Many existing health programs and interventions reach only a portion of the population in need. As a result, practitioners increasingly use tech-based interventions to deliver services to hard-to-reach populations. Because mobile devices are becoming universal, innovative service delivery methods can use mobile apps and text messaging to effectively reach some of these historically hard-to-reach groups—particularly older teens and young adults.
One such intervention, a web-based mobile app called Pulse designed by Healthy Teen Network, provides on-demand access to comprehensive, medically accurate sexual and reproductive health information. Pulse is an exclusively tech-based intervention designed to reach women in their older teens who—despite having the highest rates of unplanned pregnancy—are underserved by many pregnancy prevention programs.
Healthy Teen Network contracted with Child Trends to evaluate Pulse’s impact on young women. This evaluation included in-depth interviews to understand participants’ perceptions of Pulse, insights from which are broadly applicable to practitioners interested in technology-based interventions, especially around recruitment, enrollment, and retention.
Here are the key takeaways from our evaluation.
High-quality design, reliable information, and interactive components can enhance participants’ experiences with tech-based interventions. Pulse participants appreciated the simplicity of the app, its easy-to-navigate sections, and the ease of finding answers to their questions. Although much of the information provided wasn’t new to participants, the aggregation of necessary information in one reliable place increased users’ confidence (relative to their traditional reliance on friends, social media, and search engines for information about birth control). One participant remarked, “After reading stuff about birth control, I actually thought about changing my birth control, and [Pulse] made me rethink what I’m doing.”
Nevertheless, tech-based interventions should look for ways to further streamline the user experience, in part by keeping pace with technological changes and user preferences. For example, Pulse participants recommended converting the web-based mobile app into an actual phone app (Pulse must currently be viewed in a phone’s web browser). They also expressed a preference for a more visual and less text-heavy app. Finally, participants suggested features to make the user experience more interactive and personal, such as the option to submit comments or participate in discussion forums. “If there was a part of the app that focused on talking with other women and getting young women together, that would be good.”
Social media recruitment is effective for tech-based interventions. Participants in Child Trends’ evaluation, who were recruited exclusively through Instagram and Facebook, felt that social media (especially Instagram) is effective for recruiting young women to tech-based interventions. “So many people, especially young people, are on social media all the time. [Reaching] them where they [spend time] is a good way to [conduct outreach].” High-quality ads, professional app design, medically accurate content, and monetary incentives also support recruitment efforts by helping to dispel general public concern about the trustworthiness of information available on the web and encouraging participation. Participants were not frustrated by minimal contact with study staff, which counters a potential objection to the use of technology-only interventions.
To underscore the legitimacy of the study, Pulse participants recommended enhancing social media recruitment with the inclusion of more traditional recruitment components—for example, advertising in trusted physical locations (college campuses, clinics, community centers, etc.).
App-based interventions can improve participant engagement with a text messaging component. Some participants found the MMS messages helpful while others considered them redundant; reactions were similarly split on the frequency of texting (they received about 16 texts over six weeks with app-related content and reminders to view the app). However, participants generally found MMS messages helpful as reminders to view the app and take evaluation surveys. “[I] found [the messages] really helpful because I didn’t always go to the Pulse page and getting the text messages helped me remember.”
Participant feedback on the Pulse evaluation suggests that online- and texting-only recruitment and enrollment to an app-based intervention is feasible and effective for older teen and young adult populations. However, there are still ways to improve users’ experiences. Child Trends is continuing to conduct analyses to assess this program’s impacts on contraceptive knowledge, attitudes, and use.
 Martin, J.A., Hamilton, B.E., Osterman, M.J., Driscoll, A.K., & Drake, P. (2018). Births: final data for 2016. Hyattsville, MD: National Center for Health Statistics.
 Multimedia Messaging Service (MMS) is a standard way to send text messages that include multimedia content.
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