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Most parents hate text messaging. Adults find it annoying because teenagers text constantly during dinner, in class, while they are doing homework, while the parent is trying to talk to them. Judith Cornelius, assistant professor of nursing at the University of North Carolina at Charlotte, sees texting differently. She thinks that text messaging might, just might, be the way to get teenagers to really listen to vital information.

Cornelius is currently performing a pilot study to test the effectiveness of text messaging as a medium for delivering HIV prevention education to at-risk teens. The study is first of its kind to be performed and is being funded by the National Institutes of Health's National Institute of Nursing Research.

The study is using a Centers for Disease Control and Prevention-approved HIV education curriculum called "Becoming a Responsible Teen" (BART), which was developed to be used in face-to-face settings such as classrooms. Cornelius and her team are adapting it to work in the radically different format and communications setting of the cell phone text message.

Though the task of putting serious classroom material into the casual and fragmentary medium of the text message seems like an extreme translation challenge, Cornelius is convinced it can be done effectively and that the effort will be worthwhile. According to Cornelius, the medium offers some important advantages over the traditional face-to-face presentation method.

"Right now, with the face-to-face method we have been using, kids come in for one and a half to two hour long sessions," Cornelius noted. "Using the format of the text message, we can take the most essential pieces and send the material to them individually and have them text back a response. That simply, we get an individual interactive response and then we can follow up and continue the interaction."

Text messaging offers the personal intimacy of cell phone contact and the convenience of user-controlled access and it also has another dimension that may make it especially useful for teaching text messaging is naturally interactive. Teens in particular are socially conditioned to not just receive information in text messages, but also to interact with them, which can potentially make text-delivered content far more meaningful to the recipients.

"Everything that we do is interactive," Cornelius said. "We might send them a picture of a water fountain and ask them if they can get HIV from drinking at a water fountain, for example. The question really is, will they respond? Our bet is that when this is done in the text environment they will."

Along with such potential advantages, however, the medium also has its cultural nuances which adult educators and healthcare professionals may not be completely sensitive to. For this reason, Cornelius incorporated into the pilot project a team of cultural authorities a group of twelve Charlotte-area teens to advise and assist in adapting the messages for text. The teen advisory group has been actively involved in developing and creating the message material and will participate in a three-week trial test this April.

The issue of appropriate delivery and interaction with the text-messaged material is, Cornelius suspects, as complicated and tricky an issue as the crafting of the messages themselves, since the messages are being delivered directly into the dramatic social context of the teenage lifestyle.

"A big issue is the actual 'dosage'-- how much to send the kids. A focus group from the teen advisors told us, for example, that we should try to limit messages to once a day, in a period between 4:00 and 6:00 in the afternoon, when teens would most likely to be receptive," Cornelius said. "The advisors pointed out that text messages sent earlier or later would be more likely to be missed or ignored because they might not be seen as soon as they were received."

This parameter and other similar issues will be tested during the current three-week pre-pilot experimental trial period, which will provide some preliminary data to measure effectiveness. The experiment will involve sending text, image and video material to the same teen advisory group that assisted Cornelius in development. Data will be collected and the group will be debriefed for further insights. Following further modifications, the program will then be piloted on a group of 32 teens this summer to test effectiveness. Later, Cornelius expects to get further funding to do a larger, randomized controlled trial of the product she has fine-tuned during the pilot.

"The world has changed, and we need to adapt to the change and take advantage of it in the way we deliver public health education," Cornelius notes. "Kids don't even talk on the telephone anymore everything is texting. You could see this as a communication problem, but I think it may be an advantage. Figuring out how to take advantage is difficult because no one has done it, but I think we are getting there."


Contact: James Hathaway
University of North Carolina at Charlotte

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