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dc.contributor.authorGrutzmacher, Stephanie K
dc.contributor.authorMunger, Ashley L
dc.contributor.authorSpeirs, Katherine E
dc.contributor.authorVafai, Yassaman
dc.contributor.authorHilberg, Evan
dc.contributor.authorBraunscheidel Duru, Erin
dc.contributor.authorWorthington, Laryessa
dc.contributor.authorLachenmayr, Lisa
dc.date.accessioned2019-06-04T22:45:47Z
dc.date.available2019-06-04T22:45:47Z
dc.date.issued2019-01-21
dc.identifier.citationGrutzmacher 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.9967en_US
dc.identifier.issn2291-5222
dc.identifier.pmid30664489
dc.identifier.doi10.2196/mhealth.9967
dc.identifier.urihttp://hdl.handle.net/10150/632490
dc.description.abstractBackground: 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.en_US
dc.description.sponsorshipUnited States Department of Agriculture; Maryland Department of Human Services; University of Marylanden_US
dc.language.isoenen_US
dc.publisherJMIR PUBLICATIONS, INCen_US
dc.relation.urlhttps://mhealth.jmir.org/2019/1/e9967/en_US
dc.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 (http://mhealth.jmir.org), 12.01.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectdiet, food, and nutritionen_US
dc.subjectfood assistanceen_US
dc.subjectparentsen_US
dc.subjectretentionen_US
dc.subjectsurvival analysisen_US
dc.subjecttext messagingen_US
dc.titlePredicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthyen_US
dc.typeArticleen_US
dc.contributor.departmentUniv Arizona, Norton Sch Family & Consumer Sci, Dept Family Studies & Human Deven_US
dc.identifier.journalJMIR MHEALTH AND UHEALTHen_US
dc.description.noteOpen access journalen_US
dc.description.collectioninformationThis 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.en_US
dc.eprint.versionFinal published versionen_US
dc.source.journaltitleJMIR mHealth and uHealth
refterms.dateFOA2019-06-04T22:45:48Z


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© 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 (http://mhealth.jmir.org), 12.01.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
Except where otherwise noted, this item's license is described as © 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 (http://mhealth.jmir.org), 12.01.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).