Original article
Text Messaging Support for Urban Adolescents and Young Adults Using Injectable Contraception: Outcomes of the DepoText Pilot Trial

https://doi.org/10.1016/j.jadohealth.2015.03.008Get rights and content

Abstract

Purpose

To evaluate the feasibility, acceptability, and preliminary effectiveness of DepoText, a text messaging reminder system designed to improve moderately long-acting reversible contraception appointment attendance among young urban adolescent girls and young adult women using Depo-Provera.

Methods

Female patients aged 13–21 years willing to be randomized, using Depo-Provera, and owning a cell phone with text messaging were recruited from an urban academic practice in a community with high rates of unplanned pregnancy for this institutional review board–approved randomized controlled pilot trial. Participants completed a baseline Web-based survey and were followed for three injection cycles. Intervention participants received welcome, appointment, and healthy self-management messages using the Compliance for Life short messaging system platform over each injection cycle. Compliance for Life recorded outgoing and incoming communications, and patients were tracked for clinical behaviors. The log-transformed number of days between scheduled appointment and injection was analyzed using linear regression.

Results

Recruitment data show 95% eligibility and 91% enrollment rates with maximum enrollment completion in 3 months. Most were African-American and resided in low-income, single-parent, and mother-headed households. Most participants had cell phone plans that included unlimited text messaging and Internet access and completed all three Depo-Provera cycles. Intervention participants returned closer to their scheduled appointments than their control peers for the first visit (Β = −.75; 95% confidence interval, −1.4 to .06; p = .03) but not for the second and third visits.

Conclusions

The DepoText intervention is acceptable, feasible, and shows short-term preliminary efficacy for improving clinic attendance for moderately long-acting reversible contraception appointments. Additional research exploring the cost and longitudinal prevention effectiveness is warranted.

Section snippets

Setting and participants

This research study was conducted in a large urban academic General Pediatric and Adolescent Medicine Practice in Baltimore, Maryland, between October 2011 and February 2012 that primarily serves low-income African-American families from the neighboring East Baltimore community. Adolescents and young adults in Baltimore have high rates of unplanned pregnancy and sexually transmitted infections (STIs). This clinical program provides confidential, adolescent-centered sexual and reproductive

Participants

Most participants were African-American (96%) resided in low-income (75%), single-parent, mother-headed households (66%). Participants had high rates of parental knowledge and support for contraceptive use as 92% of parents knew that they were using Depo-Provera and 87% of parents had spoken to them about sex. Access to technology and added burden for study texts was not an issue as 92% of girls had unlimited text message, and the other 8% thought the service was sufficiently valuable and

Discussion

This pilot study demonstrates that the DepoText intervention is both a feasible and an acceptable clinical support tool for adolescents and young adult women choosing MARCs for family planning. Access to technology and added burden for study texts was not an issue as 92% of girls had unlimited text messages and the other 8% thought the service was sufficiently valuable and manageable at the time of consent that they enrolled in the study. The CFL system had on-time delivery of text messages and

Acknowledgments

The authors acknowledge support for the statistical analysis from the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through grant number UL1T000424. Finally, the authors are grateful to our patients who trusted and participated in this project and the Harriet Lane clinical staff and Adolescent Medicine Team who supported this work.

References (21)

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