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The Texting 2 Initiate (T2I) Study: A pilot randomized controlled trial using text messaging from the pediatric emergency department to increase contraception initiation among adolescent females at high pregnancy risk

Lauren Chernick, Columbia University, 2013

Project abstract

Many of the 15 million adolescents who present to emergency departments (EDs) annually are at high risk of unintended pregnancy in the next year, a risk associated with lack of a primary physician and frequent ED use. These females could be the target for pregnancy prevention interventions, but few data exist to determine feasible and effective strategies to promote pregnancy prevention in the ED.

The objective of this proposal is to develop and pilot an innovative ED-based intervention using text messages to facilitate contraception initiation for adolescents at high pregnancy risk. Our hypothesis is that adolescent females who receive text message reminders and motivational messages promoting contraception and referral to Family Planning Clinic (FPC) are more likely to initiate effective contraception than those who receive standard referral to FPC alone.

The specific aims of this pilot are to:

  1. Assess feasibility of conducting a randomized clinical trial using text messaging to improve contraception initiation among underserved adolescent ED patients, and
  2. Determine the potential effect size of an ED-based text messaging intervention in order to estimate the appropriate sample size for a definitive clinical trial.

We will conduct a pilot trial and randomize eligible patients to Text Messaging (TM) or Standard Referral (SR) arms. The TM arm will receive three months of messages with reproductive health information and strong, consistent promotion to go to the FPC; the SR arm will receive written FPC information. We will measure contraception initiation rates (primary outcome) by review of the electronic medical record and telephone follow-up three months after the ED visit.

This pilot will provide data essential to plan a definitive trial. Ultimately, a text messaging intervention that decreases pregnancy risk can be utilized by other EDs as a reproducible means of referral and collaboration between pediatric, emergency medicine, and family planning physicians.

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