Text Message Responsivity in a 2-Way Short Message Service Pilot Intervention With Adolescent and Young Adult Survivors of Cancer

Abstract

B ackground: Text message interventions hold promise for adolescents and young adults (AYAs) with chronic health conditions, including childhood cancer survivors; however, engagement is often suboptimal. Limited research has studied mobile health intervention outcomes beyond efficacy. Understanding responsivity to different types of text messages (ie, when a participant texts back) can provide practical, actionable information to optimize engagement in future projects. Objective Within a 2-way text messaging study in AYAs who recently completed treatment for cancer, we sought to evaluate text message responsivity across different types of text messages. Methods AYAs who recently completed treatment for cancer (n=26; mean age=16 years; 62% female, 16/26 participants) received 2-way text messages about survivorship health topics over a 16-week period. Using participants’ text message log data, we coded responsivity to text messages and evaluated trends in responsivity to unprompted text messages and prompted text messages of varying content (eg, medication reminders, appointment reminders, and texts about personal experiences as a cancer survivor). Results Across prompted and unprompted text messages, responsivity rapidly decreased ( P ≤.001 and =.01, respectively) and plateaued by the third week of the intervention. However, participants were more responsive to prompted text messages (mean responsivity=46% by week 16) than unprompted messages (mean responsivity=10% by week 16). They also demonstrated stable responsivity to certain prompted content: medication reminders, appointment reminders, goal motivation, goal progress, and patient experience texts. Conclusions Our methodology of evaluating text message responsivity revealed important patterns of engagement in a 2-way text message intervention for AYA cancer survivors.

Feasibility and acceptability of a pilot tailored text messaging intervention for adolescents and young adults completing cancer treatment

“…We also had no information on the extent to which AYA read and liked each message. Data on whether or not they responded to different types of text messages are reported in a companion paper . As texting is the preferred mode of communication among AYA, it will be critical to continue to study optimal content and delivery of text messages to maximize engagement and impact.…”

Technology-Assisted Psychosocial Interventions for Childhood, Adolescent, and Young Adult Cancer Survivors: A Systematic Review and Meta-Analysis

“…34,35 More importantly, as members of a tech-prone and tech-savvy generation, childhood and AYA cancer survivors are more likely to engage in technologyassisted psychosocial interventions, as many of these interventions are delivered in their preferred methods of communication (e.g., social media-based peer support groups or text messages to improve treatment compliance). 36,37 Finally, recent advances in machine learning and artificial intelligence have enabled key innovations in the delivery of psycho-oncology care for childhood and AYA cancer survi-vors. For example, psycho-oncology researchers have started to explore the use of machine learning models to inform AYA cancer survivors' survivorship care planning.…”

Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis

“…Therefore, adolescents may be less likely to engage with digital health intervention options outside of this window of time, and digital support to encourage exercise during these times could be wasteful. This persistent inopportune support is likely to lead to intervention failure and decreased user engagement, a continual challenge in the digital health literature [14][15][16]48]. These findings suggest that just-in-time support during this window could be most helpful for adolescents and lead to positive engagement with digital support for exercise.…”

“…Although mobile health interventions for improving health behavior are efficacious, these interventions primarily use technologies to send reminder messages to users [13]. Moreover, high nonusage attrition and declined user engagement throughout the intervention are concerns in the digital health literature [14,15]. Greater intervention precision, such as timely support, may improve digital intervention effectiveness and engagement [16].…”