Q&A: Sheana Bull On Enhancing Teen Pregnancy Prevention With Text Messaging

A young man reading a text message on his phone.

Can text messaging help prevent teen pregnancy? For the past few years, Sheana Bull of the Colorado School of Public Health in Aurora, CO, has been working with colleagues to answer that quetion. The team has been studying the effects of adding a text messaging component to Teen Outreach Program, or TOP, an evidence-based adolescent pregnancy prevention program. Text messages sent to youth in the program included fun facts and tips, polls, and quotes from popular artists.

The study so far, detailed in “Enhancing a Teen Pregnancy Prevention Program With Text Messaging: Engaging Minority Youth to Develop TOP Plus Text,” has found that the text component may make young people more likely to get and to stay involved with programs. But because not all teens have access to text-capable phones or phone plans, Bull and her colleagues say programs need to offer youth more than one way of receiving information.

We talked to Bull about the scope of her research, young people's input into the project, and how texts can fit into adolescent pregnancy prevention programs.

NCFY: What did you find most interesting about the study?

Bull: It’s still ongoing, so we have another year to go. I think for me it is the opportunity to answer the question about how to integrate technology into an effective program: Can technology be used not only as a standalone tool for health promotion but also to make programs better? Will it help sustain programs, and make information more available?

NCFY: How specifically were youth involved in text creation?

Bull: We had a few rounds of youth involvement before we really even began. We sat down with youth and asked them for ideas, and to give them the opportunity to tell us what message would resonate best. They helped us with things like branding, establishing the ideal number of texts per week and length of messages. Then they helped us with choosing fun facts, creating polls asking [youth] whether they were still interested and what would get them engaged. We could guarantee that [the texts] were delivered but we couldn’t guarantee that they were read.

Before the research began, we did a month-long pilot test to see whether the system functioned.

Each year for the past two years we’ve had [youth] tell us what they liked and disliked about including the text messages. We were able to improve messages and make cosmetic changes. Youth told us they liked inspirational quotes from role models, so we have quotes from artists and leaders. We want to keep those but we also want to update them. An artist who was popular three years ago might not be so relevant this year.

NCFY: Do you think the texts help reduce teen pregnancy? Why?

Bull: We’re in the third year of four years of data collection, and we’ve designed it in such a way that there are eight separate boys’ and girls’ programs that are participating in the TOP program. Four of these programs are enhanced with text messaging, and four are not, so we’re going to be able to compare the people who had TOP alone with the people who had the enhanced program.

We can compare pregnancy outcomes and performance outcomes. We likely will not have enough information on pregnancy to tell whether it made a difference in that area, but we will have information on use of contraception.

NCFY: How can other adolescent pregnancy prevention programs put this to use?

Bull: The program as we’ve developed it is really specifically tailored to the TOP program, so I don’t believe it can be taken as-is and utilized as a standalone or with a different teen pregnancy prevention program. We had a very clear protocol for how we developed the messages. But I’m confident we can adopt a text messaging protocol for other programs.

NCFY: Is there a list of texts available that other APP programs can use?

Bull: What we’re going to do is talk with Wyman, the TOP developer, and once we have our efficacy data from the trial we’re going to see whether they want to use it as part of the TOP program. We can work with any group that wants to use texts as part of their protocols.

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