Supporting Adolescent Peer Leaders Using Text Messages: Framework and Pilot in a School-Based Substance Use Prevention Program Under Development

Introduction: Text messaging is emerging as a powerful tool for delivering direct intervention to adolescents, but another potential use is to support adolescents as change agents. Texting is the dominant mode of communication for teens, and 95% of all texts are read. In this paper, we describe the development and feasibility testing of a conceptual framework for using text messaging to engage, retain, and educate adolescent peer leaders (PLs) in a substance use prevention program under development.

Method: In the context of piloting a peer-led substance use prevention program integrated with the web-based Above the Influence program, 50 8th grade students from 3 rural NY middle schools were recruited as Peer Leaders. To support PLs, we constructed interactive text messages aimed at strengthening: (a) mission and team identity; (b) sense of agency in shaping the program/messaging (c) connection to adult coaches (school staff); (d) content knowledge and personal application; and (e) preparation for school-based prevention activities. A total of 34 texts were sent to PLs across 4 months (3-4 times/week). Of these texts, 11 (32%) requested a response back. PL text replies and their participation in school-based meetings/messaging activities were recorded. PLs completed baseline and post-program surveys. Parents of PLs and school staff completed post-program questionnaires.

Result: Among PLs, 82% of parents provided the child’s cell phone number. 85% of PLs responded to at least one text message. Response rates remained constant across the 10-16 weeks of intervention. Responses to specific messages varied from 22% to 56%. 95% of PLs said they read messages even when they didn’t reply. 83% of PLs said the messages helped them accomplish their mission, and 77% reported that the frequency was “about right” (2 PLs reported “too many” and 7 PLs reported “too few”). PLs reported that they would want to receive messages in the future with links to videos (81%), stories from students facing normal stresses (91%), and invitations to share advice and experiences anonymously (93%). PL attendance had very little variability in two of three schools, but in the one school with variation, replies to texts correlated with better attendance (r =.774, p=.005).

Conclusion: Our preliminary results show that text messaging is feasible for supporting the mission of middle school PLs. Our study provides a framework for the content of messages to support adolescent PLs acting as change agents in a network intervention. The association between text activity and attendance, while not necessarily causal, should be noted because PL retention has been shown to be important for program impact. Future priorities include systematically varying text support to determine its true impact on PLs.