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Service Delivery Innovation Profile

Weekly Text Messaging Service Enhances Access to Local Clinics and Accurate Information on Sexual Health for Teens and Young Adults


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Snapshot

Summary

A statewide text messaging service (known as "Hookup") provides weekly sexual health tips and connects high-risk teens and young adults in California to locally available sexual and reproductive health services. After signing up for the service, users receive weekly tips on a variety of topics, such as sexually transmitted diseases, birth control, emergency contraception, sexual communication, domestic violence, and substance abuse. Each text includes a prompt that enables subscribers to get contact information for up to four local clinics that provide free or low-cost testing and reproductive health services. The program has enhanced access to accurate information on sexual health, which has led to positive changes in behavior and increased knowledge. The program appears to have enhanced access to local clinics providing free and low-cost services, and has generated positive feedback from stakeholders throughout California.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the total number of subscribers and clinic referral requests and on changes in sexual health knowledge and behavior reported in focus groups, along with anecdotal feedback from key program champions/stakeholder groups.
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Developing Organizations

California Department of Public Health, STD Control Branch; California Family Health Council; Internet Sexuality Information Services, Inc. (ISIS-Inc.)
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Date First Implemented

2009
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Patient Population

Age > Adolescent (13-18 years)end pp

Problem Addressed

Teens and young adults face many risks related to sexual health, including unintended pregnancies, sexually transmitted diseases, and teen dating/intimate partner violence. These risks are often exacerbated by difficulty accessing clinical services and accurate sexual health information.
  • Many sexual health risks: Teens and young adults face many risks related to their sexual health, as outlined below:
    • Unintended pregnancies: Nearly two-thirds of births to women younger than age 18 and more than half of those among 18- and 19-year-olds are unintended.1
    • Sexually transmitted diseases (STDs): Sexually active adolescents age 15 to 19 and young adults age 20 to 24 face a disproportionately high risk of acquiring STDs due to a variety of behavioral, biological, and cultural reasons. Higher prevalence of STDs among adolescents also may reflect multiple barriers to accessing quality preventive services.2
    • Dating violence: One in four adolescents report verbal, physical, emotional, or sexual abuse from a dating partner each year.3 Roughly one in 10 students nationwide report being physically hurt by a boyfriend or girlfriend in the past 12 months.4 The true magnitude of the problem may be greater because many teens do not report dating violence because they are afraid to tell friends and family.5
  • Lack of access to clinical services and accurate sexual health information: Although young people receive information about sexual health from many sources (e.g., parents, schools, friends), their knowledge remains limited and they often face barriers to accessing both information and clinical services. Barriers include fears about breaches in confidentiality, discomfort requesting services typically used by married people, lack of familiarity with local clinics and the services they provide, and little (if any) experience identifying reliable sources of sexual health information.

What They Did

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Description of the Innovative Activity

Hookup provides weekly sexual health tips and connects high-risk teens and young adults in California to locally available sexual and reproductive health services. After signing up for the service, users receive tips on a variety of topics, such as STDs, birth control, emergency contraception, sexual communication, domestic violence, and substance abuse. Each text includes a prompt that enables subscribers to get contact information on local clinics that provide free or low-cost testing and reproductive health services. Key program elements include the following.
  • Marketing through program champions: Public health and other champions in schools, community centers, youth groups, government agencies, and other youth-serving organizations throughout the state post and distribute information to promote the program. Promotional activities include sending press releases to local newspapers, posting information on social media sites, displaying posters, and distributing 'Hookup'-branded materials (e.g., removable tattoos and stickers) to youth.
  • Subscribing to service: To subscribe to the service, youth text the word 'hookup' to the phone number 877877, after which they automatically begin receiving the weekly health tips (described below).
  • Weekly health tips: Health tips contain straightforward messages related to a variety of topics, including prevention of and screening for STDs, birth control, emergency contraception, sexual communication, domestic violence, and substance abuse. Each tip ends with a link to the Teensource.org Web site, where additional information about the topic can be found. Sample text messages appear below:
    • "If you are 17 or older, you can buy emergency contraception at a pharmacy without a prescription."
    • "If u are age 12 or older, u can get ur own STD test. No parent needed."
    • "Don't assume a sexy pic you send will remain private. Think twice before u hit send."
  • Referrals to local clinics: Each tip also contains a prompt to text the word "CLINIC" and a zip code, which enables the user to get referrals to up to four clinics located in or near the teen's community.

Context of the Innovation

As part of their respective mandates to promote sexual health, leaders from the California Family Health Council, California Department of Public Health, STD Control Branch, and Internet Sexuality Information Services, Inc., (ISIS) collaborated to develop the Hookup Program. ISIS had previously created a public health text messaging program (known as SexINFO) to reach African-American youth with information about STDs. Feedback on this program indicated that users found it valuable, as long as they could initiate the messaging. SexINFO later expanded to make basic facts about safe sex, human immunodeficiency virus (HIV), STDs, and pregnancy available to any interested youth in the San Francisco area, along with contact information for local clinics. Building on this successful and technologically innovative approach, these leaders decided to design Hookup with the goal of reaching youth throughout California.

Did It Work?

