Co-design, implementation and evaluation of an SMS health messaging program in a very remote Aboriginal community in Australia

Josielli Comachio; Nicki Newton; Vishnu Khanal; Emily Saurman; Amy Von Huben; Nadarajah Kangaharan; Josie Povey; Tamsin Cockayne; Paul Burgess; Meredith Makeham; Karina Coombes; Alexandar Puruntatameri; Keleasha Ogden; Kureisha Wilson; Sarah Norris; Michelle Dickson; Sean Taylor; Jeff Robson; David Reeve; David Edwards; Alison Lloyd; John Wakerman; Deborah Russell; Tim Shaw

doi:10.21203/rs.3.rs-9999252/v1

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Co-design, implementation and evaluation of an SMS health messaging program in a very remote Aboriginal community in Australia

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Co-design, implementation and evaluation of an SMS health messaging program in a very remote Aboriginal community in Australia

Josielli Comachio, Nicki Newton, Vishnu Khanal, Emily Saurman, Amy Von Huben, Nadarajah Kangaharan, Josie Povey, Tamsin Cockayne, Paul Burgess, Meredith Makeham, …

Research Square, Vol.23 June 2026

Research Square Company

2026

DOI: https://doi.org/10.21203/rs.3.rs-9999252/v1

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Abstract

Aboriginal and Torres Strait Islander health

mHealth

text messaging

community-based participatory research

remote communities

health promotion

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 codesign, 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.

Details

Title: Co-design, implementation and evaluation of an SMS health messaging program in a very remote Aboriginal community in Australia
Authors: Josielli Comachio (Corresponding Author) - The University of Sydney
Nicki Newton - University of the Sunshine Coast
Vishnu Khanal (Author) - Charles Darwin University
Emily Saurman (Author) - The University of Sydney
Amy Von Huben (Author) - The University of Sydney
Nadarajah Kangaharan (Author) - Northern Territory Health Services
Josie Povey (Author) - Charles Darwin University
Tamsin Cockayne (Author) - Northern Territory Health Services
Paul Burgess (Author) - Aboriginal Medical Services Alliance of the Northern Territory (Australia)
Meredith Makeham (Author) - The University of Sydney
Karina Coombes (Author) - Charles Darwin University
Alexandar Puruntatameri (Author) - Charles Darwin University
Keleasha Ogden (Author) - Northern Territory Health Services
Kureisha Wilson (Author) - Charles Darwin University
Sarah Norris (Author) - The University of Sydney
Michelle Dickson (Author) - The University of Sydney
Sean Taylor (Author) - The University of Melbourne
Jeff Robson (Author) - Charles Darwin University
David Reeve (Author) - Aboriginal Medical Services Alliance of the Northern Territory (Australia)
David Edwards (Author) - The University of Sydney
Alison Lloyd (Author) - Northern Territory Health Services
John Wakerman (Author) - Charles Darwin University
Deborah Russell (Author) - Charles Darwin University
Tim Shaw (Author) - The University of Sydney
Publication details: Research Square, Vol.23 June 2026
Publisher: Research Square Company 
Date published: 2026
DOI: 10.21203/rs.3.rs-9999252/v1
Data Availability: Relevant data generated or analysed are included in this article. De-identified data can be obtained from the corresponding author on reasonable request. The data are not publicly available due to them containing information that could compromise research participant privacy and consent.
Grant note: Digital Health CRC Limited (DHCRC). DHCRC is funded under the Australian Commonwealth’s Cooperative Research Centres (CRC) Program.
Organisation Unit: Centre for Human Factors and Systems Science
Language: English
Record Identifier: 991252399002621
Output Type: Preprint

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