Online Program

Retaining participants in a text-message health promotion program: A survival analysis of dose and message content

Tuesday, November 3, 2015 : 3:30 p.m. - 3:45 p.m.

Yassaman Vafai, MPH, Department of Family Science, Maternal and Child Health Program, University of Maryland College Park, College Park, MD
Ashley Munger, MS, School of Public Health, Department of Family Science, University of Maryland School of Public Health, College Park, MD
Stephanie Grutzmacher, PhD, Department of Family Studies, School of Public Health, University of Maryland, College Park, MD
Katheryne Downes, MS, School of Public Health, Department of Family Science, University of Maryland College Park, College Park, MD
Lindsey Zemeir, Maryland Food Supplement Nutrition Education, Columbia
Laryessa Worthington, Maryland Food Supplement Nutrition Education, Columbia, MD
Erin Braunscheidel, MHS, RD, LDN, Extension - FSNE Program, University of Maryland, Columbia, MD
Nicole Finkbeiner, PhD, Extension - FSNE Program, University of Maryland, Columbia, MD
Lisa Lachenmayr, Director, MD Food Supplement Nutrition Education Program, Extension - FSNE Program, University of Maryland, Columbia, MD
Introduction: Text message programs have been increasingly used to deliver or complement health interventions. However, little research addresses why participants drop out of text-based health programs and how to prevent program attrition. The purposes of this paper are to 1) examine whether message content, including messages instructing participants how they may un-enroll from the program (“stop” messages), impacts participant retention and 2) describe patterns in duration of program participation using data from Text2BHealthy. Text2BHealthy is a school-based nutrition and physical activity text message program for low-income parents of elementary students receiving classroom-based nutrition education. Parents who enroll are sent two to three messages per week tailored to their school community.

Methods: For each participant, retention time was calculated using enrollment and drop-out dates.  Message content associated with each dropout event was also recorded to investigate whether content was associated with frequency of dropouts. Time-to-event analyses were conducted using the Kaplan-Meier estimate to provide retention duration and percent retained per school.

Results: Eighty-six percent of participants were retained. Mean participation length was 36 weeks. Participant dropout coincided with delivery of stop messages; however, fewer dropouts occurred when stop messages were paired with program content than when they were sent alone. Most participant dropouts occurred midway through the program, corresponding with schools’ winter breaks.

Discussion: Message content and participation length are important considerations for retention. Understanding the ways in which participants react to messages can help bolster retention and advance the development of best practices in SMS health programming.

Learning Areas:

Chronic disease management and prevention
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Explain the relationship between message content and dropout rates in a health-based text message program. Describe common strategies for reducing dropout rates and maintaining high retention rates when using text messages for health promotion programs. Identify considerations related to timing and content of "stop" messages employed in text message-based programs.

Keyword(s): Nutrition, Practice-Based Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I prepared the databased and conducted data analysis for process evaluation data of the Text2BHealthy program after carefully reviewing the extant literature on retention in mhealth programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.