Effect of daily text messages on oral contraceptive continuation: a randomized controlled trial.

OBJECTIVE To estimate whether daily educational text messages affect oral contraceptive pill (OCP) continuation at 6 months. METHODS We randomized young women electing OCPs at an urban family planning health center to either routine care or routine care plus 180 days of daily educational text messages. Investigators masked to treatment allocation randomized participants who were not masked to treatment. The primary outcome measure was self-reported OCP continuation through a telephone call at 6 months (contacts between 5 and 8 months). RESULTS We enrolled 962 participants (480 intervention and 482 routine care) and obtained continuation data on 683 (346 and 337, respectively). At the follow-up, 64% of participants randomized to the intervention were still OCP users compared with 54% of the routine care group (P=.005). Continuation was highest in the intervention group if the interview took place while the intervention was ongoing (75% compared with 54%, P=.003); the effect of the intervention on continuation was less after the intervention ended (60% compared with 54%, P=.16). Participants receiving the intervention were more likely to continue oral contraception than control participants at 6 months (odds ratio 1.44, 95% confidence interval 1.03-2.00) in analyses adjusted for age, race or ethnicity, age at coitarche, pregnancy history, and OCP experience. CONCLUSION The use of daily educational text messages improves OCP continuation at 6 months over routine care alone. Ten women would need to receive this simple intervention to improve continuation in one. This effect is strongest in the women whose follow-up took place while the text intervention was ongoing. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00677703.