x-message reminders: are symbols better than words?
I want to open a discussion on text message simplification to symbols in low-literacy, developing world settings.
A colleague in Sierra Leone and I were discussing effective content for text message reminders in a population where we are challenged by high rates of illiteracy. Our conclusion was that symbols might be better understood than words. For example, xxx = reminder 3 days prior to visit, xx = 2 days prior, and x = 1 day prior, and patients would be explained what the symbols mean prior to receiving them. We posed this idea more as a retention tool for appointment notification because modulation of the message seemed inspiring.
Expanding on the concept, I wonder if we could improve adherence or persistence by using a motivational combination of 'x's.' For example, we could start the week with 7x and finish the week with 'x'. My guess is that habituation may occur unless there is an induction (7x, 6x, 5x, 4x, 3x, 2x, x) and maintenance phase (once weekly 'x'). Reviewing how other studies have used SMS, I have only noted text messages with words/sentences, but I suspect I'm missing something.
Does anyone have experience using symbols as a message reminder +/- motivational, countdown components? Even if not, does anyone have a sense of the usefulness of this methodology? Lastly, any thoughts on use as a tool for adherence, retention, persistence or all of the above?