Digital Parenting of Emerging Adults in the 21st Century

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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Text messages to reduce depressive symptoms: Do they work and what makes them effective? A systematic review

Health Education Journal ◽

10.1177/0017896920959368 ◽

2020 ◽

pp. 001789692095936

Author(s):

Katherine L Cox ◽

Sabine M Allida ◽

Maree L Hackett

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Text Messaging ◽

Meta Analysis ◽

Text Message ◽

Well Being ◽

Behavioural Therapy ◽

Pooled Analysis ◽

Text Messages ◽

World Health

Objective: In this systematic review and meta-analysis, we aimed to quantify the effects of text messaging interventions to reduce depressive symptoms and identify variables that might influence the effectiveness of the intervention. Design: Electronic databases including EMBASE, CENTRAL, MEDLINE, CINAHL, PsycINFO and SCOPUS, as well as Clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) were searched for randomised controlled trials that sent one or more text messages with health-related content to adults who had been identified by a healthcare provider. Results: Seven trials (nine comparisons), with 1,918 participants, were included in the review, and the pooled analysis revealed a borderline statistically significant reduction in depressive symptom scores between the text messaging intervention and control groups (standardised mean difference [SMD], −0.27; 95% confidence interval [CI], −0.54 to 0.00; p = .00) favouring intervention at the end. Statistically significant reductions were shown in important subgroups, for example, where the primary aim of the messages was to reduce depressive symptoms; in those using the Beck Depression Inventory (BDI) or 9-item Patient Health Questionnaire (PHQ-9) questionnaires; where text message content was targeted at mental well-being, mood improvement and cognitive behavioural therapy information; and when the message frequency was ⩾2 times per week. Conclusion: Text messaging has potential to reduce depressive symptoms. The results of this review should be interpreted with caution, however, due to the methodological limitations of included trials. More research is required before recommendations can be made about the routine use of text messaging for the management of depressive symptoms.

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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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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

JMIR mhealth and uhealth ◽

10.2196/17328 ◽

2020 ◽

Vol 8 (4) ◽

pp. e17328 ◽

Cited By ~ 1

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 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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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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Are perceptions of grandparenthood related to family and life satisfaction? A study with emerging adults

Journal of Social and Personal Relationships ◽

10.1177/0265407520981152 ◽

2021 ◽

pp. 026540752098115

Author(s):

Isabel Miguel ◽

Alexandra M. Araújo ◽

Sandra Fernandes ◽

Luísa Carneiro ◽

Paula Fernandes

Keyword(s):

Life Satisfaction ◽

Emerging Adults ◽

Family Relationships ◽

Structural Equation ◽

Emerging Adult ◽

Well Being ◽

Family Satisfaction ◽

Self Report ◽

Equation Modeling ◽

Adult Grandchildren

Given the crucial role that grandparents play in the upbringing and well-being of their grandchildren, research regarding the perceived importance of grandparents for their emerging adult grandchildren is of particular relevance. This study examined the relations between perceived grandparents’ roles and family and life satisfaction in Portuguese emerging adults. Participants (N = 387), aged 18–25, completed a structured self-report questionnaire. Findings of structural equation modeling showed that emerging adults’ perceptions of grandparental roles of counselor, enjoying the relationship, and indulgence are positively related to their family and life satisfaction. The mediation analysis showed that family satisfaction mediated the relation between perceptions of grandparents acting as counselors and the life satisfaction of emerging adult grandchildren. Implications of family relationships and grandparenting in the context of emerging adulthood are discussed.

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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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An Adaptive, Algorithm-based Text Message Intervention to Promote Health Behavior Adherence in Type 2 Diabetes: Treatment Development and Proof-of-Concept Trial

Journal of Diabetes Science and Technology ◽

10.1177/19322968211065067 ◽

2021 ◽

pp. 193229682110650

Author(s):

Christopher M. Celano ◽

Christina Massey ◽

Jessica Long ◽

Sonia Kim ◽

Olivia Velasquez ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Adaptive Algorithm ◽

