Acceptability, Language, and Structure of Text Message-Based Behavioral Interventions for High-Risk Adolescent Females: A Qualitative Study

doi:10.1016/j.jadohealth.2013.12.017

Journal of Adolescent Health

Volume 55, Issue 1, July 2014, Pages 33-40

https://doi.org/10.1016/j.jadohealth.2013.12.017 Get rights and content

Abstract

Purpose

To elucidate key elements surrounding acceptability/feasibility, language, and structure of a text message-based preventive intervention for high-risk adolescent females.

Methods

We recruited high-risk 13- to 17-year-old females screening positive for past-year peer violence and depressive symptoms, during emergency department visits for any chief complaint. Participants completed semistructured interviews exploring preferences around text message preventive interventions. Interviews were conducted by trained interviewers, audio-recorded, and transcribed verbatim. A coding structure was iteratively developed using thematic and content analysis. Each transcript was double coded. NVivo 10 was used to facilitate analysis.

Results

Saturation was reached after 20 interviews (mean age 15.4; 55% white; 40% Hispanic; 85% with cell phone access). (1) Acceptability/feasibility themes: A text-message intervention was felt to support and enhance existing coping strategies. Participants had a few concerns about privacy and cost. Peer endorsement may increase uptake. (2) Language themes: Messages should be simple and positive. Tone should be conversational but not slang filled. (3) Structural themes: Messages may be automated but must be individually tailored on a daily basis. Both predetermined (automatic) and as-needed messages are requested. Dose and timing of content should be varied according to participants' needs. Multimedia may be helpful but is not necessary.

Conclusions

High-risk adolescent females seeking emergency department care are enthusiastic about a text message-based preventive intervention. Incorporating thematic results on language and structure can inform development of future text messaging interventions for adolescent girls. Concerns about cost and privacy may be able to be addressed through the process of recruitment and introduction to the intervention.

Section snippets

Study design, setting, and population

Participants were recruited for this qualitative intervention development study from the pediatric ED of an urban academic hospital in the Northeast, which serves over 50,000 pediatric patients per year. The patient population is diverse, with 40% publicly insured, 40% Hispanic, and 50% white. During a convenience sample of shifts from July 2012 to April 2013, patients presenting to the ED for any chief complaint were screened for participation using a brief confidential iPad survey. Screening

Results

Twenty adolescent female ED patients completed the interviews, representing 71% of those both eligible for and consenting to interviews (Figure 1). Demographics of the participants mirrored the ethnicity and insurance status of our adolescent female ED population (Table 1). Participants reported approximately equal frequency of physical peer victimization (median 4, mean 7 [SD 9.9]) and perpetration (median 4, mean 9.4 [SD 11.9]). Although the majority of participants (85%) reported cell phone

Discussion

In this article, we present novel qualitative data about essential format, structure, and acceptability elements of a text message-based preventive intervention for high-risk adolescents. Most importantly, this study supports that a text message-based preventive intervention would potentially be well received by high-risk female adolescents in the ED. In fact, many participants felt a text-message violence prevention program could provide a trustworthy support otherwise missing from their

Limitations

This study was conducted at a single urban center, potentially limiting generalizability. Although participation reflected the demographics of our ED, and interviews continued until saturation was reached, it is possible that different themes would arise with participants in other settings. In addition, our study was conducted with only female participants, yet males may have different acceptability needs. Some participants mentioned including boys as intervention participants. This may be

Acknowledgments

We acknowledge Christina Sales, Cathy Nam, Eve Purdy, and Alexandra Pierszak for their dedication to patient recruitment and Sarah Bowman for her assistance with coding.

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Original articleAcceptability, Language, and Structure of Text Message-Based Behavioral Interventions for High-Risk Adolescent Females: A Qualitative Study

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study design, setting, and population

Results

Discussion

Limitations

Acknowledgments

Am J Prev Med

Am J Prev Med

Amer J Prev Med

Ann Emerg Med

Gen Hosp Psychiatry

J Adolesc Health

J Psychosom Res

Gen Hosp Psychiatry

J Adolesc Health

Social Sci Med

J Nutr Educ Behav

Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments

Br J Health Psychol

Adolescents who use the emergency department as their usual source of care

Arch Pediatr Adolesc Med

Violence prevention in the emergency department: Clinician attitudes and limitations

Arch Pediatr Adolesc Med

Adolescents' preference for technology-based emergency department behavioral interventions: Does it depend on risky behaviors?

Pediatr Emerg Care

Emergency department patients' preferences for technology-based behavioral interventions

Ann Emerg Med

Teens and mobile phones

A mobile phone program to track young people's experiences of mood, stress and coping. Development and testing of the mobiletype program

Soc Psychiatry Psychiatr Epidemiol

Text-message-based drinking assessments and brief interventions for young adults discharged from the emergency department

Alcohol Clin Exp Res

Original article
Acceptability, Language, and Structure of Text Message-Based Behavioral Interventions for High-Risk Adolescent Females: A Qualitative Study