Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review (Preprint)

Abstract

BACKGROUND More than half of adult mental disorders have their onset before the age of 18 and nearly one third of children and adolescents with a mental illness are estimated to have more than one diagnosable disorder. Improving broad dissemination of developmentally appropriate treatment and scaling up evidence-based interventions is vital to addressing issues before adulthood. Interventions delivered using text messaging have been effective in promoting behavioural change in various clinical contexts, but the reach and implementation of text messaging interventions within child and adolescent mental health and addictions are not well understood. OBJECTIVE The objective of this scoping review was to map and categorize the current state of peer-reviewed research around the use of text messaging based interventions for mental health and addictions services among children and adolescents. METHODS A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was co-created and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework as well as input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data was extracted on study methodology and measures, intervention design, implementation characteristics, as well as policy, practice and research implications. RESULTS Seven hundred and thirty six abstracts were screened. Twenty-five articles published between 2013 to 2018 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (15/25) followed by changes in cognitions (14/25) (e.g., disease knowledge, self-awareness) and acceptability (13/25). Interventions were typically delivered in <12 weeks and adolescents received 1-3 messages per week. Sixty-eight percent (17/25) involved bi-directional messaging. Limited description of implementation features (e.g., cost, policy implications, technology performance) were reported. CONCLUSIONS The use of text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bi-directionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone based interventions for this population a rigorous program of large-scale, well-designed trials is urgently required.