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CBC Digi-Hub Blog



Looking at modality and intention setting with Planned Parenthood’s Chat/Text program

By Emma Norris, on 28 September 2018

By Nicole Levitz – Planned Parenthood Federation of America

Many digitally-based health programs lack a theory-base, despite evidence that greater effect sizes are seen when there is a theoretical underpinning. Planned Parenthood Federation of America’s national Chat/Text program was launched in 2010 with a theory-base to improve access to sexual and reproductive health care among young people. Chat/Text educators have conducted over 1,000,000 conversations using an evidence-based protocol which integrates principles of communication and decision-making science to influence sexual and reproductive health.

The program is staffed by trained health educators who freely tailor scripted health information messages to individual users’ needs. Program conversations are structured to firstly allow the health educator to establish trustworthiness, expertise, and accessibility with the user. The health educator then works with the user to explicitly identify their health concerns and goals, relying most heavily on the Unified Theory of Behavior. Within each conversation, health educators typically address several UTB constructs, including (1) beliefs surrounding the health behavior in discussion, (2) emotions related to this behavior, (3) self-image, and (4) self-efficacy.  The program can be accessed via different modes: mobile web chat, web-based desktop chat and short message service (SMS) text messaging.

We recently conducted a study to examine whether the modality used to access the program affected users’ intention to execute the action plan they developed with the help of the educator during the conversation. This is the first instance of such an analysis that we are aware of. We found that all three modes were not significantly associated with user confidence, but each had a significant association with educator confidence, and showed similar effect sizes as user confidence. All effects were very small changes on the four-point scale.

Being a digital intervention, we can’t physically bring individuals to seek the care they need, but we can help them develop an action plan and set an intention to take the next best step to deal with whatever question they come to us with. We know that intentions are the best predictors of behavior but didn’t know how modality could influence intention setting. What we found is that the mode of intervention delivery was not associated with users’ confidence in their ability to carry out their intended action plan, suggesting that all modes are legitimate for delivering this theory-based intervention. Further, this study suggests that program developers need to focus on the underlying theoretical approach of interventions and not simply on mode of delivery when creating interventions.

Use of existing program data comes with its limitations. In the future, it would be great to work with data specifically collected for an analysis like this and examine confidence with more nuance and consistency.

You can find the full paper here: Levitz, N., Wood, E. & Kantor, L. (2018). The Influence of Technology Delivery Mode on Intervention Outcome: Analysis of a Theory-based Sexual Health Program. Journal of Medical Internet Research. 20(8):e10398.


Discussion questions

Why are so few digital interventions theory-based?

What kinds of interventions might be affected by modality?



Nicole Levitz (@NicoleLevitz) is a Director of Digital Products at the Planned Parenthood Federation of America. She oversees Planned Parenthood’s Chat/Text program and supports use of science-informed practice across the national office.  Nicole was previously a Research Scientist at New York University’s Silver School of Social Work. At NYU, she managed the design and evaluation of an evidence-based contraceptive counseling program.


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