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Background  A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change.    Objective  This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors.    Methods  Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input and review.    Results  Steps for developing a text messaging program include conducting formative research for insights into the target audience and health behavior, designing the text messaging program, pretesting the text messaging program concept and messages, and revising the text messaging program.    Conclusions  The steps outlined in this guide may help in the development of SMS-based behavior change programs.

Developing and Pretesting a Text Messaging Program for Health Behavior Change: Recommended Steps