The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial

Background Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. Objective This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)—the single, leading modifiable cause of unintended breastfeeding reduction and cessation. Methods We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message–based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging–based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. Results Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants’ pre-existing breastfeeding knowledge and unique breastfeeding trajectory. Conclusions Prenatal and postpartum evidence–based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. Trial Registration ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969

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The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial (Preprint)

10.2196/preprints.17328 ◽

2019 ◽

Author(s):

Jill R Demirci ◽

Brian Suffoletto ◽

Jack Doman ◽

Melissa Glasser ◽

Judy C Chang ◽

...

Keyword(s):

Text Messaging ◽

Text Message ◽

Text Messages ◽

Breastfeeding Support ◽

Lactation Consultant ◽

First Time Mothers ◽

Perceived Insufficient Milk ◽

Insufficient Milk ◽

First Time ◽

Sms Text Messaging

BACKGROUND Several recent trials have examined the feasibility and efficacy of automated SMS <i>text messaging</i> to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. OBJECTIVE This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)—the single, leading modifiable cause of unintended breastfeeding reduction and cessation. METHODS We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message–based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging–based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. RESULTS Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants’ pre-existing breastfeeding knowledge and unique breastfeeding trajectory. CONCLUSIONS Prenatal and postpartum evidence–based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. CLINICALTRIAL ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969

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Digital Parenting of Emerging Adults in the 21st Century

Social Sciences ◽

10.3390/socsci10120482 ◽

2021 ◽

Vol 10 (12) ◽

pp. 482

Author(s):

Michaeline Jensen ◽

Emily Haston ◽

Andrea M. Hussong

Keyword(s):

Emerging Adults ◽

21St Century ◽

Text Messaging ◽

Objective Assessment ◽

Text Message ◽

Emerging Adult ◽

Well Being ◽

Text Messages ◽

Digital Pressure ◽

First Time

In emerging adulthood, when many young people are away from their families for the first time, mobile phones become an important conduit for maintaining relationships with parents. Yet, objective assessment of the content and frequency of text messaging between emerging adults and their parents is lacking in much of the research to date. We collected two weeks of text messages exchanged between U.S. college students (N = 238) and their parents, which yielded nearly 30,000 parent-emerging adult text messages. We coded these text message exchanges for traditional features of parent-emerging adult communication indexing positive connection, monitoring and disclosures. Emerging adults texted more with mothers than with fathers and many messages constitute parental check-ins and emerging adult sharing regarding youth behavior and well-being. Findings highlight that both the frequency and content of parent-emerging adult text messages can be linked with positive (perceived text message support) and negative (perceived digital pressure) aspects of the parent-emerging adult relationship. The content of parent-emerging adult text messages offers a valuable, objective window into the nature of the parent-emerging adult relationships in the digital age of the 21st century.

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One-Way and Two-Way Mobile Phone Text Messages for Treatment Adherence Among Patients With HIV: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.16127 ◽

2019 ◽

Author(s):

Dickson Shey Nsagha ◽

Vincent Verla Siysi ◽

Same Ekobo ◽

Thomas Obinchemti Egbe ◽

Odette Dzemo Kibu

Keyword(s):

Quality Of Life ◽

Data Collection ◽

Text Messaging ◽

Controlled Trial ◽

Text Message ◽

Text Messages ◽

Randomized Controlled ◽

The Impact ◽

Sms Text Messaging

BACKGROUND Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. OBJECTIVE This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). METHODS A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. RESULTS Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). CONCLUSIONS The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16127

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One-Way and Two-Way Mobile Phone Text Messages for Treatment Adherence Among Patients With HIV: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/16127 ◽

2020 ◽

Vol 9 (9) ◽

pp. e16127

Author(s):

Dickson Shey Nsagha ◽

Vincent Verla Siysi ◽

Same Ekobo ◽

Thomas Obinchemti Egbe ◽

Odette Dzemo Kibu

Keyword(s):

Quality Of Life ◽

Data Collection ◽

Text Messaging ◽

Controlled Trial ◽

Text Message ◽

Text Messages ◽

Randomized Controlled ◽

The Impact ◽

Sms Text Messaging

Background Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. Objective This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). Methods A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. Results Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). Conclusions The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. International Registered Report Identifier (IRRID) DERR1-10.2196/16127

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Text Messaging as a Mental Health Treatment Intervention: A Corpus-Based Study

10.31234/osf.io/gt73p ◽

2019 ◽

Author(s):

Megan Partch ◽

Cass Dykeman

Keyword(s):

