title: Text Messaging Support for Urban Adolescents and Young Adults Using Injectable Contraception: Outcomes of the DepoText Pilot Trial.
abstract: OBJECTIVE
  To evaluate the feasibility, acceptability, and preliminary effectiveness of DepoText, a text messaging reminder system designed to improve moderately long-acting reversible contraception appointment attendance among young urban adolescent girls and young adult women using Depo-Provera.
  
  
  METHODS
  Female patients aged 13-21 years willing to be randomized, using Depo-Provera, and owning a cell phone with text messaging were recruited from an urban academic practice in a community with high rates of unplanned pregnancy for this institutional review board-approved randomized controlled pilot trial. Participants completed a baseline Web-based survey and were followed for three injection cycles. Intervention participants received welcome, appointment, and healthy self-management messages using the Compliance for Life short messaging system platform over each injection cycle. Compliance for Life recorded outgoing and incoming communications, and patients were tracked for clinical behaviors. The log-transformed number of days between scheduled appointment and injection was analyzed using linear regression.
  
  
  RESULTS
  Recruitment data show 95% eligibility and 91% enrollment rates with maximum enrollment completion in 3 months. Most were African-American and resided in low-income, single-parent, and mother-headed households. Most participants had cell phone plans that included unlimited text messaging and Internet access and completed all three Depo-Provera cycles. Intervention participants returned closer to their scheduled appointments than their control peers for the first visit (Β = -.75; 95% confidence interval, -1.4 to .06; p = .03) but not for the second and third visits.
  
  
  CONCLUSIONS
  The DepoText intervention is acceptable, feasible, and shows short-term preliminary efficacy for improving clinic attendance for moderately long-acting reversible contraception appointments. Additional research exploring the cost and longitudinal prevention effectiveness is warranted.
authors.affiliation: Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: mtrent2@jhmi.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Trent
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Carol
authors.initials: C
authors.lastname: Thompson
authors.affiliation: Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kathy
authors.initials: K
authors.lastname: Tomaszewski
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D001071:Appointments and Schedules; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005193:Family Planning Services / Q000379:methods; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D010349:Patient Compliance; D010865:Pilot Projects; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D017010:Reminder Systems; D060145:Text Messaging; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: Adolescent; Contraception; Depo-Provera; Meaningful use; Texting; Urban