HealthyhornsTXT A Text Messaging Program to Promote Student Health & Academic Success
Contributors Elizabeth M. Glowacki, MA Doctoral Candidate, Department of Communication Studies Center for Health Communication Susan Kirtz, MPH Health Promotion Coordinator, University Health Services Center for Health Communication Jay M. Bernhardt, MPH, PhD Dean, Moody College of Communication Founding Director, Center for Health Communication Jessica Duncan Cance, MPH, PhD Assistant Professor, The College of Education, Department of Kinesiology and Health Education Jessica Hughes Wagner, MPH, MCHES Manager of Health Promotion, University Health Services Denise Barrera Student Assistant, University Health Services
Background • Funded by the National Social Norms Center at Michigan State University • Aimed at supporting students’ health and academic success • Students send an average of 70+ texts per day (up to 300+) • Connects with students at critical moments in their health and social decision making process Fall 2014 Fall 2015 Spring 2016 • Year-long • Develop • Time study program partnerships • Linguistic pilot • Dose study agency study
Development • Topics : Alcohol, stress, sleep, sex, physical activity, nutrition, campus events • Messages developed by : University Health Services, Counseling & Mental Health Center, RecSports, students • Scheduled based on campus events (UHS flu shot campaign, football game weekends, exams, etc.) • Uses Mosio text messaging software • Not linked with students’ EHR at UHS
Recruitment • Opt-out in Think About It online education program – Required of all incoming students • Text to subscribe • Currently 5208 active participants Retention • Weekly gift card drawing – Ready to win some tacos? Reply TACOS by 5pm today to enter to win a Torchy's giftcard. Good luck!
Students love tacos!
Sample Messages • We asked, and y'all answered. The majority of Longhorns who drink had 4 or fewer the last time they went out! Will you stay with the herd tonight? • Looking for the best birth control method for you or your partner? University Health Services can help! bit.ly/UTBirthControl • Come get a FREE Healthyhorns Safe Spring Break Kit with 20 awesome items from UHS this week! Text SSBK for the giveaway schedule. – Safe Spring Break Kit schedule: Mon-Tue from 11-1 at West Mall, Wed- Thu from 11-1 at Gregory. #whilesupplieslast
Implementation and Evaluation • Two-condition experiment evaluating message dose: • Daily: one message per day • Weekly: one message per week • 907 participants completed post-test survey: – Current health practices and attitudes (questions from National College Health Assessment) – Intentions to engage in recommended health behaviors – Attitudes toward HealthyhornsTXT • Survey links sent to participants’ mobile phones • Incentives: One out of every 200 participants entered in a drawing for a $50 Amazon gift card
Quantitative Findings Did you talk with anyone about the messages you received? If so, who? 37% Friends at UT 32% Roommates 12% Significant other 10% Family member 9% Friends outside UT
Message Relevance Sleep/Napping 64.06% Stress Management 59.98% Hydration 39.47% Nutrition 36.38% Fitness 30.43% University Health Services 28.34% Campus Resources 26.90% Healthy Sexuality 24.92% Alcohol Use 24.70% Cold/Flu 19.07% Body Image 18.08% Tobacco Use 4.63% Prescription Drug Use 3.97%
Participant Feedback Scores Mean Score Item 1=Strongly Disagree 5=Strongly Agree The text messages I received increased my knowledge of how to stay healthy at UT. 3.60 The text messages I received increased my awareness of my health (or ways to improve my health) on a regular 3.51 basis. I liked the messages I received. 3.50 The messages I received about health were relevant for me and my experiences as a UT student. 3.48
Participant Feedback Scores Mean Score Item 1=Strongly Disagree 5=Strongly Agree I would feel comfortable text messaging with my healthcare provider. 3.35 I took a specific action to improve my health as a result of receiving a text message from HHTT. 2.86 I shared information from the text messages with another person. 2.86 My health behaviors have changed because of the messages received in this program. 2.73 I received too many messages from this program. 2.78 I didn’t receive enough messages from this program. 2.43
Opt-Outs Daily Group Weekly Group # of Opt Outs by Subject of Text # of Opt Outs by Subject of Text HHTXT Program 190 Gift Card for Torchy's Tacos 214 Gift Card for Torchy's Tacos 79 HHTXT Program 188 Well-being/Misc. 76 Mental health 24 Healthy sexuality 66 Alcohol use 22 Alcohol use 63 Nutrition 16 Mental health 52 Cold/flu 13 University Health Services 38 Fitness 6 Sleep/napping 37 Sleep/napping 4 Hydration 23 Healthy sexuality 2 Fitness 19 Well-being/Misc. 0 Prescription drug abuse 18 University Health Services 0 Cold/flu 17 Tobacco use 0 Stress management 15 Stress management 0 Tobacco use 14 Prescription drug abuse 0 Body image 13 Hydration 0 Campus resources 11 Campus resources 0 Nutrition 9 Body image 0
Responses to Keywords Key Word Usual Care Weekly Daily Combined plzsleep 4 0 16 20 tacos 3653 11457 11015 26125 vteer 0 1 201 202 utcompassion 89 0 123 212 surewalk 52 0 113 165 flu 44 238 166 448 hornslink 37 0 97 134 wrapitup 65 0 149 214 ecig 0 0 0 0 booflu 67 0 140 207 utfruit 20 0 59 79 uthands 0 0 27 27 smokefree 50 0 100 150 amnesty 20 21 27 68 consent 6 0 13 19 napmap 0 0 180 180 testme 0 0 79 79 Total 4107 11717 12505 28329
Link Clicks by Subject (tracked using bitly.com) HHTXT Program 4352 Mental health 890 Healthy sexuality 494 Sleep/napping 442 Cold/flu 423 Stress management 406 Campus resources 309 Well-being/Misc. 249 Alcohol use 173 Nutrition 48 University Health Services 18 Prescription drug abuse 10 Fitness 3 Tobacco use 0
Qualitative Findings I took a specific action to improve my health as a result of receiving a text message from HealthyhornsTXT. If yes, please describe briefly. “I started eating more servings of fruits and I began eating healthier. I also began • implementing a better sleep schedule and managed my stress better.” “I found out about unknown napping spots on campus so I could get some rest from • studying all night the day before.” “Tried to eat more vegetables and drank more water to prevent dehydration.” • “I decided to quit drinking soda and stick to water just because HHTT motivates me • to improve my health and strength as a former athlete.” “Remembered to start bringing a water bottle to school to get more water.” •
Qualitative Findings “I looked into getting counseling for some personal and academic problems I was • having.” “I saw signs of alcohol poisoning this past weekend that I read from the link sent on a • text message.” “The drinking tips were healthy and had some great pointers about steps to take before • and after drinking. For example, the suggestion to eat before and to hydrate before and after.” “One text linked me to be healthy horns contraception videos and I made an • appointment at the women's health center at the SSB as a result.” “Got tested for the full range of STIs.” • “I practiced the stress management techniques!” •
Challenges • Limited to 160 characters (challenging to share information in concise, engaging manner) • Gathering/creating messages • Finding tone/style appropriate for students • Technical issues (tracking links, exporting tracking info from Mosio)
Ongoing Projects and Next Steps Time of message delivery: 11am vs. 9pm Linguistic Agency Non- Human vs. human Threat Threat Treatment Treatment Regulatory Fit: Prevention vs. Promotion Messages
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