Youth Access Health Information via Text Message
From Shareideas
Interview: Andrew Woodruff
Andrew Woodruff is Program Director at Internet Sexuality Information Services, Inc. (ISIS-Inc.), a nonprofit organization in Oakland, California, USA that uses technology to prevent disease and enhance the sexual health of individuals and communities. In April 2006, ISIS partnered with the San Francisco Department of Public Health (SFDPH) to launch SEXINFO, a project that uses mobile technology to provide sexual health information to low-income youth. In the following interview, Andrew talks about the project’s approach and impact to date.
What are SEXINFO’s origins?
The San Francisco Department of Public Health contracted ISIS to develop an approach to address rising rates of sexually transmitted disease among at-risk youth. Between 2004 and 2005, research pointed to a hundred percent increase in gonorrhea among African American youth, 15 to 19 years of age, in Bayview Hunter’s Point, a low-income, predominantly African American, neighborhood in greater San Francisco. The rates for African American women were 12 times that for white women. While the Internet holds potential for distributing sexual health information, many of these kids don’t have access to computers. And if they do at school, this may not be a place where they feel comfortable accessing sensitive information. At the same time, over eighty percent of youth in the area were found to have cell phones. Mobile technology offered a way to reach kids who may not have the freedom or privacy to find the information they needed. The Department of Health was the ideal partner because they were on cutting edge of wanting to use new technologies. Our approach was inspired by a similar initiative operating in the UK.
How does it work?
SEXINFO is a text message-based information and referral service. To access information, users simply enter a five digit number (61827) into their cell phone keypad. They then receive a “phone tree” with a menu of options from which to choose. For example, an individual simply needs to type 1 if their condom broke or 5 if they want STD info. In addition to receiving a basic fact in connection with their question, users are referred to a local clinic where they can access free, confidential services. How did you go about developing a youth-friendly approach?
The Department of Public Health worked with Youth United Through Health Education (YUTHE), a program of SFDPH, to help us form youth advisory panels and conduct youth outreach. Focus groups were held to assist with the development of the service and marketing. With this information we were able to develop materials that were relevant and youth-friendly.
It was also important to generate community “buy in” to what we were doing. A consortium of community organizations was regularly consulted to provide guidance on the project.
How did you go about marketing the service?
Originally, advertisements were put up in bus shelters and on billboards in the neighborhoods being targeted. Information cards were also distributed via outreach workers on the street and to nurses or the health person at high schools and college campuses. Banner ads were also run on Yahoo! for two weeks. We also conducted press outreach with articles appearing in the local and national media, along with radio and TV coverage. Recently, we made a public service announcement with the rap musician Mistah F.A.B., which is now available on YouTube and was broadcast locally on BET (Black Entertainment Television) and MTV.
How successful has SEXINFO been at reaching its goals?
When we first started out, people were saying you can’t reach low-income populations using technology. We found that, at least in San Francisco, we were able to reach this at-risk group in a very meaningful way. For example, during the first 25 weeks of the project, 4,500 individuals accessed the service, with 2,500 of those going on to seek additional information and referrals. We’ve found the approach does get the information into people’s hands. They can be anywhere and access the information they need. How, if at all, have you gone about evaluating impact?
Working with the government – and in our case, the public health department – has helped enormously with evaluation efforts. In one case, we measured whether our target audience used the service by counting how many youth went to public health clinics because of a SEXINFO referral. Because they’re free, these are the clinics our target youth tend to use most.
What have been the costs associated with launching and maintaining SEXINFO?
The start-up costs were around US$20,000. It costs US$1,500 a month to maintain the short-code number that users dial into. Initial marketing and evaluation efforts cost $15,000. Marketing is a big part of any texting project. Your target audience needs to know the service is available.
Additionally, Full Circle Fund has been instrumental as a recent funder in fine-tuning the service from a technological standpoint.
What factors should a nonprofit consider in exploring such an approach?
You need to determine if a large percentage of your at-risk population has text messaging capability. Are they used to doing this? Would they do this? Are there relevant referral services out there and do they protect the confidentiality of individuals? A needs assessment should be conducted to identify the types of information people need to access in a private way. A service can be tailored to provide information for myriad sexual health needs. We built a companion website www.sextextsf.org that listed all answers available through the service and local referral agencies. Through this non-text resource, parents and other adults can get information. This helps mitigate people’s fears about the types of information being provided. It’s important that the information be made available for individuals seeking help, but also to the public.
What are your plans for the future?
About a year after launch, the YUTHE team went out on the street with a video camera, and a professional market researcher to see how young people used the service. Fifteen youth participated, and within 4-5 months, simple changes were made to the service to provide ease-of-use. We are motivated to do more and are looking at ways to continue to improve the service. We’re also talking with another funding source about ways to role out the system so as to reach more people.
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