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Results

The program has enhanced access to accurate information on sexual health, which has led to positive changes in behavior and increased knowledge. The program appears to have enhanced access to local clinics providing free and low-cost services and has generated positive feedback from stakeholders throughout California.
  • Enhanced access to sexual health information: Since the launch of the program in April 2009, 4,441 unduplicated users have subscribed and now receive the weekly messages. In the absence of this program, most of these users likely would not have seen the information included in the messages.
  • Positive changes in behavior, increased knowledge: In a survey of subscribers, nearly half (44 percent) indicated they had made positive changes in their sexual behaviors, such as asking a partner about their sexual history. Nearly one-third (30 percent) reported increased knowledge and awareness of sexual health, such as the fact that birth control pills do not protect against STDs.
  • Many requests for clinic information, suggesting better access to services: Roughly one-third of subscribers (1,341 individuals located in 45 counties) have requested clinic referrals. Program leaders do not know how many of these individuals actually accessed services at one of the clinics, but their interest in this information suggests that at least some of them have done so.
  • Positive feedback from stakeholders: Stakeholders throughout California, including health department staff, educators, and providers, have given positive feedback about the program.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the total number of subscribers and clinic referral requests and on changes in sexual health knowledge and behavior reported in focus groups, along with anecdotal feedback from key program champions/stakeholder groups.

How They Did It

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Planning and Development Process

Key steps include the following:
  • Collaborating on design, implementation, and evaluation: A team consisting of representatives from each organization worked together to define the scope of the program, topics to be covered, messages, and evaluation methods.
  • Awarding contract: ISIS responded to a health council request for proposal to design and implement the program (with input from the team). The council awarded the contract to ISIS using funding from the Centers for Disease Control and Prevention Infertility Prevention Project.
  • Designing technology platform: ISIS modified the technology platform used for its other projects for Hookup.
  • Conducting research: The team conducted focus groups in high schools and clinics to test messages, program feasibility, and implementation procedures (e.g., design of the texting interaction).
  • Developing marketing plan and materials: The team developed a promotional plan to launch the program and maintain ongoing awareness through low-cost marketing. They also developed marketing materials, including a sample announcement, flyers/posters, palm card, stickers, temporary tattoos, and logos. The team posted electronic versions of these materials on a publicly available Web site.
  • Notifying providers: Before the official launch, each partner organization used e-mail and other communication vehicles to notify its network of sexual health providers and other relevant organizations about the program and available marketing materials.

Resources Used and Skills Needed

  • Staffing: A half-time project manager directs the Hookup program with minor administrative support. Other staff devote approximately 5 to 10 percent of their time to the project. The director of programs reviews all materials and provides feedback and oversight, the TeenSource Program Manager provides input and works with the HookUp Program Manager to ensure the HookUp is represented on Teensource, and the webmaster works with the team to keep all Web features updated.
  • Costs: ISIS received $30,000 for program startup to cover information technology and other technical services. However, would-be adopters would likely need to spend between $80,000 and $100,000 to start up a similar program. Annual operating costs will likely run about $100,000 a year, although for Hookup much of this cost represents in-kind services rather than actual dollars (ISIS provides $20,000 in in-kind services each year).
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Funding Sources

Centers for Disease Control and Prevention Infertility Prevention Project
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Adoption Considerations

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Getting Started with This Innovation

  • Agree on program goals: All partners need to agree on program goals, such as providing honest answers to questions about sexual health and promoting access to the services young adults need to stay healthy.
  • Obtain long-term funding: Mobile communication technologies have great potential for effectively communicating public health information. However, the significant startup costs and the long lead time required to reach a broad market create the need for long-term funding and an institutional commitment to this approach.
  • Seek partnerships: Approach leaders of other organizations that use mobile communication technologies and/or promote sexual health to gauge their interest in pooling resources for program development.
  • Involve users: Gather input on content, message development, and other relevant aspects of the program from representatives of the target audience.
  • Identify and approach community champions: Effective marketing requires the support of schools, youth organizations, public health departments, and other groups and organizations that serve young people. As a result, would-be adopters need to identify, meet with, and gain the support of potential program champions in these venues.

Sustaining This Innovation

  • Elicit regular user feedback: To keep the program fresh and current, obtain regular feedback from users about program messages and other aspects of the service.
  • Maintain marketing: Sustaining the program requires promotional activities targeted to champions, current users, and potential users. Would-be adopters should also consider ways to refresh marketing materials and tap into new media used by youth to publicize the program.
  • Stay abreast of new technologies: Teens tend to want real-time information and hence frequently change their use of communication technologies. Remain aware of and take advantage of such changes as they occur.

More Information

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Contact the Innovator

Rebecca Braun
Lead Program Manager
California Family Health Council, Inc.
2550 Ninth Street, Suite 110
Berkeley, CA 94710-2554
Phone: (510) 486-0412 x2327
Fax: (510) 486-0421
E-mail: braunr@cfhc.org

Innovator Disclosures

Ms. Braun reported having no financial interests or business/professional affiliations relevant to the work described in this profile other than the funders listed in the Funding Sources section.

References/Related Articles

The California Family Health Council developed the following Web site to provide nonjudgmental, accurate, and reliable sexual and reproductive health information and resources for young adults: http://www.teensource.org/ts/.

Footnotes

1 Chandra A, Martinez GM, Mosher WD, et al. Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. National Vital Health Stat. 2005;23(25):12. [PubMed]
2 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2009. Atlanta: U.S. Department of Health and Human Services; 2010.
3 Foshee VA, Linder GF, Bauman KE, et al. The Safe Dates project: theoretical basis, evaluation design, and selected baseline findings. Am J Prev Med. 1996;12(Suppl 2):39-47. [PubMed]
4 Centers for Disease Control and Prevention. Youth Risk Behavioral Surveillance—United States, 2009. MMWR Surveill Sum. 2010;59(5):1-142. [PubMed]
5 Understanding Teen Dating Violence. Fact Sheet 2012. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Available at: http://www.cdc.gov/ViolencePrevention/pdf/TeenDatingViolence2012-a.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
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Original publication: April 27, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: October 09, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: April 24, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.