Title: Can text messages increase safer sexual health behaviours in young people? Intervention development and pilot trial.
Funder: Department of Health (England)

Abstract: Design: Part A: Intervention development. Part B: A pilot randomised controlled trial. Part C: Final modifications to the intervention. Setting: Recruitment: community sexual health clinics general practices and pharmacies. Intervention delivery: via mobile phones in the community. Target population: Chlamydia screening programme participants diagnosed with chlamydia or gonorrhoea and/or who have had unsafe sex in the last year (more than one partner and at least one occasion of unprotected sex). Part A: Developing the intervention: Existing evidence: New results from our txt2stop trial show that text-messaging interventions can sustain health behaviour change in the long term. The text based intervention doubled biochemically verified smoking cessation at six months: 10.7% txt2stop versus 4.9% control RR 2.20 (95% CI 1.80-2.68)(2). Mobile phones are able to provide confidential and non-judgemental support which is essential for a sexual health intervention(3). Interactive support can be delivered at any time. Behaviour change techniques used in effective face-to-face interventions can be modified for delivery via text message(4-5). The content can be personalised for different gender and ethnic groups. Recipients referred to the text messaging support we developed as: ‘being ‘a ‘friend’ it felt like someone was holding your hand throughout.’ (Female) and ‘you’ve got someone there giving you a bit of support which is what you need isn’t it?’ (Male). Thus support via text message could be acceptable to young people and might increase safer sexual health behaviours. We conducted systematic reviews of interventions promoting condom use and mobile technology based interventions(6-7) and described the behaviour change techniques used in effective interventions(5-12). We developed preliminary content and conducted interviews and focus groups discussions with young people. The discussions suggested that the preliminary content was welcomed effectively communicated sensitive issues and was effective in portraying gender and ethnic appropriate content. Theory: Sexual behaviour is influenced by motivation capability and opportunity. The intervention aims to alter these factors to reduce sexual risk. First by encouraging those in the target audience to use condoms Second by encouraging participants to obtain testing for STI for themselves and their sexual partner(s) prior to unprotected sex. Third by urging participants to correctly follow instructions for STI treatment and informing partner(s) about infection.Text message development: To develop messages we will use the approach we used to develop our previous effective text messaging intervention(15-16). The content will be based on the content of effective sexual health behaviour change support(8-12) modified for delivery by text message. We will develop messages with the input of sexual health counsellors and young people. We will ask a panel of young people about their preferences for the intervention the acceptability comprehensibility and appropriateness of the text messages and suggestions for improvement. According to their feedback we will retain discard or modify messages and retest them. We will then ask 100 participants to score text messages regarding their acceptability comprehensibility and appropriateness. Part B: We will conduct a pilot randomised controlled trial of the intervention in 200 participants to test all trial methods and procedures. Participants will provide written informed consent. A web-based link to an independent randomisation service will allocate participants to intervention or control groups. The system will automatically generatetext messages according to allocation. Part C: We will make final intervention modifications and design the main trial.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH