IFD&TC 2012: Use of Text Messaging for NHANES

Text Messaging to Improve Respondent
Fasting and STD Results Compliance
Lew Berman, PhD, MS
Division of Health and Nutrition Examination Surveys
National Center for Health Statistics
Centers for Disease Control and Prevention
May 22, 2012

Presentation Outline
• NHANES Background
• Compliance problems
• Text Messaging Objective
• Solution
• Protocol and Results
• Discussion and Limitations
• Conclusion
5/21/2012 2

National Health and Nutrition
Examination Survey
• Assess the health of the US population each year
• N = 5000 / year
• 15 PSUs
• Nationally representative
• All ages
• HH questionnaire
• Extensive physical examination, specimen
collection, and follow-up exams / questionnaires
5/21/2012 3

Oral Glucose Tolerance
• Goal: to reassess the prevalence of diabetes and
impaired glucose tolerance in the US population
ages 12 and older.
• Protocol
– Fasting blood glucose test
– Drink sweet liquid
– Blood glucose test
• Problem: reminder letters and phone calls not
consistently reinforcing fasting instructions
(compliance).
5/21/2012 5

NHANES Respondent 9-Hour OGTT
Fasting Compliance, 1999-2009
5/21/2012 6
70
80
90
100
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
%
Year
fasting compliance

Sexually Transmitted Disease (STD)
Results
• Goal: to ensure that respondents call in for their STD
results. Eligible respondents are 14-59 years old.
• Protocol
– Specimen collection at MEC
– Respondent provides password at MEC to receive results
– Laboratory processing for chlamydia, genital herpes, HIV,
female human papillomavirus
– Respondent calls NCHS physician and provides password
for results
• Problem: decline in proportion of respondents who
call-in for results (compliance)
5/21/2012 7

NHANES Respondent STD Call-in
Compliance 1999-2008
5/21/2012 8
50
60
70
80
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
%
Year
STD Results Compliance

Text Messaging Objective
Contact respondents with text message
reminders to increase OGTT fasting
compliance and STD call-in compliance.
5/21/2012 9

Obtaining Permission to Text
• Permission requested during home interview
• Age
– 12-15 year olds: parents respond
– 16+: answer for themselves
• Describe messages to be received
• Obtain respondent cell phone number
5/21/2012 10

Text Message Solution
5/21/2012 11
Text
Messaging
Application
Short
Message
Peer-2-Peer
Gateway
Cellular
Carriers
Phone #,
text message

Example OGTT
Fasting Text Messaging Protocol
5/21/2012 12
MEC Exam &
Specimen
Collection
Home
Screener and
Interview
June 1 June 28
1pm on
June 27
7pm on
June 27
Text Message: “Your health exam is at 8:30am tomorrow. Please do not
eat or drink anything except water after 11:30am tonight.”

OGTT Text Messaging Results
May 2011 – May 2012
Eligible and
Blood Drawn
(1636)
No Cell phone
(567)
No Fast (49)
Fast (518,
91.4%)
Cell Phone
(1069)
No Permission
to Contact
(403)
No Fast (35)
Fast (368,
91.3%)
Permission To
Contact (666)
No Text (178)
No Fast (8)
Fast (170,
95.5%)
Text (488)
No Fast (14)
Fast (474,
97.1%)
5/21/2012 13

Example
STD Text Messaging Protocol
5/21/2012 14
MEC Exam &
Specimen
Collection
Home
Screener and
Interview
+38d +48d +58d
+38d +48d +58d
Text Message: “Reminder: please call 888-301-2360 to get your
password protected test results from the health survey.”
18 - 59
year olds
14 – 17
year olds
June 1 June 15
July 23
August
2
August
12

STD Text Messaging Results
May 2011 – May 2012
Eligible and
Blood Drawn
(2243)
No Cell phone
(548)
No Call-in
(253)
Call-in
(295,
53.8%)
Cell Phone
(1695)
No Permission
to Contact
(527)
No Call-in
(229)
Call-in
(298,
56.5%)
Permission To
Contact (1168)
No Text (337)
No Call-in
(114)
Call-in
(223,
66.2%)
Text (831)
No Call-in
(337)
Call-in
(494, 60%)
5/21/2012 15

Limitations
• Not an experimental design
• Text messaging added to existing protocol
• STD call-ins not parsed by age group and
differing protocol
• Some text messages not received for unknown
reasons
5/21/2012 16

Conclusion
• Text messaging is easy to implement and cost effective
• OGTT
– Cell-phone users have greater compliance than non-cell
phone users
– Compliance with text messaging higher than 1999-2009
• STD
– Cell-phone users have greater compliance than non-cell
phone users
– Compliance improved with text messaging, but not as high
as 1999-2003.
• Plans underway to include text messaging for other
parts of NHANES
5/21/2012 17

Acknowledgements
• Steve Bernas, Westat
• Tatiana Nwankwo, CDC/NCHS
• Kathryn Porter, CDC / NCHS
5/21/2012 18

Percent of NHANES Respondents Participating in Oral
Glucose Tolerance Test Morning Session with a Cell
Phone by Age and Race, May 2011-May 2012
5/21/2012 20
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
12-19 20-39 40-59 60+
%
Age Group
Hispanic
Black
Asian
White/Other

Percent of NHANES Respondents Participating in STD
Testing with a Cell Phone by Age and Race, May 2011-
May 2012
5/21/2012 21
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
14-17 18-59
%
Age Group
Hispanic
Black
Asian
White/Other

IFD&TC 2012: Use of Text Messaging for NHANES

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