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    Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy

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    Name:
    8a077df1-6685-4f7b-af58-d39e45 ...
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    Author
    Grutzmacher, Stephanie K
    Munger, Ashley L
    Speirs, Katherine E
    Vafai, Yassaman
    Hilberg, Evan
    Braunscheidel Duru, Erin
    Worthington, Laryessa
    Lachenmayr, Lisa
    Affiliation
    Univ Arizona, Norton Sch Family & Consumer Sci, Dept Family Studies & Human Dev
    Issue Date
    2019-01-21
    Keywords
    diet, food, and nutrition
    food assistance
    parents
    retention
    survival analysis
    text messaging
    
    Metadata
    Show full item record
    Publisher
    JMIR PUBLICATIONS, INC
    Citation
    Grutzmacher SK, Munger AL, Speirs KE, Vafai Y, Hilberg E, Braunscheidel Duru E, Worthington L, Lachenmayr L Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy JMIR Mhealth Uhealth 2019;7(1):e9967 DOI: 10.2196/mhealth.9967
    Journal
    JMIR MHEALTH AND UHEALTH
    Rights
    ©Stephanie K Grutzmacher, Ashley L Munger, Katherine E Speirs, Yassaman Vafai, Evan Hilberg, Erin Braunscheidel Duru, Laryessa Worthington, Lisa Lachenmayr. Originally published in JMIR Mhealth and Uhealth
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Background: Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants' context, may have an impact. The impact of stop messages-messages with instructions for how to drop out of an SMS text message program-may be particularly important to investigate. Objective: The aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. Methods: Using data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. Results: Retention rates by school ranged from 74% (60/81) to 95.0% (132/139), with an average retention rate of 85.7% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95% CI 32.46-81.7; P<.001). Furthermore, each additional stop message received increased the probability of attrition (hazard ratio=10.36, 95% CI 6.14-17.46; P<.001). The degree of rurality also had a significant effect on the probability of attrition, with metropolitan county participants more likely to drop out of the program than rural county participants. The interaction between SMS text message type and total number of stop messages received had a significant effect on attrition, with the effect of the number of stop messages received dependent on the SMS text message type. Conclusions: This study demonstrates the potential of SMS text message programs to retain participants over time. Furthermore, this study suggests that the probability of attrition increases substantially when participants receive messages with instructions for dropping out of the program. Program planners should carefully consider the impact of stop messages and other program content and characteristics on program retention. Additional research is needed to identify participant, programmatic, and contextual predictors of program duration and to explicate the relationship between program duration and program efficacy.
    Note
    Open access journal
    ISSN
    2291-5222
    PubMed ID
    30664489
    DOI
    10.2196/mhealth.9967
    Version
    Final published version
    Sponsors
    United States Department of Agriculture; Maryland Department of Human Services; University of Maryland
    Additional Links
    https://mhealth.jmir.org/2019/1/e9967/
    ae974a485f413a2113503eed53cd6c53
    10.2196/mhealth.9967
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    UA Faculty Publications

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