Using Text Messaging to Connect At-Risk Youth to Testing

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This document summarizes a study that used text messaging to connect with adolescents in the Bayview Hunters Point neighborhood of San Francisco. The neighborhood has high rates of chronic disease, incarceration, unemployment, and STDs compared to the city overall. The study sent 5 weekly text messages to 97 adolescents to provide health information and reminders. 88 adolescents completed post-tests. Results showed increased HIV knowledge, improved condom attitudes, and a trend toward less unprotected sex. The study demonstrated the potential for using technology to improve health outcomes among adolescents.

Gesundheit & Medizin

BAYVIEW HUNTERS POINT
• TOTAL POPULATION=35,890 (SAN FRANCISCO
FOUNDATION, 2010)
• ONE OF THE LARGEST NEIGHBORHOODS THAT
COMPRISE D10
• AVERAGE PER CAPITA INCOME=$19,484 VS.
$26,880 DISTRICT-WIDE AND $44,373 CITY-WIDE
• GREATER THAN 50% OF RESIDENTS HAVE AN
EDUCATIONAL LEVEL OF HIGH SCHOOL OR LESS

UNIQUE PROBLEMS WE FACE
• SUPERFUND SITE: HIGHEST RATES OF CHRONIC
DISEASES (I.E. ASTHMA, DIABETES AND CANCER)
• HIGHEST RATES OF ARRESTS AND INCARCERATION
IN SF
• HIGHER UNEMPLOYMENT RATES
• HIGHER RATES OF STDS IN BOTH ADULTS AND
YOUTH
• INCREASED EXPOSURE TO TRAUMA

ADOLESCENTS…
HOW DO WE CONNECT WITH YOUTH?
DO THEY WANT TO ATTEND GROUPS OR COME TO
THERAPY?

TEXT MESSAGE INTERVENTIONS
• INDICATIONS OF SUCCESS: ASTHMA
MANAGEMENT, WEIGHT LOSS, MEDICATION
ADHERENCE, DIABETES MANAGEMENT, SMOKING
CESSATION
• DISEASE MANAGEMENT, DISEASE PREVENTION
• PROVIDE INFORMATION
• REMINDERS

OUTCOMES
• GREATER HIV KNOWLEDGE
• IMPROVED CONDOM ATTITUDES
• INCREASED PERCEIVED HIV RISK SCORE
• TREND IN NUMBER ENGAGED IN UNPROTECTED SEXUAL INTERCOURSE

TEXTING DATA
• APPROACHED: 153
• REFUSED: 28 (18%)
• INELIGIBLE: 25 (16%)
• CONSENTED: 100
• SENT TEXT: 97
• 5 TEXTS
79
• 5+ TEXTS: 18
• POST-TEST: 88

EXAMPLE TEXTS
• HEY YOU GUYS THIS __, DID YOU KNOW THIRD ST YOUTH CLINIC IS NOW LOCATED ON
1728 BANCROFTS AVE. RIGHT AROUND THE CORNER FROM WINGSTOP
• HEY GIRL THIS _____________ WEN U CUM BCK FRM TEXAS HERE AT THE CLINIC ON
3RD U SHULD STP BI THEY HAV GUD CLASSES N PROGRAM N ULL FEL LYK HOME
• COME TO THE THIRD ST YOUTH CLINIC FOR STD CHECK
• HEY. SO I'M AT THE CLINIC AND I'M GONNA GET TESTED. YOU SHOULD COME GET
CHECKED TOO. I'LL COME WITH YOU IF YOU WANT. IT'S OVER ON 3RD NEXT TO THE NEW
WINGSTOP.
• HEY I'M AT THE THIRD STREET CLINIC IT'S A GOOD IDEA TO GET CHECKED OUT
• I JUST GOT CHECKED OUT AT THE 3RD ST CLINIC AND THEY WERE REALLY NICE THEY
OFFER FREE TESTING AND HELPED ME A LOT, YOU SHOULD COME DOWN TOO.

CONCERNS
• NOTHING (N=55)
• RESPONSE FROM FRIEND (N=17)
• OTHER (N=28)
• THAT FRIENDS WOULD REMEMBER
• THEY WON’T TAKE MY ADVICE
• NOT AGREE TO GO TO CLINIC
• THINK I HAVE SOMETHING
• TOO MANY PEOPLE CALL CLINIC PHONE

•“ARE YOU OK”
•“ARE YOU FINNA BE A DADDY?
•“LOL. WHAT? THAT WAS HECCA RANDOM”
•“LMFAO. NICE. OKAY WELL WHEN I GET HOME”
•“OK!! LET ME CHECK IT RIGHT OUT”
•“FA SHO. WHAT TIME IT ENDS? I GET OUT @ 4”
•“I JUST GOT CHECK, THAT SHIT AIN’T NOTHING TO BE PLAYED WITH”
•“BITCH WHAT YOU TELLING ME FOR? I GO TO MY DR. EVERY 3 MONTHS FOR THE
•FREE AND I DAMN SHO AINT GOT HIV”
RESPONSES

CONCLUSIONS & LESSONS LEARNED
• GET RID OF SMALL GROUP INTERVENTIONS?
• TRADE OFFS: INTENSITY VS. REACH
• BEHAVIOR CHANGE MODELS STILL HOLD
• USE THE STRENGTHS OF TECHNOLOGY
• DON’T FORGET THE SCIENCE
• DANGERS?
• OPPORTUNITIES

THANK YOU
Dr. Marguerita Lightfoot
Dr. Ayanna Bennett
National Institute of Drug Abuse
National Institute of Mental Health
William T. Grant Foundation
MAC Foundation
Research Team
Agencies, schools, providers
3rd Street Youth Center & Clinic
Youth willing to share their lives

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