Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis.
BACKGROUND
Over 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention.


OBJECTIVE
The aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females.


METHODS
We conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel.


RESULTS
Participants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were "brief," "professional," and "nonaccusatory." Respondents favored texts with links to websites, repeated information regarding places to receive "confidential" care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to maintain "surprise." No participant feared that text messages would violate her privacy.


CONCLUSIONS
Adolescent female patients at high pregnancy risk are interested in ED-based pregnancy prevention provided by texting. Understanding preferences for the content, frequency, and timing of messages can guide in designing future interventions in the ED.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, NY, United States. lc2243@columbia.edu.
Lauren Stephanie
http://orcid.org/0000-0001-7050-0025
LS
Chernick
Rebecca
http://orcid.org/0000-0003-2184-4045
R
Schnall
Melissa S
http://orcid.org/0000-0002-2113-7247
MS
Stockwell
Paula M
http://orcid.org/0000-0002-0370-0390
PM
Castaño
Tracy
http://orcid.org/0000-0003-0660-4561
T
Higgins
Carolyn
http://orcid.org/0000-0002-3622-8846
C
Westhoff
John
http://orcid.org/0000-0003-2768-1910
J
Santelli
Peter S
http://orcid.org/0000-0001-7750-6665
PS
Dayan
contraception; emergency medicine; pregnancy in adolescence; preventive medicine; reproductive health; text messaging
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