists and programs that have implemented texting campaigns.
  • Implementation of pilot projects to gather practical, hands-on knowledge of how to best use text messaging within a health department context.

Pilot projects

This research includes two reports. The first project analyzed teen receptiveness to text messages about healthy eating and active living by creating, testing, and revising text messages. The second report describes text messaging computer applications and recruitment methods to send health promotion messages to teens in Seattle school-based health centers.

This pilot project also available in PDF format

OVERVIEW: We designed an employee emergency texting program in which employees receive text messages during emergency situations that affect their ability to work. Opt in is strictly optional; to date over 500 (about 36% of all staff) have signed up on their personal phones. Response to texts has been very positive. We plan to expand our marketing to enroll additional employees in the months ahead.

METHOD/PARTICIPANTS: Public Health – Seattle & King County currently employs approximately 1400 staff located at dozens of sites across King County. In 2010, 800 employees responded to a survey that asked about their interest in signing up for an emergency program, as well as any concerns that they might have about such a service.


Key themes from the employee survey showed that:

  • About 60% of all staff wanted to receive work site closure and other emergency information
  • The most salient emergency information for employees was site closure information
  • Cost of receiving texts was not a concern for younger employees, but was a consideration for employees 30 and older
  • Most employees (60%) did not think two-way messaging was necessary
  • Additional concerns were that texts would intrude on employees' "off-time." In addition, some employees said that it was inappropriate to be spending money on a texting program during a time of public health budget cuts and funding crises.

In January, 2012, our region was hit by a large snow and ice storm. We used the employee emergency texting program for the first time on a wide scale. We sent 15 messages over 5 days. Topics included site closures, late work-day starts and safe commuting reminders. For example:

  1. 01/19/2012 8:26:31 AM to ALL : Ice storm. Roads dangerous. PHSKC on late start at 10. If not critical staff check with supervisor before coming. Check web and hotline 206205XXXX for info.
  1. 01/19/2012 010:32:08 AM to Renton Dental: PHSKC: RENTON DENTAL is closed due to lack of power. Check with supervisor about work plan for day. More info from HR to follow. Check PH web for updates.

In the week following the snowstorm, over 180 employees responded to a survey about the texting program:

  • 83% of employees thought that the messages they received were either very relevant and helpful (63%), fairly relevant and helpful (20%), or somewhat relevant and helpful (12%). Only 5.4% of recipients thought that the texts were annoying.
  • With respect to the number of messages that were sent: 83% of recipients thought we sent "about the right number" of texts; 15% felt we sent too few, and only 2% thought we sent too many.


  • Survey your employees to find out what kinds of messages they want prior to launching a texting program.
  • Keep opt-in marketing materials simple, and respond to issues raised in initial survey. For example, we explained that employees could opt-out at any time without penalty.
  • Limit the number of text messages you send to only what's most important. Otherwise, employees may view the messages as "spam" and opt-out.
  • Try to provide customized messages whenever possible. Our employees can sign up to receive only messages about their particular worksite, several worksites, or all worksites.
  • Provide a website where employees can learn more about the texting program and how to sign up and opt out.

This pilot project also available in PDF format

OVERVIEW: Investigators conducted a pilot project to learn about how to set up a texting program that could be utilized in the event of a public health emergency and to test people's willingness to participate in a texting program from Public Health. During a mass flu vaccination exercise, we asked parents of children who needed two doses of flu vaccine if they would like to receive a text message reminding them to return for a second dose of vaccine. Of parents whose children needed a second dose of vaccine, 84% opted in to the texting program in the first year of the pilot and 95% opted in during the second year.

Through the pilot project, researchers also explored issues of working with a text messaging vendor and uncovered many important legal issues related to using text messaging to communicate protected health information to the public

View the presentation on our pilot project from the 2011 Preparedness Summit held in Atlanta, GA in February 2011.

METHOD/PARTICIPANTS: We piloted the text messaging project at two mass vaccination exercises in the fall of 2010 and 2011. Educators utilized an algorithm to assess whether children receiving the flu shot at the mass vaccination exercise needed a second dose in thirty days. Parents were then asked if they wanted to receive a text message reminder and provided their cell phone number and whether they wanted a text message in Spanish or English. Researchers utilized a third-party texting vendor to send a text message reminder to those who opted-in to the program.

RESULTS: In year one of the pilot, 84% of parents whose children needed two doses of vaccine opted in to receive text messages. In year two, 95% of eligible parents opted in to the program.


  • Explore health communication gaps within your health department and how texting might fill those gaps in efficient and effective ways.
  • You must get individuals' permission to send them text messages. Piggyback on other interactions with public health audiences to assess whether your particular audiences are interested in receiving text messages from Public Health and what kinds of messages they are interested in receiving.
  • Start small and expand. It takes some time to learn to write brief 160 character messages, to work with texting vendors and to train staff on sending text messages using texting systems. Start with a small program and then expand once you have some experience.

This pilot project also available in PDF format

OVERVIEW: This project aims to develop guidelines for a text message system that addresses the barriers to treatment for patients with latent tuberculosis infection (LTBI) at an outpatient TB clinic. The long-term goals of the project are to improve LTBI treatment adherence, reduce the number of missed appointments, and reduce the time to completion of treatment. The short-term goal is to design a text messaging program that incorporates research evidence and participatory research into a viable and useful communication modality for the TB clinic and its patients.

METHOD/PARTICIPANTS: We will conduct focus groups with clinic staff and individual interviews with clients to determine the essential components of text messages for the clinic. This data will be combined with literature review to develop a framework for effective, evidence-based messages. These messages will address critical barriers to treatment and will follow three distinct messaging topics: appointment reminders, medication reminders, and psychosocial support.

RESULTS: Results of this project are expected to benefit public health departments seeking more effective ways to address LTBI treatment adherence. This project is also expected to contribute to the advancement of community health nursing practice.

RECOMMENDATIONS: Upon completion of the project, recommendations will be disseminated for the design of a text message system to improve LTBI treatment

This pilot project also available in PDF format

OVERVIEW: To explore the significance of source credibility on an individual's desire to opt in to a text messaging program, we partnered with Entre Hermanos, a nonprofit organization that works to improve the health of the Latino community, on a text messaging program to send health and emergency preparedness messages.

METHOD/PARTICIPANTS: We developed two near identical postcards to recruit participants to opt in to the program. One postcard presented the information from Public Health – Seattle & King County and the other from Entre Hermanos. We promoted the postcards simultaneously and through the same delivery channels, recruiting 51 participants into the program.

RESULTS: The source of the postcard did not have a significant effect on opt in rate.

RECOMMENDATIONS: The results of this small scale study suggest that the content of messages may influence opt in decision more than the source of messages. Research suggests that individuals are more likely to opt in to programs with targeted, customized content. Marketing efforts should emphasize that text messages are relevant and timely to the individual.

Our publications