Liveblog: mHealth for Youth Track — Text Messaging Success

[one paper is omitted from the liveblog – sorry!]

Katie Malbon, Mount Sinai Adolescent Health Center, New York

The problem: the type of birth control going most to teens, oral contraceptives, is the one least likely to have good compliance. The solution: reminder/educational texts.

Flyer issued to female patients about texting -> if interested, complete screener for eligibility (15-19, speak English, own cell phone, starting BC today)

intervention group receives text messages — 3 per week for 3 weeks, 2 per week for 5 weeks, then 1 per week reminding them.

control group receives standard counseling

both groups — at 4 months, phone questionnaire; at 12 months, use EHR to look at what methods they are on and whether they’re continuing it, and positive pregnancy tests.

Our study is ongoing — we started in March last year.  Unfortunately, we didn’t see a big impact initially by looking at our data. So we went deeper. It turns out only 52 are still using a birth control method, and both groups are relatively adherent…except with the pill. a statistically significant number of teens on the pill in the control group missed doses, as vs the other group, but this is a very small group.  As a result, we’re going to end this study & start a new one — is it content, does, timing, or health education? we want a third arm with text messages giving different info. we also want to be sure that they are receiving text messages. finally, we believe we are seeing Hawthorne effect/volunteer bias.

Satisfaction: 79% said timing is just right, 55% shared with friends, 93% said number of messages was just right. 88% enjoyed texts, 75% read all texts.

Conclusion: adherence to the pill MAY BE improved with a text method. we have not yet affected continuation of any birth control. However, adolescents enjoyed receiving the messages.

Text us ur questions 4 real sex info – Myra Hellerstein, MPH – CUNY/Adolescent Health Center at The Door

The Door is an adolescent center — programs offered college advisement, counseling, creative arts, GED, dinner, more…sees 11K young people per year / 60% female. majority of our young people are between 16 & 21, and while we are in Manhattan, most of our young people come from Brooklyn. most of our services go to young people of color.

We market the text line to the members of this community, through our peer educators who go into a school, after school & community-based programs, local colleges & community health fares. Everyone we are targeting is between 12 & 21.

Research study: qualitative content analysis of text messages received by The Door’s text line between April-June 2012. Text messages were coded & analyzed by independent coders.

Of all of the messages, the word we heard the most by far was pregnant, followed by sex, followed by period and boyfriend.

There was a range of message topics including family planning, STDs, relationships, more. Questions were usually asking for information or advice.  37% of the messages were asking about pregnancy & birth control. 29% of questions were about disease and diagnosis (similar to Googling for symptoms). 23% of questions were about forging & navigating relationships. 10% were about dealing with sadness or stress.

Findings: users sought advice & support just as often as they sought accurate sexual health information. adolescents want to engage in conversations. getting advice & support for relationships was paramount for everyone, even wrapped in informational theories. volume of incoming messages are directly related to outreach promotions.  text line provides anonymous access to trusted adults, not peer responses. text messages testing our boundaries were fewer than we thought. questions were sent from both males & females fairly evenly split based on the ones where they explicitly identified anything about their gender, although we don’t know for sure because there’s obviously a volunteer bias. we have no demographic data at all; we made a decision NOT to text out a survey or anything like that.

Measuring success – repeat users, informal focus groups, thank you texts of appreciation

Long Term Engagement & Health Behavior: Best Practices for Texting With Teens — Sam McKelvie, Mobile Commons, @sam_mckelvie

Why use SMS? That’s where the youth are, easy way to further your reach, don’t have to have smartphone.

The way to engage is through 2-way communication in fully integrated campaigns, with a group you understand.

teens respond best to real time chat with a person, automated customized responses, and even interactive campaigns like little quizzes. even if you have relatively small resources, automation is a way; another way is to have the line “open” at certain times.


Planned Parenthood (PPInfo, combines automated responses & a real person to give BC/pregnancy info) (The Pregnancy Text, campaign where the “baby” texted you randomly at inopportune times, to help teens understand real implications of having a baby)

Your decision about what to do should depend on YOUR GOALS and the group: all decisions are goal driven.
Fully integrated campaigns use all media available to you as a point of entry AND a point of engagement – tweet about it, blog about it, write a call to action.

Understand your texters — just ask them! they enjoy quizzes or free response messages. Get info you need, engage your texters, target future messaging, and use transitions to increase action.

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ZonaSegura ZonaSegura is a trauma-informed youth-centered innovative mobile solution to address teen dating violence in Honduras. Learn more about ZonaSegura on our program page.