What Do Adolescents Say in Text Messages to Motivate Peer Networks to Access Healthcare and STI Testing? (Preprint)

BACKGROUND To understand the types of messages youth believe were motivating and persuasive when asked to text friends to encourage them to seek HIV/STI testing services at a neighborhood clinic. OBJECTIVE To understand the types of messages youth believe are motivating and persuasive when asked to text friends to encourage them to seek HIV/STI testing services at a neighborhood clinic. METHODS We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youth (n= 100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to five friends they believed were sexually active to encourage their friends to visit the clinic and receive STI/HIV screening. Thematic analysis was employed to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding was used to ensure interrater reliability and significance of themes. RESULTS We identified 4 themes in the messages sent by participants: i) calls to action to encourage peers to get tested, ii) personalized messages with sender-specific information, iii) clinic information such as location and hours, and iv) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youth were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40%) received an immediate response to their message and most participants reported receiving at least one positive response, while few reported that they had received at least one negative response. There were some differences in responses by the type of message sent. CONCLUSIONS Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youth are willing to text message their friends and there are clear types of messages they developed and utilized. Future research should employ these methods with a large, more diverse sample of youth and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV/STI among adolescents and young adults.