Understanding Adolescent Nonresponsiveness to Text Messages: Lessons from the DepoText Trial

Abstract

Urban adolescents face economic, social, and behavioral challenges in adhering to long-term contraceptive use. Use of text messaging reminders has the potential to increase adherence to family planning appointments and to educate patients about safe sexual health practices; however, nonresponsiveness to messages is difficult to interpret and may jeopardize programmatic success. We aimed to understand why adolescent girls enrolled in a randomized, controlled pilot trial (DepoText) designed to increase attendance at family planning visits were periodically nonresponsive to text messages through conducting structured interviews with participants whose text reply rates were less than 100 % during the trial period. Qualitative and quantitative data were collected and classified using descriptive data analysis. Reasons for nonresponsiveness, barriers to continuous cell phone coverage, cell phone plan characteristics, and attitudes toward the DepoText program were the primary endpoints of interest. Most participants (78 %) attributed instances of nonresponsiveness to being away from the phone or due to a personal conflict such as school or work. Service interruption due to bill nonpayment (44 %), phone loss (28 %), and cell phone number change (28 %) were significant barriers to continuous coverage during the trial period, and many respondents indicated that the downturn in the economy made it more difficult to maintain their cell phone plan. Almost a third reported having to choose between cell phone and other payments, but the vast majority (88 %) considered their cell phone a Bneed^rather than a Bwant.^Participants universally expressed satisfaction with the text messaging program and reported feeling more connected to the clinic (96 %) through the messages serving as reminders (64 %), encouragement to assume personal responsibility for their health care (12 %), and enhanced personal connection with the clinic staff (4 %). Our study suggests that a text messaging program can be used in an urban clinical setting to communicate with adolescent girls about family planning services. While economic barriers to continuous cell phone coverage do exist, adolescents indicate that the text message reminder system can be a valuable tool for enhancing clinic connectedness and promoting autonomy in careseeking behavior.

Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial

“…Phone numbers change frequently; hence it could not be ascertained how many participants in the experimental group received the text message sent to them. A study looking at communication with adolescents via text messages in the context of Depo-Provera injections showed that phone number changes, unpaid cell phone bills, and phone loss significantly contribute to adolescent text nonresponsiveness rate [22]. …”

Handling Contraceptive Acceptors’ Complaints by Using Android-Based Application

“…Chris Smith et al, (2013) who studied about family planning services in the form of messages and voice calls found that there was an increase in service quality and acceptor satisfaction at a rate 44% by using MOTIF applications (Mobile Technology of Family Planning). Koes Irianto (2014) stated that handling acceptors problems or complaints is essential to prevent them drop out. The regulation of ministry of health regarding family planning service guidelines No.…”

“…The application is called Smart Contraception. It consists with three features such as consultation service provided by a midwife to acceptor, automatic reminder which will ring 3 days before the day to be injected, and contraceptive information which is needed by the acceptors (Koes Irianto, 2014;Yudhanto Yuda, 2018;Irsdyad Hanif, 2015;Permenkes, 2017;Oktariana, 2013;BKKBN, 2011;Yanti Elfrida, 2015, Abdul Bari Saifuddin, 2016Kemenkes, 2016;Oktariana 2013;Harry et al, 2017;Bocanegra et al, 2017).…”

Initial loss to follow up among tuberculosis patients: the role of Ward-Based Outreach Teams and short message service (SMS) technology (research proposal)

“…Although linkage to care has been a favorable outcome of using SMS intervention in healthcare, there have also been instances of unresponsiveness to SMS messages. A study to understand the factors which influence adolescents’ non-responsiveness to text messaging was conducted by Irons et al [28]. This was a sub-study of a trial that evaluated the feasibility, acceptability and effectiveness of a text messaging reminder system to improve clinic attendance at family planning appointments among 5 young women using Depo-Provera contraception.…”

“…The sample was drawn from the intervention arm of a small feasibility and acceptability family planning trial. The sample size may have limited ability to further stratify to identify differences between non-responders [28].…”