Text message reminders boost Depo-Provera adherence

Using a text messaging system to remind adolescents of scheduled appointments for a contraception injection appears to improve clinic attendance. The 100 participants in a research study conducted in a Baltimore, Maryland clinic ranged in age from 13 to 21 years; were currently using Depo-Provera; and had a cell phone with text-messaging capability. The young women, who primarily were from low-income African American families living in a community with high rates of unplanned pregnancy, were followed for 3 Depo-Provera cycles.

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At every Depo-Provera visit, all participants received a nursing assessment, counseling, the contraceptive injection, and an appointment card with the date of the next injection. As part of this standard clinical protocol, they also received an automated reminder via their home phone before the next appointment and were called if they missed an appointment. Young women assigned to the intervention group also were sent a welcome text message at enrollment as well as daily texted appointment reminders beginning 72 hours before the scheduled visit. These text messages ceased when the respondent indicated “yes,” she planned to keep the appointment, whereas a “no” response triggered a call from the nurse case manager to reschedule the appointment.

Overall, on-time visit adherence declined over time: 51% of participants in both groups kept their first visit appointment; 47% kept the second appointment; and 43% the third. However, 68% of participants who received the text reminders kept their appointment for the first visit compared with 56% of their peers. For the second cycle, the comparable proportions were 68% versus 62%, and for the third, virtually no difference was seen between the 2 groups-73% versus 72% (Trent M, et al. J Adolesc Health. 2015;57[1]:100-106).   

Commentary: In this urban clinic serving primarily low-income young women, 100 of 116 patients approached had access to a cell phone with texting capability and most had unlimited texting. A recent study by the Pew Research Center confirms what you’ve observed at Starbuck’s: Most teenagers carry a cell phone (68% of 12- to 13- year-olds). Interestingly, the proportion of those phones that are “smart” phones varies little with household income. The point is that this technology is everywhere, and the potential to reach our patients through their phones (and now watches) is enormous. To help you sort through this maze of technology, you may want to check out www.imedicalapps.com, an online publication run by physicians who use and review available medical applications. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.