Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Dr. Ta'Neka Lindsay

Second Advisor

Dr. Kathy Hager

Third Advisor

Dr. Steve Heilman



Healthcare organizations want to provide quality care, decrease costs, and promote preventative services for the communities they service. Mobile health units have become an extension of many healthcare organizations and provide different types of services, such as mammography. Providing mammography and wellness exams on a mobile unit presents several challenges; appointment adherence is one of them. Mobile units typically travel to underserved areas to serve people at risk for various health conditions such as breast cancer. Breast cancer is estimated to affect over 250,000 women in the United States during 2017; women have a 1:8 lifetime risk of being diagnosed withbreast cancer (American Cancer Society, 2017).

Text messaging (SMS) is a new technology that can be used to aid healthcare organizations in increasing their attendance rate to appointments. With 95% of Americans owning a cell phone and 73% of them engaging in text activity, it was hypothesized that text message appointment reminders would increase appointment adherence (Pew Research Center, 2011). A pilot study was implemented in a Prevention and Wellness department that provides mammogram screenings and wellness exams on a mobile unit. Implementation of text message appointment reminders was conducted for one month. Retrospective analysis of the data was conducted during the one month period. In total, 240 women attended their screening appointment. The non-attendance appointment rate for the intervention cohort group was 4.94%; the nonattendance rate for the customary method cohort group was 6.43%. There was a 23% reduction in non-attendance rate after the implementation of text message reminders.

Keywords: text messaging, appointment adherence, mammogram, mobile unit