Background
Short Message Service (SMS) messaging has emerged as a low-cost and scalable approach to health promotion, particularly in rural and remote communities where access to health information and services may be limited.
Objectives
To co-design, implement, and evaluate an SMS health messaging program for Aboriginal people in a very remote Australian community.
Methods
From April 2023 to November 2025, a Developmental Evaluation approach was used to support the co-design, implementation, and refinement of an SMS health messaging program and a complementary website information hub. The study comprised three phases: (1) concept development, needs assessment, co-design, and pilot testing; (2) implementation and iterative refinement; and (3) evaluation. A mixed-methods evaluation was conducted. Qualitative data were collected through interviews and focus groups, while quantitative measures included message delivery rates, click-through rates, and participant retention.
Results
Forty-six participants completed a digital readiness survey, indicating stability of phone numbers (> 2 years, 48%) mobile phone ownership (73%), minimal device sharing (72%), and minimal privacy concerns (93%). Forty-two participants (24 female, 18 male) were enrolled in the SMS program. During implementation, 42 participants enrolled in the program and 54 unique messages were delivered, with a 94% successful delivery rate and no unsubscribe requests. Interviews (n = 13) and two group yarning sessions indicated high acceptability. Participants described messages as encouraging, culturally appropriate, and locally relevant, particularly those related to health check-ups and mental health.
Conclusion
SMS health messaging was acceptable and useful in a remote Aboriginal community. Co-design, cultural relevance, and community leadership were critical to engagement.</p>