SMS Program Info

SMS Communication Module 

Implementing a Virtual Program to Build Resilience and Reduce Burnout in Early-Career Nurses

This appendix describes the  SMS communication module that supports the New Nurse Support Network (NNSN) study. The SMS component is designed exclusively for general study reminders (e.g., notifications that new weekly content is available or brief encouragements to sustain participation) and is implemented in a manner that does not expose personal identifiers to the participant portal, maintains strict separation from research data, and complies with IRB data-protection expectations.

1. Purpose of SMS Messages

SMS messages are used solely to deliver brief, non-sensitive reminders intended to support participant engagement. Messages do not include Protected Health Information (PHI), personal health content, clinical advice, or individualized feedback. Typical SMS content includes short neutral statements such as “This week’s reflection activity is available” or “Thank you for continuing in the NNSN program.”

2. Data Elements and Storage

The SMS module uses a restricted-access “Contact File” that contains only:

• Participant ID (PID), and
  
  

• Mobile telephone number (in E.164 format).
  
  

The standard phone number format used by Twilio (and most global communications systems) is called E.164 format. Here’s what you need to know:

E.164 Phone Number Format 

Structure:

Example (UK):

Local: 020 7183 8750

E.164: +442071838[+][country code][area code][subscriber number]

Example (US):

Local: (415) 555-2671

E.164: +14155552671

750

Maximum Length:

Up to 15 digits (not including the plus sign)

No Spaces, Dashes, or Parentheses:

Only numbers, with a leading + sign

Key Points

Always include the country code (e.g., 1 for US/Canada, 44 for UK).

Remove any leading zeros from the area code or subscriber number when converting to E.164.

Do not use spaces, dashes, or other punctuation.

No names, emails, or survey data are included.
This contact file is stored in a separate, access-limited Google Sheet or secure cloud storage directory available only to designated members of the research team (e.g., PI, research coordinators). The PID in the contact file matches the pseudonymous PID used throughout the NNSN portal, preserving the study’s de-identification model.

The participant-facing web portal never receives nor displays phone numbers and has no ability to retrieve contact-sheet information. All SMS operations are completed on the secure researcher dashboard side of the project.

3. SMS Delivery Mechanism (Twilio)

SMS messages are sent through the Twilio messaging API, a widely used commercial communications platform. Twilio transmits standard SMS messages but does not receive study data beyond the text of the message and the destination phone number. SMS logs generated by Twilio are stored only in the encrypted Twilio account dashboard and within the study’s internal “SMS Log” file, which records:

• Timestamp of the SMS send,
  
  

• PID,
  
  

• Phone number (redacted internally where feasible),
  
  

• Delivery success/failure status.
  
  

No behavioral, message-reading, or interaction data are collected by Twilio.

4. Researcher Controls and Scheduling

All SMS operations occur through the researcher dashboard, which includes:

• One-time SMS broadcast using the most recent approved message text.
  
  

• Optional scheduled delivery of prewritten reminder messages.
  
  

• Controls for activating/deactivating individual participant phone numbers.
  
  

• A summary panel showing last message text, date/time sent, and send success rates.
  
  

Only members of the research team with proper authorization can initiate, schedule, or edit SMS messages.

5. Participant Risk and Safety

SMS content is intentionally minimal, generic, and non-sensitive to minimize privacy risks in case a participant’s phone is shared or accessible by others. Participants are informed during enrollment that they may receive optional SMS reminders and may opt out at any time by contacting the study team. No urgent or time-critical information is delivered via SMS.

6. Data Retention and Deletion

SMS logs are retained only for the duration of the study plus the IRB-approved retention period. Phone numbers may be deleted immediately upon withdrawal if required by the participant. At study closeout, Twilio logs and local SMS logs will be securely archived or permanently deleted according to the Data Management Plan.