Text4PTSI Program and Data Collection

Text4PTSI was launched in July 2021 to support PSP’s mental health in Alberta, Canada [31,32]. The targeted PSP group included emergency department health workers, paramedics, and police and law enforcement agents. This innovative program provides supportive text messages to PSP to prevent and manage posttraumatic stress disorder and other common mental health symptoms. The text messages are based on CBT principles [33]. The messages had a 160-character limit written by cognitive behavioral therapists in partnership with patients and other mental health professionals who addressed the aspects of potential psychological stress, anxiety, and depression. Examples of the text messages sent are:

Trauma can feel like a gloomy cloud over all areas of your life. The first step in treatment is to understand what trauma is, the symptoms, and how and why it is treated.

If you find yourself worrying excessively, make some boundaries with these thoughts. Jot down your worries throughout the day and let them go. Then set a time aside for 20 minutes to review what you wrote down.

Similar programs have demonstrated effectiveness in mitigating mental health symptoms like mood disorders in the general population with high user satisfaction rates. For example, a study on the impact of supportive messages among subscribers of Text4Mood reported that about 82% of the respondents felt hopeful about managing life issues and experienced an overall mental well-being [20].

Data collection procedures used in this study are described in the published study protocol [33]. In summary, PSPs enroll in the program by texting “PTSI” to 1-844-990-4343. From the day of enrollment, participants receive 1 text daily, which is unidirectional computer-programmed supportive text messages. These messages are based on CBT principles. Users are at an advantage similar to CBT sessions, where a therapist helps participants to evaluate and challenge negative thoughts, feelings, and emotions [32]. Participants are also invited to complete a web-based program evaluation at 6 weeks, 3 months, and 6 months after enrolling in the intervention. The survey generally took 5 to 10 minutes to complete using their cell phones.

Participation in the Text4PTSI program was voluntary, with no incentives. Receiving supportive messages was independent of survey completion. Participants could opt out of the program at any time by texting back the word “STOP.”

Satisfaction data were collected between September 7, 2021, and October 27, 2022. Figure 1 illustrates the participants' pathways when completing the surveys at each designated time point.

Study flowchart.