Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women.

This was an observational secondary analysis, so it cannot show that more messages caused postpartum follow-up. Women who completed follow-up may have been more reachable, motivated, or less busy, which could explain both more replies and more attendance. Only text and email messages were analysed. Phone and in-person communication were not available, so the full communication picture is missing. Communication was highly individualized, with varying frequency, duration, and content, so there was no standard texting dose or message set. The study was exploratory and had no sample size calculations. The authors could not confirm that messages were received or understood as intended, especially when patients did not respond. Some barriers, such as inadequate literacy, may have prevented women from responding fully or benefiting from expanded communication. The cohort was specific: publicly insured women at a Chicago tertiary care center, mostly non-Hispanic Black and Hispanic, with high access to unlimited texting.

The authors reported no potential conflicts of interest. The article metadata lists NIH extramural and non-U.S. government research support.

Do not conclude that sending six or more texts causes women to attend postpartum visits. The study compared messages between women who already had completed follow-up and those who had not, so more texting may simply reflect a patient who was more reachable or motivated.