Improving attendance using behavioural SMS reminders in a paediatric programme

Background

Missed appointments remain a major inefficiency in healthcare systems. Behavioural science suggests that message framing, social norms and loss aversion may influence patient engagement. This study assesses whether modifying SMS reminders improves attendance in a paediatric prevention programme.

Methods

We conducted a a before–after observational study in the “6-10-14 for Health” programme in Gdańsk, Poland. Two SMS strategies were compared. In January–March 2026, standard reminders were sent one week before the visit. From April 2026, messages were redesigned using behavioural insights (clear call to action, response deadline, social value framing, and loss of appointment slot), with additional follow-up reminders for non-responders and a final reminder before the visit. The primary outcome was full attendance per clinic day.

Results

During the baseline period (67 working days), full attendance occurred on 7 days (10.4%). After introducing the behavioural SMS strategy (20 working days), full attendance increased to 11 days (55.0%). This corresponds to an absolute increase of 44.6 percentage points and more than fivefold relative improvement (∼5.3×). The intervention was associated with a markedly higher likelihood of full attendance, suggesting a strong behavioural effect of message framing and deadline-based communication.

Conclusions

Behaviourally informed SMS reminders can substantially improve attendance in preventive health programmes. Simple, low-cost communication strategies may enhance healthcare efficiency and reduce missed appointments. Future studies should evaluate statistical significance, cost-effectiveness and scalability in larger populations.

Key messages

• Behaviourally informed SMS reminders with deadlines and social framing can substantially improve attendance in preventive health programmes.

• Low-cost communication changes can reduce missed appointments and improve efficiency in paediatric health services without additional resources.