October 31, 2013 — Summary of "Using Chat and Text Technologies to Answer Sexual and Reproductive Health Questions: Planned Parenthood Pilot Study," Giorgio, Journal of Medical Internet Research, September 2013.
The need for "new approaches to sexuality education are needed that can meet the needs of those not receiving adequate sexuality education in schools and communities and may meet needs in a moment of high worry," according to Margaret Giorgio of the Department of Nutrition, Public Health and Food Studies at New York University and colleagues from Planned Parenthood Federation of America.
Recognizing this need, PPFA "launched a texting and [instant message] program in September 2010 targeted at teens and young adults between 15-24 years who have an urgent sexual or reproductive health need," Giorgio and colleagues wrote. The program's goals included "giv[ing] immediate answers to urgent sexual and reproductive health questions from a reliable and confidential source" and "link[ing] young people to sexual and reproductive health services if needed," they added. The program focuses on four topic areas: emergency contraception, pregnancy tests, abortion and sexually transmitted infection testing.
The study aimed to determine the program's success over its first year in reaching its target population in situations with high levels of anxiety or worry. It also sought to determine if user characteristics varied by mode (texting or IM) and which method of communication was more likely to reach individuals when they had a pressing reproductive or sexual health question.
The researchers collected data on the program from three sources from September 2010 until August 2011. One source was "a short prechat survey that was offered to all users prior to being connected to an agent." While this survey was required for individuals communicating via IM, it was not required by those communicating via text message.
The other data sources included results from a postchat survey and information from two service providers of IM and text messaging.
From these data sets, a number of variables were assessed, including age, gender, race and ZIP code. Individuals were categorized as teens ages 17 and younger, young adults ages 24 and younger, and adults older than age 25. Race was identified as white, black, Latino/Hispanic or other.
Users were asked to identify their question topic if using IM but not for text messaging. The topics included abortion, STI testing, pregnancy testing, EC and other. In addition, users were asked to classify their level of worry as very worried, somewhat worried or not at all worried. When they were finished using the service, users were asked if their level of worry was greater, less or the same as beforehand. They also were asked to rank the helpfulness of the survey.
The researchers analyzed the data to determine differences in results by mode of conversation. They also assessed whether various factors where associated with prechat levels of worry and changes in worry postchat.
The program conducted 32,589 conversations during the first year. The study showed that most users of the services were white (46.17%), Latino/Hispanic (18.59%) and black (16.87%). They also were mostly female (89.29%). By age group, individuals ages 18 to 24 were most likely to use the services (51.2%), followed by those ages 17 or younger (23.3%).
The results showed sharp differences between texting and IM users by demographics and topic. For instance, text users were more likely to be male (14.15%), Latino/Hispanic (24.65%) and ages 17 or younger (39.02%). In addition, 23.27% of texters asked questions about abortion, while 46.61% of IM users did so. STI testing was the least-common topic, with texters (16.49%) more likely than IM users (8.55%) to ask about it.
Before chatting, individuals using text messaging were more likely to feel not at all worried (15.52%), compared with IM users (11.24%). Meanwhile, IM users were more likely to report feeling very worried (43.7%), compared with texters (38.79%). After chatting with an agent, more texters reported feeling not at all worried (32.16%), compared with IM users (27.7%).
The response rate for the postchat survey was 17.67%. In general, levels of worry were lower postchat, the researchers wrote, adding that only 19.33% of respondents reported being very worried after chatting with an agent. The postchat survey also found that 61.91% of respondents found the service to be helpful.
Discussion and Conclusion
The findings suggested "that the program was successful in reaching its target audience, with a large portion of users being young (≤24 years), black, and Latino/Hispanic," the researcher wrote. The study also demonstrated that the program reached users at a vulnerable time.
The results "indidcate[d] that [text messaging] was more likely to be used by younger users and racial minorities than the IM service," which "highlights the importance of offering the program through different modes of technology," according to the researchers. They noted that while text messaging users "did appear to be less worried overall, after controlling for the study covariates, there was no difference in the program's effectiveness in reducing levels of worry postchat for texting versus IM users."
However, changes in level of worry did differ significantly by the topic area of the user's question. The program was more effective at reducing worry among users who had questions about EC, compared with those who had questions about abortion. However, the likelihood of feeling less worried postchat was lower among users asking about STI testing than for abortion.
One explanation for these findings is that users with questions about EC had a poor understanding of it prechat and were relieved by the information they received through the service, the researchers wrote. They suggested that the low reduction in levels of worry among users with STI testing questions "may be a result of the nature of STI questions," particularly given that many users wanted agents to tell them what STI they have but were instead told to go to a health center for testing.
In their conclusion, the researchers noted that "use of Internet and mobile technology is increasingly becoming an integral part of our everyday interactions and activities," adding, "If interventions can be developed that reach young people with information and education that helps reduce worry, encourages the use of needed health services, and motivates changes in health behaviors, these technologies could be an important addition to public health practice."