Province in Thailand
Variables 1-way SMS n (%) 2-way SMS n (%) Control n (%) Total n (%) p-value Number
Age group (years) 64 64 64 192 0.058a
Mean ± S.D. 21.34±0.72 21.75±1.14 21.48±0.82 21.53±0.92
21 49 (76.6) 39 (60.9) 39 (60.9) 127 (66.1)
≥22 15 (23.4) 25 (39.1) 25 (39.1) 65 (33.9)
Marital status 0.057
Never married 38 (59.4) 50 (78.1) 39 (60.9) 127 (66.1)
Married 25 (39.1) 13 (20.3) 21 (32.8) 59 (30.7)
Others 1 (1.6) 1 (1.6) 4 (6.2) 6 (3.1)
Types of mobile phones are used most frequently 0.377
A basic mobile phone 34 (53.1) 23 (37.1) 24 (40.0) 81 (43.5)
Smart phone 28 (43.8) 36 (58.1) 32 (53.3) 96 (51.6)
Not sure 2 (3.1) 3 (4.8) 4 (6.7) 9 (4.8)
No response - (2) (4) (6)
aAge and monthly income using ANOVA; other variables using Pearson’s Chi-square test.
Alcohol drinking before or during having sex: The percentage of participants who never drank alcohol before or during having sex in both intervention groups was higher than the control group. Statistical analysis showed that there were significant differences among three groups at 6 months (p-value = 0.009) and significant difference for abstinent from alcohol drinking in the 2-way SMS group (p-value=0.026).
Table 2: Alcohol drinking before or during having sex Alcohol
consumption baseline
n (%) 1 month
n (%) 3 months
n (%) 6 months
n (%) Chi-square p-value
p-value 0.037 0.447 0.306 0.009
1-way SMS 5.529 0.477
Never 16 (35.6) 18 (46.2) 19 (51.4) 23 (59.0) Sometimes 25 (55.6) 19 (48.7) 16 (43.2) 15 (38.5)
Every time 4 (8.8) 2 (5.4) 2 (5.4) 1 (2.5)
Total 45 (100.0) 39 (100.0) 37 (100.0) 39 (100.0)
72 Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 Contd…
2-way SMS 14.341 0.026
Never 16 (32.0) 16 (50.0) 13 (40.6) 25 (67.6) Sometimes 31 (62.0) 15 (46.9) 19 (59.4) 12 (32.4)
Every time 3 (6.0) 1 (3.1) 0 0
Total 50 (100.0) 32 (100.0) 32 (100.0) 37 (100.0)
Control 9.349 0.154
Never 20 (45.5) 13 (35.1) 19 (51.4) 17 (42.5) Sometimes 24 (54.5) 20 (54.1) 14 (37.8) 22 (55.0)
Every time 0 4 (10.8) 4 (10.8) 1 (2.5)
Total 44 (100.0) 37 (100.0) 37 (100.0) 40 (100.0) Using Pearson’s Chi-square test
Condom use: Condom use among 3 groups was no significant difference between intervention groups and control group (p-value = 0.083). After the end of the intervention, between group analyses found that there was a significant difference at 6 months (p = 0.012). The significant difference for condom use was fond in the 1-way SMS group (p = 0.036).