Controlled Trial ◽

Text Message ◽

Self Care ◽

Well Being ◽

Psychological Outcomes ◽

Text Messages

Background: Most individuals with type 2 diabetes (T2D) struggle to adhere to one or more health behaviors. Text message interventions (TMIs) have the potential to improve adherence but have had mixed effects on diet and activity in T2D. We developed an eight-week, adaptive, algorithm-driven TMI to promote physical activity, diet, self-care, and well-being. Then, in a single-arm trial, we assessed its feasibility, acceptability, and preliminary efficacy in 15 individuals with T2D and suboptimal adherence. Methods: Participants received daily text messages and were asked to rate the utility of each message (0=not helpful, 10=very helpful). These ratings were used by an algorithm to select subsequent messages based on each participant’s prior ratings. We assessed intervention feasibility by rates of message transmission/response and acceptability through ratings of message utility and burden. Finally, we examined pre-post changes in diabetes self-care, diet, physical activity, and psychological outcomes and calculated effect sizes (Cohen’s d). Results: All text messages were delivered, and participants provided ratings for 79% of messages, above our a priori thresholds for feasibility. Participants rated the individual messages and overall TMI as subjectively useful (utility: 8.1 [SD=2.1] and 7.8 [SD=2.0], respectively) and not burdensome (burden: 0.8 [SD=1.8]). The intervention led to significant, medium- to large-sized improvements in self-care ( d=0.77), diet ( d=0.99), and activity ( d=0.61) but minimal change in psychological outcomes. Conclusions: The TMI was feasible and well-accepted, and it led to promising improvements in adherence-related outcomes. These findings should be confirmed in a larger randomized controlled trial.

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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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Parenting Practices and Emerging Adult Well-Being in the United States and China

Journal of Comparative Family Studies ◽

10.3138/jcfs-2021-0032 ◽

2021 ◽

Author(s):

Shu Su ◽

Alyssa McElwain ◽

Xi Lin

Keyword(s):

Emerging Adults ◽

Parental Support ◽

Parenting Practices ◽

Psychological Control ◽

Adult Child ◽

Emerging Adult ◽

Well Being ◽

The United States ◽

Helicopter Parenting ◽

Two Samples

Parenting practices that promote or inhibit autonomy in their emerging adult child can impact the well-being of emerging adults. This study explored a variety of parenting practices and how these practices impact emerging adult well-being across two cultures. Associations between parental support, involvement, helicopter parenting, and psychological control and emerging adults’ well-being were compared between two samples of participants ages 18-25: American ( n = 643) and Chinese ( n = 514). Results indicate that parental support can promote well-being among emerging adults, but autonomy-limiting practices of psychological control and helicopter parenting seem to be unfavorable for emerging adults regardless of culture. Differences in reported mean levels of the four parenting practices were observed across the two culturally specific samples; however, the strength of associations between practices and emerging adult well-being was not statistically different.

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Abstract P196: Personalized Dynamical System Models Of Individual Text Message Effects On Changes In Physical Activity

Circulation ◽

10.1161/circ.141.suppl_1.p196 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Sarah Hojjatinia ◽

Constantino M Lagoa ◽

Ashley B West ◽

Sahar Hojjatinia ◽

Taylor Turrisi ◽

...

Keyword(s):

Physical Activity ◽

Emerging Adults ◽

Systems Engineering ◽

Computational Models ◽

Cardiovascular Health ◽

Decision Rules ◽

Text Message ◽

Text Messages ◽

Dynamical Models ◽

Step Counts

Introduction: Text-message interventions with universal decision rules (treatment algorithms) demonstrate modest and inconsistent effects on physical activity. Efforts to increase effect sizes by targeting, tailoring or generically customizing content have largely been unsuccessful. In this study, system identification methods from control systems engineering were applied to develop person-specific dynamical models of individual responses to motivational text messages. Methods: Emerging adults not meeting aerobic physical activity guidelines (verified by accelerometer during a 1-week run-in period) received 0-6 messages/day while wearing a Fitbit Versa watch for 3 months. Experimental messages targeted cognitive or affective determinants of physical activity (move more) or sedentary behavior (sit less); comparator messages were inspirational quotes. For each participant, two dynamical models were estimated using difference equations: one to model the effects of move more and sit less messages and the other to model the effects of affectively- and cognitively-targeted messages. Both models included comparator messages. Effects represent the expected change in behavior immediately after message receipt (vs expected behavior without a message). Model order was determined individually to balance uncertainty and overfitting (range = 2-9). Results: The sample (n = 20) was mostly female (60%), White (65%), and not Hispanic or Latino (95%) with a mean age of 24.4 years (SD = 3.3; range = 19-29). Idiographic patterns of behavior change were readily observed from the personalized dynamical models. Most participants’ step counts increased after messages to move more (60% of participants’ responses exceeded the 95% error interval [responders], M = 94.3 steps; 83% of responders increased steps) and sit less (50% responders, M = 114.6 steps; 90% of responders increased steps), as well as control messages (75% responders, M = 59.5 steps; 60% of responders increased steps). Step counts also increased after messages targeting cognitive determinants (80% responders, M = 97.1 steps; 75% of responders increased steps) and affective determinants (75% responders, M = 52.9 steps, 67% of responders increased steps), as well as control messages (75% responders, M = 57.8 steps; 60% of responders increased steps). Conclusions: Motivational text messages can alter physical activity dynamics, and responses to different message types are highly personalized. Among responders, most message types increased expected step counts but some messages were iatrogenic and decreased expected step counts. Computational models of those dynamics provide a foundation for personalizing decision rules to select the type and time the delivery of messages to promote physical activity and improve cardiovascular health.

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