Sexually active women, ages 15 to 19 years, report higher rates of unintended pregnancy than other age groups. Women ages 15 to 24 years are at greater risk of acquiring sexually transmitted infections (STIs). A text messaging intervention designed to engage adolescents could help them improve their reproductive health and prevent pregnancies, research shows.1,2
“We developed a text messaging intervention focused on the Health Belief Model,” says Deborah Rinehart, PhD, MA, an associate director of the research methods core and a senior research associate in the Center for Health Systems Research at Denver Health.
The Health Belief Model is a social cognitive framework that is focused on decision-making and behavior that supports contraceptive research and practice.3
“We looked at existing texting interventions and had a multidisciplinary group that developed the actual texts,” adds Rinehart, an associate professor at the University of Colorado Denver School of Medicine.
The texts include advice, such as how to use a condom: “Check expiration date; open carefully; pinch tip; roll all the way down; use a new one each time.” They also can engage adolescents’ attention with a quiz feature, such as this: “True or False — Most kids my age are having sex.” The messages also mention topics the adolescents may not have known or considered: “Did you know that some STIs prevent you from having babies when you’re older? Don’t take that chance.”3
“The [youths] told us they were reading the text messages and liked the messages and learned new information,” Rinehart says.
Rinehart and colleagues recruited adolescent females at Federally Qualified Health Centers (FQHCs), enrolling patients with the permission of clinic staff.
“We’d explain the study to them and consent them, and they were randomized to get the texting intervention or usual care,” Rinehart explains. “Within 24 hours, we’d send an introductory text.”
The first text message informed participants they would receive resources and quizzes about reproductive health. The interactive texts included links to websites, graphics to reinforce messages, and true/false and multiple-choice questions.
“The texts were sent out mostly in after-school times,” Rinehart says. “Some people said to send it first thing in the morning because then it’s first in their queue of texts. We did that, too.”
Over 12 weeks, the participants received 58 texts that focused on reproductive health and dual protection. The messages also included some links for substance use and mental health resources.
“We had three research pilot studies, and mine was focused on reproductive health of youth. Another was on weight loss, and another was focused on asthma,” Rinehart says. “We had a large infrastructure grant, and this [study] was a pilot project that was part of that larger grant.” The control group did not receive any text messages — just usual care.
Rinehart and colleagues found that youths liked the text messages. Receiving information in a private, remote way allowed them to learn more about sexual health without fearing stigma.
“It’s getting information out to them so they can be empowered to do with it what they want,” Rinehart says. “It did impact knowledge from baseline to follow-up.”
The text messaging also affected participants’ use of prescription birth control. For example, if someone chose a contraceptive patch, the person would receive a text reminder to replace it.
“You could see a fairly high rate of long-acting reversible contraception because Denver Health has done a lot in reducing barriers,” Rinehart says. “We have standard work where health educators work alongside providers in our clinics. It reduces barriers to access, so someone can get in to meet with health educators faster than seeing a provider.” Health educators spend more time with patients and talk about each person’s sexual and reproductive health needs.
Participants in the text messaging intervention were more than three times more likely to use birth control. “There was an increase in knowledge and an increase in use of prescription birth control,” Rinehart notes.
Although the text messaging intervention worked well, it is challenging to sustain without grant funding. “I don’t know how reasonable it is for a healthcare system to maintain this infrastructure, so maybe we should partner with nonprofits that can support this,” she adds.
Another option is for reproductive health providers and clinicians to refer patients to existing apps that offer a similar service. One option is the Planned Parenthood app, which anyone can use. Trained health educators are available to answer sexual health questions via online chat or through texting.4
The goal is to offer youths options that allow them to comfortably seek answers to their sexual and reproductive health questions. For many, the anonymity of texting or web chats works well. Receiving informational text messages also improves engagement with patients over time.
“There are some positive aspects to getting these messages from your healthcare provider,” Rinehart says. “You want them to stay connected and be comfortable with their provider. This is a way to stay connected.”
REFERENCES
- Rinehart DJ, Frost HM, Thomas-Gale T, et al. Progress in the use of text-messaging to support adolescent sexual and reproductive health. Acad Pediatr 2022;S1876-2859(22)00628-3.
- Rinehart DJ, Leslie S, Durfee MJ, et al. Acceptability and efficacy of a sexual health texting intervention designed to support adolescent females. Acad Pediatr 2020;20:475-484.
- Rinehart DJ, Leslie SE, Kuka K, et al. Adolescent female perspectives in an urban safety net: Developing an intervention focusing on sexual health and text-messaging. J Health Care Poor Underserved 2020;31:1379-1398.
- Planned Parenthood. Need help? Chat with a health educator. 2023.
Sexually active women, ages 15 to 19 years, report higher rates of unintended pregnancy than other age groups. Women ages 15 to 24 years are at greater risk of acquiring sexually transmitted infections. A text messaging intervention designed to engage adolescents could help them improve their reproductive health and prevent pregnancies, research shows.
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