3 - (SYM 110) Using Text Messaging to Extend the Reach of STEP: Examining Naturalistic Response Rate and Predictors of Engagement in Three Samples

Delivery of interventions via text messaging can increase access for populations that experience barriers to in-person treatment and extend the reach of short-term adjunctive interventions. Mobile extensions may also be more appealing and increase engagement in adolescent and young adult populations than in-person interventions alone. The STEP intervention was initially developed to combine in-person sessions to build positive affect with a remote delivery component of daily text messages and weekly phone calls. We operationalized responsiveness as participants’ responses to daily mood monitoring questions and a prompt to select a positive affect skill of their choice to practice. Participants were not compensated for responses to messages; thus, data reflect naturalistic response tendencies. We will present findings from the three STEP projects: an Open Trial and a Randomized Control Trial (RCT) with adolescents receiving inpatient care for suicidal thoughts and behaviors, and an RCT with young adults with depression. We examined response rates, predictors of high vs. low responding, and qualitative feedback about the text messaging component.

In the Open Trial (n=19), adolescents completed text messages once daily for the first month after discharge. Participants responded on 72% of days (range: 20-100%). Despite the small sample, differences in response rates emerged. Four participants who were not responsive to phone calls were highly responsive to text messaging (70-83% response rate). Several participants in the Open Trial reported wanting an extension of the text messages. In future trials we delivered messages daily for the first month, and then 3x/week for the following two months.

In the RCT (n=52) the text response rate for the STEP condition was 70.2%, significantly higher than the 49% observed in the control condition. Over 80% of adolescents rated the text messages as “somewhat” to “a great deal” helpful, and over 50% opted for a 3-month extension of text messages, thus confirming the acceptability for a longer duration of delivery.

In the Young Adult RCT, we piloted a 4-week group version of STEP. Messages were delivered based on the content of the group for the week, rather than participants' choice. Interim analyses indicated a high engagement rate in the first month of daily messages (75% all prompts), which continued into the 3-month extension (64% any prompt).

Taken together, our findings suggest that mobile messages may be acceptable and preferable to telephone outreach for some adolescent and young adult participants