Mental Health ◽

Mental Health Treatment ◽

Text Messaging ◽

Low Cost ◽

Statistical Significance ◽

Text Message ◽

Treatment Session ◽

Text Messages ◽

Health Treatment ◽

Emotional Tone

Mental health treatment providers seek high-impact and low-cost means of engaging clients in care. As such, text messaging is becoming more frequently utilized as a means of communication between provider and client. Research demonstrates that text message interventions increase treatment session attendance, decrease symptomology, and improve overall functioning. However, research is lacking related to the linguistic make up of provider communications. Text messages were collected from previously published articles related to the treatment of mental health disorders. A corpus of 39 mental health treatment text message interventions was composed totaling 286 words. Using Linguistic Inquiry and Word Count (LIWC) software, messages were analyzed for prevalence of terminology thought to enhance client engagement. Clout, demonstrating the writer’s confidence and expertise, and positive Emotional Tone were found to be at a high level within the corpus. Results demonstrated statistical significance for five linguistic variables. When compared with national blog norms derived from Twitter, Clout, Emotional Tone, and use of Biological terminology were found to be at higher rates than expected. Authenticity and Informal terminology were found at significantly lesser rates.

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Nudge me: tailoring text messages for prescription adherence through N-of-1 interviews

Translational Behavioral Medicine ◽

10.1093/tbm/ibab056 ◽

2021 ◽

Author(s):

Joy Waughtal ◽

Phat Luong ◽

Lisa Sandy ◽

Catia Chavez ◽

P Michael Ho ◽

...

Keyword(s):

Chronic Conditions ◽

Text Messaging ◽

Healthcare Delivery ◽

Text Message ◽

Text Messages ◽

Multiple Chronic Conditions ◽

Medication Refill ◽

Interactive Text ◽

Prompt Action ◽

Negative Messages

Abstract Almost 50% of patients with cardiovascular diseases face challenges in taking medications and increased morbidity and mortality. Text messaging may impact medication refill behavior and can be delivered at scale to patients by texting mobile phones. To obtain feedback from persons with chronic conditions on the design of interactive text messages and determine language of message for making messages that can motivate patients to refill medications on time. We purposively sampled 35 English and Spanish speaking patients with at least one chronic condition from three large healthcare delivery systems to participate in N-of-1 video-based synchronous interviews. Research assistants shared ideas for theory-informed text messages with content intended to persuade patients to refill their medication. We transcribed recorded interviews and conducted a content analysis to identify strategies to employ generating a dynamic interactive text message library intended to increase medication refill. Those interviewed were of diverse age and race/ethnicity and typical of persons with multiple chronic conditions. Several participants emphasized that personally tailored and positively framed messages would be more persuasive than generic and/or negative messages. Some patients appreciated humor and messages that could evoke a sense of social support from their providers and rejected the use of emojis. Messages to remind patients to refill medications may facilitate improvements in adherence, which in turn can improve chronic care. Designing messages that are persuasive and can prompt action is feasible and should be considered given the ease with which such messages can be delivered automatically at scale.

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Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study

JMIR mhealth and uhealth ◽

10.2196/15890 ◽

2020 ◽

Vol 8 (6) ◽

pp. e15890

Author(s):

Jessica L Watterson ◽

Diego Castaneda ◽

Caricia Catalani

Keyword(s):

Data Analysis ◽

Maternal Health ◽

Antenatal Care ◽

Pregnant Women ◽

Text Messaging ◽

Individual Characteristics ◽

Text Messages ◽

Quasi Experimental ◽

Text Messaging Intervention ◽

Sms Text Messaging

Background Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization.

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Recovery Following Peer and Text Messaging Support after Discharge from Acute Psychiatric Care: A Randomized Controlled Pilot Trial (Preprint)

10.2196/preprints.27137 ◽

2021 ◽

Author(s):

Reham Shalaby ◽

Marianne Hrabok ◽

Pamela Spurvey ◽

Rabab M. Abou El-Magd ◽

Michelle Knox ◽

...

