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Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial

Free, C; McCarthy, O; French, RS; Wellings, K; Michie, S; Roberts, I; Devries, K; ... Baraitser, P; + view all (2016) Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial. Health Technology Assessment , 20 (57) pp. 1-186. 10.3310/hta20570. Green open access

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Abstract

Background Younger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and feasibility of a randomised controlled trial of safer sex support delivered by text message are not known. Objectives To assess the acceptability and feasibility of a randomised controlled trial of a safer sex intervention delivered by text message for young people aged 16–24 years. Design (1) Intervention development; (2) follow-up procedure development; (3) a pilot, parallel-arm randomised controlled trial with allocation via remote automated randomisation (ratio of 1 : 1) (participants were unmasked, whereas researchers analysing samples and data were masked); and (4) qualitative interviews. Setting Participants were recruited from sexual health services in the UK. Participants Young people aged 16–24 years diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year. Interventions A theory- and evidence-based safer sex intervention designed, with young people’s input, to reduce the incidence of STIs by increasing the correct treatment of STIs, partner notification, condom use and STI testing before unprotected sex with a new partner. The intervention was delivered via automated mobile phone messaging over 12 months. The comparator was a monthly text message checking contact details. Main outcome measures (1) Development of the intervention based on theory, evidence and expert and user views; (2) follow-up procedures; (3) pilot trial primary outcomes: full recruitment within 3 months and follow-up rate for the proposed primary outcomes for the main trial; and (4) participants’ views and experiences regarding the acceptability of the intervention. Results In total, 200 participants were randomised in the pilot trial, of whom 99 were allocated to the intervention and 101 were allocated to the control. We fully recruited early and achieved an 81% follow-up rate for our proposed primary outcome of the cumulative incidence of chlamydia at 12 months. There was no differential follow-up between groups. In total, 97% of messages sent were successfully delivered to participants’ mobile phones. Recipients reported that the tone, language, content and frequency of messages were appropriate. Messages reportedly increased knowledge of and confidence in how to use condoms and negotiate condom use and reduced stigma about STIs, enabling participants to tell a partner about a STI. Conclusions Our research shows that the intervention is acceptable and feasible to deliver. Our pilot trial demonstrated that a main trial is feasible. It remains unclear which behaviour change techniques and elements of the intervention or follow-up procedures are associated with effectiveness. A further limitation is that in the trial one person entering data and the participants were unmasked. A randomised controlled trial to establish the effects of the intervention on STIs at 12 months is needed. Trial registration Current Controlled Trials ISRCTN02304709.

Type: Article
Title: Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial
Open access status: An open access version is available from UCL Discovery
DOI: 10.3310/hta20570
Publisher version: http://doi.org/10.3310/hta20570
Language: English
Additional information: © Queen’s Printer and Controller of HMSO 2016. This work was produced by Free et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.
Keywords: Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, SEXUALLY-TRANSMITTED INFECTIONS, HUMAN-IMMUNODEFICIENCY-VIRUS, SMOKING-CESSATION SUPPORT, LIFE-STYLES NATSAL, HIV-PREVENTION, HEALTH-SERVICES, NATIONAL SURVEYS, CLINICAL-TRIALS, CHLAMYDIA, RISK
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1508758
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