Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial

Abstract

BackgroundYounger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and feasibility of a randomised controlled trial of safer sex support delivered by text message are not known.ObjectivesTo assess the acceptability and feasibility of a randomised controlled trial of a safer sex intervention delivered by text message for young people aged 16–24 years.Design(1) Intervention development; (2) follow-up procedure development; (3) a pilot, parallel-arm randomised controlled trial with allocation via remote automated randomisation (ratio of 1 : 1) (participants were unmasked, whereas researchers analysing samples and data were masked); and (4) qualitative interviews.SettingParticipants were recruited from sexual health services in the UK.ParticipantsYoung people aged 16–24 years diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year.InterventionsA theory- and evidence-based safer sex intervention designed, with young people’s input, to reduce the incidence of STIs by increasing the correct treatment of STIs, partner notification, condom use and STI testing before unprotected sex with a new partner. The intervention was delivered via automated mobile phone messaging over 12 months. The comparator was a monthly text message checking contact details.Main outcome measures(1) Development of the intervention based on theory, evidence and expert and user views; (2) follow-up procedures; (3) pilot trial primary outcomes: full recruitment within 3 months and follow-up rate for the proposed primary outcomes for the main trial; and (4) participants’ views and experiences regarding the acceptability of the intervention.ResultsIn total, 200 participants were randomised in the pilot trial, of whom 99 were allocated to the intervention and 101 were allocated to the control. We fully recruited early and achieved an 81% follow-up rate for our proposed primary outcome of the cumulative incidence of chlamydia at 12 months. There was no differential follow-up between groups. In total, 97% of messages sent were successfully delivered to participants’ mobile phones. Recipients reported that the tone, language, content and frequency of messages were appropriate. Messages reportedly increased knowledge of and confidence in how to use condoms and negotiate condom use and reduced stigma about STIs, enabling participants to tell a partner about a STI.ConclusionsOur research shows that the intervention is acceptable and feasible to deliver. Our pilot trial demonstrated that a main trial is feasible. It remains unclear which behaviour change techniques and elements of the intervention or follow-up procedures are associated with effectiveness. A further limitation is that in the trial one person entering data and the participants were unmasked. A randomised controlled trial to establish the effects of the intervention on STIs at 12 months is needed.Trial registrationCurrent Controlled Trials ISRCTN02304709.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 57. See the NIHR Journals Library website for further project information.

Safetxt: a pilot randomised controlled trial of an intervention delivered by mobile phone to increase safer sex behaviours in young people

“…We randomised 200 participants between 9 September 2013 and 26 November 2013 (figure 1). 23 Ninety-nine participants were allocated to the intervention and 101 were allocated to the control group. We conducted follow-up between October 2013 and February 2015.…”

“…We recruited 200 participants within 3 months and we achieved 81% follow-up completion (162/200, 95% CI 74.86 to 86.19) for cumulative incidence of chlamydia at 12 months23 26 (table 2). …”

“…20 23 It consists of short, non-judgmental text messages designed to reduce STI in young people by supporting them in using condoms, telling a partner about an infection and testing before unprotected sex with a new partner. There are four intervention message sets, tailored to gender and infection status at enrolment sent over 12 months: women-positive (63 messages), men-positive (61 messages), women-negative (51 messages) and men-negative (49 messages).…”

“…We developed the intervention based on: behavioural science;19 20 the content of effective face-to-face safer sex interventions;21 the factors known to influence safer sex behaviours;4 22 the views of 82 young people collected in focus group discussions23 24 and a questionnaire completed by 100 people aged 16–24 2324 In interviews with 16 participants, young people reported that the intervention tone, frequency and content were acceptable 25.…”

Safetxt: a safer sex intervention delivered by mobile phone messaging on sexually transmitted infections (STI) among young people in the UK - protocol for a randomised controlled trial

“…Mobile phones have the potential to provide effective, low cost health behaviour support 11 12. However, evidence for the effect of mobile phone support for safer sex behaviours such as condom use, partner notification and STI testing is equivocal 13–15. Interventions have targeted testing for STI,16–21 delaying resumption of sexual activity until 42 days after circumcision22 and condom use,17 18 23 24 but none have aimed to increase partner notification.…”