Keyword(s):

Peer Support ◽

Text Messaging ◽

Psychiatric Care ◽

Text Message ◽

Text Messages ◽

Treatment As Usual ◽

Usual Condition ◽

Randomized Controlled ◽

Acute Psychiatric Care

BACKGROUND Peer support (PS) is emotional, social, and practical help that is provided by non-professionals to assist others in sustaining health behaviours. PS is valued in recovery-oriented models of mental health and is becoming implemented increasingly at the organizational level. Text messaging is a relatively low cost, high impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. OBJECTIVE This study aims to evaluate the effect of an innovative peer support system plus supportive text messaging program on the recovery of discharged patients from acute psychiatric care. METHODS This is a prospective, rater-blinded, pilot randomized controlled trial, including 180 patients discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages, peer-support only, or peer-support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale; RAS) was completed at baseline, six weeks, three months, and six months. Descriptive analysis, One-Way ANOVA, and repeated measures MANCOVA were deployed to examine the changes in RAS among the study groups and over the follow-up time points. RESULTS Sixty-five patients completed assessments at each time-point. For the overall sample, higher scores were found for the peer-support plus text message condition compared to the text message only and treatment as usual condition on several scales (i.e., Willingness to ask for help and Personal Confidence and Hope) and total score on the RAS. CONCLUSIONS Peer support plus supportive text messaging results in improved recovery compared to other interventions. It is advisable to incorporate the two interventions as a part of routine practice for patients with psychiatric disorders upon their hospital discharge. CLINICALTRIAL The study received ethical approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from the Alberta Health Services regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

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Children's Text Messaging and Traditional Literacy

Handbook of Research on New Media Literacy at the K-12 Level ◽

10.4018/978-1-60566-120-9.ch032 ◽

2009 ◽

pp. 492-504 ◽

Cited By ~ 1

Author(s):

Beverly Plester ◽

Clare Wood ◽

Samantha Bowyer

Keyword(s):

Mobile Phone ◽

Text Messaging ◽

Reading Ability ◽

School Achievement ◽

Text Message ◽

Text Messages ◽

Standard English ◽

Verbal Reasoning ◽

Mobile Phone Use ◽

Lack Of Knowledge

The authors present three investigations into pre-teen children’s text message language and measures of their standard literacy abilities. The children translated sentences, from standard English into text, and from text into standard English , and wrote text messages appropriate to a set of scenarios. They categorised text abbreviations used and calculated the proportion of abbreviations to total words. The children completed a questionnaire about their mobile phone use. Text messaging facility was positively associated with verbal reasoning, vocabulary, school achievement in English, and reading ability across the three studies. Texting provides opportunity for children to communicate in writing without the constraints of standard English, and we propose that the playful variants on words that they use in texting, and their ability to encode spoken slang graphically, show not a lack of knowledge of English, but a light hearted use of phonological and alphabetic decoding principles that also underpin standard English.

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The sleeper effect of perceived insufficient milk supply in US mothers

Public Health Nutrition ◽

10.1017/s1368980020001482 ◽

2020 ◽

pp. 1-7

Author(s):

Mackenzie DM Whipps ◽

Jill R Demirci

Keyword(s):

Life Course ◽

Breast Feeding ◽

Ordinary Least Squares ◽

Milk Supply ◽

Breast Feed ◽

First Time Mothers ◽

Reproductive Life ◽

Insufficient Milk ◽

First Time

Abstract Objective: To test whether perception of insufficient milk (PIM) supply in the breast-feeding relationship of one child predicts how long mothers breast-feed subsequent children, and whether this association differs for first-time mothers v. mothers with previous children. Design: Secondary analysis of Infant Feeding Practices Study II (ordinary least squares regression) and Year 6 follow-up. Setting: Mailed, self-report survey of US mother–infant dyads, 2005–2012. Participants: Women pregnant with a singleton were recruited from a consumer opinion panel. Exclusion criteria included: mother age <18; infant born <5 lbs, born before 35 weeks or with extended NICU stay, and mother or infant diagnosed with condition that impacts feeding. A subsample with PIM data (n 1460) was analysed. Results: We found that women who weaned because of PIM with the index child stopped breast-feeding 5·7 weeks earlier than those who weaned due to other reasons (4·9 weeks earlier for multiparas, P < 0·001; 7·1 weeks earlier for primiparas, P < 0·001). Using Year 6 follow-up data (n 350), we found subsequent child 1 weaned 9·2 weeks earlier if the mother experiences PIM as a multipara (P = 0·020) and 10·6 weeks earlier if the mother experiences PIM as a primipara (P = 0·019). For subsequent child 2 (n 78), the magnitude of association was even larger, although insignificant due to low power. Conclusions: These findings indicate that PIM may carry forward in the reproductive life course, especially for first-time mothers. Perceptions of breast milk insufficiency and contributors to actual inadequate milk supply with the first child should be targeted, rather than intervening later in the reproductive life course.

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