Using a Mobile Health Intervention for Promoting Intention to Avoid Sexually-Provocative Media Exposure: A Pilot Study

Abstract

Information technology and communication is exceedingly involved with people’s daily lives.  Internet use is very common among adolescents, where it is typically accessed via smartphones. This is likely to increase the accessibility of sexual-content media on the internet, which may lead to higher risk of having sexual intercourse and negative consequences such as teenage pregnancy.  Mobile Health (mHealth) intervention has been applied to support medical and public health services as well as health behavior change. To find out a model of supplementary instruction on avoiding sexually-provocative media exposure among adolescents, a pilot study of the mHealth intervention with LINE application was initially developed. The objectives of the study were to evaluate reactions to the mHealth intervention and its effectiveness on change in attitude toward the subjective norm, as well as intention to avoid exposure to sexually-provocative media.  

The study was carried out in a secondary school belonging to the Secondary Educational Service Area Office, Bangkok Metropolitan Area, Region 1. A quasi-experimental, one-group pre/posttest, design was used to evaluate the intervention effectiveness. The sample consisted of 75 grade 8 students (13-14 years of age), who were recruited from selected classrooms based on the inclusion criteria of having a smartphone with an installed LINE application, and voluntarily participation in the study. The intervention was designed based on Berlo's model of communication, the theory of reasoned action and the information processing model, and was delivered via the LINE application. It consisted of delivering 5 infographics and 4-weekly question-answer activities using text messages and Google form links. The study period was 6 weeks. Data toward reactions to the mHealth intervention, attitude toward, subjective norm and intention to avoid sexually- provocative media exposure were collected using a self-administered questionnaire. Descriptive statistics were employed to describe descriptive results and a paired sample t-test was used to examine the differences in attitude toward, the subjective norm, and the intention to avoid sexually-provocative media exposure before versus after the intervention. 

The evaluated results of reactions to the mHealth intervention revealed most of the students read the sent-text messages (76%).  Almost two-thirds of them responded to the text messages sent in the LINE application (62.0%) and could remember half or more of the content matter (62.0%). Overall, the students expressed their satisfaction with the intervention at a somewhat high level ( = 4.00, SD=0.74), especially the dimensions of usefulness, the suitability of time and activities, and attractiveness.  The evaluation of effectiveness showed that after the intervention the mean score of the subjective norm to avoid sexually-provocative media exposure ( = 38.61, SD = 5.10) increased significantly as compared to that before the intervention ( = 36.88, SD = 6.22) (p= 0.024). In contrast, there were no statistically significant increases in the mean scores of attitude toward and intention to avoid sexually-provocative media exposure. However, significant increases in the mean scores of attitudes and intention were found among male students.

These results indicated that it might be feasible to use the mHealth intervention via the LINE application to supplement health education instruction. Nevertheless, improvements are needed in the intervention regarding the preparation of using technology, the use of reinforcement techniques, the increase in message contents through various media types, and an additional in-class discussion. Moreover, further research needs to be repeatedly conducted to ensure its effectiveness.