Adapting a Brief Evidence-Based Intervention for Text Message Delivery to Young Adult Black Women
Young adult Black women have the highest sexually transmitted disease rates among all U.S. women. There are several evidence-based interventions (EBIs) targeted toward this population, yet they each require travel to a healthcare facility or other location. With the increased use of mobile devices, mobile health technology is being utilized more frequently to deliver health interventions. Instead of creating entirely new technologically savvy interventions, the CDC recommends adaptation of EBIs. The purpose of this study was to adapt an EBI for delivery via text messages.
This two-phase, mixed methods pilot study was guided by several philosophical underpinnings (empiricism, critical theory, pragmatism, and intersectionality) and theories (Social Cognitive Theory, Theory of Planned Behavior, and Theory of Gender and Power). A modified version of the ADAPT-ITT model was also used to guide the study. During phase one, a research advisory board was recruited to assist with intervention adaptation, phase two recruitment strategies, and interpretation of study results. In phase two, the newly adapted intervention was pilot tested among a sample of young adult Black women (n = 88), who were randomized to the intervention or control group. Study outcomes included intervention acceptability and feasibility, and preliminary changes in condom use, condom-use self-efficacy and intention, and sexual relationship power.
Acceptability and feasibility of the intervention were high. The overwhelming majority of comments from intervention group participants were positive. Between baseline and follow-up, condom use frequency increased among participants in both study groups. However, there was no significant time by group interaction. Furthermore, while condom use self-efficacy and intention significantly increased among participants in both groups, no time by group interaction was found. Finally, intention was identified as a main predictor of condom use at baseline and follow-up.
The results of this study provide support for intervention modifications that may strengthen outcomes in a future efficacy study of the revised S2S text messaging intervention. It is important that women’s health researchers and educators continue to adapt and evaluate interventions using technologically advanced methods of delivery. Text messaging is a promising method of delivery for EBIs aimed at the reduction of high-risk sexual behaviors among young adult Black women. Intervention adaptation using other types of technology should be investigated as well.