NHS appointment reminders
When complete information still does not produce attendance
A reminder stating the approximate cost of a missed appointment reduced non-attendance from 11.1% to 8.4% in one trial. A second trial found 8.2% non-attendance for a specific-cost message versus 9.9% for a general cost statement.
What transition is actually failing?
A technically complete reminder can state the clinic, date, time, and cancellation instructions while failing to make the consequence of non-attendance concrete. The operational target is not merely opening the SMS; it is attending or cancelling in time.
What the study tested
Two randomized controlled trials at a London NHS trust compared standard reminders with variants that added social norms or general and specific cost information. The essential appointment facts remained broadly similar while the cue configuration changed.
How the framework reads the result
The essential appointment facts remained similar, but the concrete consequence may have changed Stake, credibility, memory, or why the receiver believed the number was included.
This is Violet’s theoretical interpretation, not a mechanism directly established by the original outcome alone.
What Violet would examine next
- Define the target transition as attend or cancel—not open the reminder.
- Place the practical consequence and cancellation route before secondary detail.
- Measure informed cancellation separately from attendance and non-response.
- Test whether cost, urgency, credibility, or memory mediates the effect rather than assuming one mechanism.
- Check whether transport, work, fear, or access—not communication—is the real barrier for key receiver groups.
What the result does not prove
The trials establish a local effect of message assignment on attendance. They did not directly establish which psychological mechanism changed.