title: Acceptability, language, and structure of text message-based behavioral interventions for high-risk adolescent females: a qualitative study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine, Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island. Electronic address: mranney@lifespan.org.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Ranney
authors.affiliation: Department of Emergency Medicine, Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Esther K
authors.initials: EK
authors.lastname: Choo
authors.affiliation: Injury Control Research Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Cunningham
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Anthony
authors.initials: A
authors.lastname: Spirito
authors.affiliation: Brown University, Providence, Rhode Island.
authors.forename: Margaret
authors.initials: M
authors.lastname: Thorsen
authors.affiliation: Department of Emergency Medicine, Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mello
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Morrow
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D010379:Peer Group; D036301:Qualitative Research; D018570:Risk Assessment; D060145:Text Messaging / Q000592:standards*; D014754:Violence / Q000517:prevention & control* / Q000523:psychology
keywords: Adolescents; Behavior change; Health promotion; Text messaging