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Texts or emails to patients, e.g. confirming appointments, referrals etc #366
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Notes from work on NBS appointment confirmation and reminder texts and emails:
Research insights from 6 remote interviews in March 2021 about appointment reminder notifications:
Business rules for sending:
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Rules and tips for writing SMS/email messages on Gov.Notify (used by Test and Trace eg for coronavirus test results messages). Length: Maximum of 918 characters including blank/white spaces. For coronavirus test result messages, 50 characters must be left for full name to be inserted. Birth date and Test taken need 18 characters each. So in total there is 806 characters for the main body. Formatting: Formatting is limited on SMS. It's fine to use bullets but we cannot use bold. Links: NCSC guidance is to avoid long and deep links in SMS/email because they are easier to spoof and open the message to malicious intent. Links must be given as urls and in full eg https://covid/19.nhs.uk Cost: SMS pricing increases with message length. Every 153 characters costs 1 text message. For the longest messages, they therefore cost 6 messages worth - in effect 9.5p per message. They will still appear as a single large message on the device, but will cost more to send. As such a reduction in size, down to say 450 characters would halve costs. All characters, including spaces and line breaks count towards the message length. Email doesn't attract a cost as it's very cheap. For info it's around £80 per million emails sent by Notify regardless of length. International telephone numbers: For the telephone number field there is a maximum of 14 digits. Most international numbers are allowed, but there are some that are not – this is mandated by Gov.Notify. |
In the NHS App, 71% of iOS and Android users are choosing to opt-in to receive push notifications. Every user who opts in for push notifications gives the NHS an opportunity to avoid SMS (1.55p+VAT each) and paper letter (up to £1+VAT each) costs in the future. |
A few content design fail stories from the content channel in the GOV.UK Slack instance.
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And another example from NHS.UK: I was late for a hospital appointment last week as there are 2 departments - 1 for pre-assessment and 1 for the actual clinic - at opposite ends of the hospital. Some of the signs are obsolete as departments have moved into temporary buildings so people can easily get mis-directed. I was told that I needed to go to an entrance near Car Park 2. Car Park 2 no longer exists because of rebuilding/modernisation. |
May be of interest: NHS App messaging - a better way to talk to patients |
A question about the term SMS. Looks like preferred usage among content designers is: text message (SMS). From conversations on NHS.UK Slack:
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As part of our study into usability of GP websites, we asked participants what they thought the term 'Secure message' meant. No one mentioned SMS and 4 participants used the term 'text'. The individual responses from 31 participants with low digital and written English confidence are here:
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A proposal from the Digital First Primary Care team:
I think we could combine this with recent discussions in NHS.UK that recommend not using SMS on its own. Instead we propose "text message (SMS)". For next Style Council meeting. |
I've been working on the Notifications and Messaging area of the NHS App. Though we don't write messages ourselves, we tested viewing and responding message samples provided by GPs. Providing information to help users understand what they need to If you are asking users to respond with information, messages should be written to cover all possible scenarios. During research, we presented users with an appointment reminder message. Users understood that they should respond ‘Cancel’ to cancel an appointment or take no action to keep the appointment. However, most users expressed that they would expect to be able to confirm an appointment or - if they couldn't make it anymore - reschedule it. The single reply option left them feeling uneasy or dissatisfied. Let me know if you'd like any more information :) |
Thanks @stefanNHSdigital. That's interesting. If you have any screenshots or example wording, that may help other teams. |
At Style Council meeting October 2022, we approved the following 2 entries to the style guide A to Z. (Still needs clinical approval.)
Note: user research found that talking about “secure” messages raised questions about security. |
Approved by clinicians. Preparing to publish in the New Year. |
Published. Moving this back into the backlog while we gather more guidance on texts and emails. |
Feedback from the NHS App Notifications and Messaging team - we may want to give the entry a bit more clarify and cover in-app messaging. E.g. we could amend it to.
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Existing style guide entry on “secure message”:
At the June Style Council meeting, the NHS App team proposed a minor change: Proposed entry
Action: approved highlighted text. To be added to the style guide, subject to clinical approval. Note the sentence about the word "secure" raising questions about security came from the research by NHSE's Digital First Primary Care team. |
An example I posted on Twitter: https://x.com/S_Wilcox/status/1547677082896912393?s=20. The letter turned out to be a message about a triaging date - a note of when the consultant and team would review the case, but the letter was worded such that we thought it was a telephone/video appointment. @AndyLongContent - this may be of interest. We're uploading a few other anecdotes here. |
What
Content designers are increasingly writing content for a range of channels including texts or emails. It would be good to collect tested examples to understand better what works for users.
Update February 2024
There is a piece of work underway to produce guidance or a toolkit on effective messaging for primary care. This may be published in the service manual content guide.
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