Skip to main content
King County Courthouse Third Avenue entrance closed until January 1, 2020. Please use alternative routes.  
King County logo

For a text messaging program to be successful, the texts must reach the target communities.

Unlike other forms of communication, individuals must agree to receive text messages on their cell phones before a health department can send the messages.

Therefore, marketing the texting program to encourage opt-in becomes critically important. To effectively market a program, it is important to understand what makes text messaging appealing to target audiences.

Texting 101: Chapter 2

What our audiences want from Public Health text messaging programs.
Enlarge video.

OVERVIEW: Distinct texting "personas"—each with specific uses for texting, attitudes towards texting, and reasons for doing it—were found among specific target audiences. By focusing on the characteristics of the personas, public health communicators can craft more enticing marketing campaigns to increase opt-in and inform the development of text messages that resonate with the audience.

METHOD/PARTICIPANTS: We used Q method to interview over 125 texters from five different communities: 1) Spanish speaking young adults, 2) adults who are Deaf and hard of hearing, 3) young adults from the general population in urban and rural environments, 4) young Native American adults.


This section also available in PDF format

OVERVIEW: In order to better understand the communication preferences and practices of the population we serve, we conducted a telephone survey with King County residents about texting and mobile technology habits, feelings about receiving messages from the health department, and willingness to sign up for and receive emergency text messages.

METHOD/PARTICIPANTS: We developed a 28-question telephone survey and surveyed 402 King County residents via random digit dialing. Surveys were conducted on land lines and mobile phones.


  • Most residents would trust messages from Public Health: A majority of the participants (62.5%) agreed or strongly agreed that they would trust messages that came from the health department.

  • Residents vary on their willingness to receive different types of texts: The table below shows the percentage of participants who said that they were likely to sign up to receive the following types of text messages from Public Health.
Message topic Percent of participants who are very likely or likely to sign up to receive messages on that topic
Emergencies 83%
General health information 24%
Entertaining health messages 9%
Personalized health tips 20%
How to prepare for emergencies 46%

RECOMMENDATIONS: Understanding what audiences want in a texting program is critical, particularly because individuals must opt in to a texting program before they can start to receive text messages. Findings suggest that marketing campaigns should promote text message alerts for emergencies, a topic with widespread interest. Marketing messages with phrases like "have information at your fingertips in case of a dangerous situation" and "receive texts with critical information for your safety to store right in you phone" will appeal to a wide audience.

This section 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. 
  2. 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 section also available in PDF format

OVERVIEW: The lack of ASL interpreters and adaptive technology at health departments has hindered our ability to communicate effectively with Deaf and hard of hearing populations, especially during emergencies. Fortunately, Deaf and hard of hearing people have high text message utilization and adoption.

We sought to develop communication strategies based on research evidence about how and why Deaf and hard of hearing individuals use texting. In this way, we could be more successful in using texting to address critical communication gaps.

METHOD/PARTICIPANTS: We used an approach to the research called Q Methodology, which combines quantitative and qualitative methods to arrive at groupings or "types" of users. Rather than looking for correlations between variables, Q Methodology looks for correlations between subjects across variables.

We used key informant interviews and literature review to arrive at a set of 46 different opinion statements related to texting. We then gave these opinion statements to 23 Deaf and hard of hearing texters and asked them to sort the statements along a continuum from agree to disagree. After they sorted the statements, we interviewed subjects about why they sorted the way they did. We then used a Q-factor analysis to sort different groups of people with similar feelings about texting and similar usage of texting.

The Q-sort elicited three groups of people with distinct uses and gratifications of texting. Correlations from the Q-sort and interviews were analyzed to identify specific characteristics of each group and to name each group.

Once we had a clear idea of how Deaf and hard of hearing community members use texting, we were ready to start creating text messages, but we wanted to make sure our messages were relevant and understandable. To do this, we developed a set of test text messages, derived from press releases and based on communications experience. We conducted in-person interviews with seven Deaf and Deaf-blind subjects and online surveys with 17 Deaf and hard of hearing subjects. We asked what elements were essential and what language was most understandable for messages.

RESULTS: The Q-sort identified 3 texter types, each with uses and thinking about texting that are distinct from the other types:

  • Convenience texters see texting as an easy way to communicate; texting is fast and enables multi-tasking.

  • Informational texters see texting as a tool for planning and managing work and life and as a conduit for facts and information; texting is useful and necessary, but not for conversations or for building relationships.

  • Social texters feel that texting makes communication easy and fun; texting is essential for maintaining connections with friends and family.
    Research involving the test messages revealed essential elements and design of messages for communicating with the Deaf community. Three specific recommendations arose: identification, information, and language. Subjects agreed that it is important for PH messages to include identification of the sender. When messages are identified as coming from PH, people will trust the sender and the message. Subjects also agreed that it is important to include a link to more information in the message. Some said that they often keep old messages for future reference, and having a link to more information in the message would be very useful. And subjects agreed that it is important to write messages using language that is accessible. For most Deaf people, English is their second language.


Use the knowledge of texter types to inform communication and marketing strategies. Be sure opt-in message campaigns cover essential elements of each type of texter, such as emphasis on family and friend relationships for the social texter, ease and speed of texting for the convenience texter, and usefulness for planning and gathering facts for the informational texter. This way, campaigns will attract users from different texting groups.

Use the knowledge of language barriers to write meaningful and understandable messages. Use syntax and vocabulary that is easy to comprehend, including avoiding shorthand, jargon, and multi-syllable words. Include identification of the sender and links to more information.

See presentation below on our research with the Deaf and hard of hearing community (click on the arrows to navigate through presentation):

This section also available in PDF format

OVERVIEW: In the spring of 2012, researchers will assess the ways text messaging can fill health communication gaps within a school-based center setting.

The assessment will addresses three questions:

  • What health topics or information are students interested in receiving via text message?
  • Text messaging has the potential to fill communication gaps. From the perspective of providers at the school-based health centers, what are current health communication gaps that text messaging programs might fill?
  • What technical, legal and logistical issues impact the feasibility of implementing a text messaging program for high school students within a school-based center setting?

METHOD/PARTICIPANTS: Investigators will conduct qualitative interviews with students and providers at several school-based health centers within King County, WA.

RESULTS: Report of results.

RECOMMENDATIONS: Available Fall 2013.

This section also available in PDF format

Research publications