Table 3: Condom use Condom use baseline
n (%) 1 month
n (%) 3 months
n (%) 6 months
n (%) Chi-square p-value
p-value 0.083 0.238 0.889 0.012
1-way SMS 8.528 0.036
Never 14(29.8) 8(20.5) 2(5.4) 6(15.4)
Sometimes 26(55.3) 23(59.0) 24(64.9) 24(61.5)
Every time 7(14.9) 8(20.5) 11(29.7) 9(23.1)
Total 47(100.0) 39(100.0) 37(100.0) 39(100.0)
2-way SMS 2.116 0.548
Never 5(10.0) 6(18.8) 5(14.7) 7(20.6)
Sometimes 28(56.0) 14(43.7) 18 (52.9) 15(44.1)
Every time 17(34.0) 12(37.5) 11(32.4) 12(35.5)
Total 50(100.0) 32(100.0) 34(100.0) 34(100.0)
Control 7.371 0.060
Never 14(29.2) 12(30.8) 4(9.8) 8(17.4)
Sometimes 27(56.2) 19(48.7) 26(63.4) 35(76.1)
Every time 7(14.6) 8(20.5) 11(26.8) 3(6.5)
Total 48(100.0) 39(100.0) 41(100.0) 46(100.0)
Using Pearson’s Chi-square test
dISCuSSION
Study has demonstrated on the effective of SMS for reducing alcohol drinking. There was significantly different at 6 months (p-value=0.009). Participants of 2-way SMS group had the highest percentage of
abstinence from alcohol drinking “never” when they had sex. Drinking alcohol among youth is a major public health problem. Sexual activity and sexual risk behavior are the serious problem consequence from alcohol drinking. The results of current laboratory-based experiments provide support for a causal effect of alcohol
Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 73 on sexual risk behavior in that alcohol consumption
leads to decrements in the hypothesized theoretical determinants of condom use. Most importance of sexual risk taking includes an early age of first intercourse, having multiple sexual partners, unprotected sexual behaviors, and having sex prior or during alcohol and substance use (12). Adolescents who use alcohol and illicit drugs are more likely to engage in high-risk sexual behavior. Adolescents who have more to drink five or more drinks on an occasion are approximately three times less likely to use condoms (13). Although other technologies have also the potential to reach adolescents and young adults, SMS via mobile phone has appeared as a promising and cost-effective gateway to promote healthy behaviors. The potential of SMS may be particularly significant among population groups most likely to use mobile phone as their primary means of communication. Mobile phone use is becoming popular among adolescents, young adults, socioeconomically disadvantaged people, less educated young adults, and people who frequently change addresses. Therefore, SMS could be a prime delivery channel for health behavior change interventions, especially in populations of lower socio-demographic status and populations with poorer health(16).
Safe sex in terms of condom use was also significantly different among 3 groups at 6 months (p-value = 0.012). This result was similar to the earlier study of effectiveness was showed the SMS group having significantly increased knowledge, practice in condom use and perceived advantage and frequency of using SMS. The message through SMS provided health education information to promote safe sex and awareness regarding HIV and other communicable disease (14). SMS allowed the quick and almost real-time exchange of short text messages between users of fixed line or mobile phone devices. However, condom use was not significant difference in the 2-way SMS group. The previous study that aimed to prevent HIV/AIDS among men who have sex with men (MSM) and female sex workers presented an increase in knowledge and intention to use condoms. Furthermore, voluntary counseling and testing uptake increased after the launch of the campaign
(10). Short Message Service is a highly promising method of health promotion for multiple reasons which can be sent to multiple recipients simultaneously and delivered immediately (15). A chance to respond to messages or seek specific advice from researchers has been the key
component of the 2-way SMS group. However, there were only 25% of respondents who have a question for safe sex methods during the intervention period (approximately 5-10 questions per week). This is similar to a previous study which had low response rate to the questions administered via SMS among HIV-positive
MSMs (18). Low response may possible that conscripts
have not pay attention on the message and possibly due to many questions has been already answered during the training period before SMS’s allocation. Sending back SMS to the researchers might be burdensome because of the routine responsibilities of conscripts in the military.
Our finding on condom use among three group showed significant difference at 6 months (p-value= 0.012). The 2-way SMS group was higher than the 1-way SMS and control group at each follow-up. Howevr, the results on condom use of the 2-way SMS groups was not significantly different (p-value=0.548). The exploitation on sending messages back to the researcher is the key to success for safer sex practice. Conscripts in the 2-way SMS group have not much question and response with the text message.
CONCluSION
Study demonstrated the effectiveness of SMS in both 1-way and 2-way SMS communication. Implementing SMS intervention program for promoting safe sex among conscripts can translate to less risky sex practices and that mobile phone communication can be influential in promoting behavior change.
ReCOMMeNdATION
We recommend the use of inexpensive technologies in promoting safe sex behaviors among this high-risk segment of the population, with regular evaluation of its effectiveness in the long-term. However, SMS alone may not entirely drive safer sex behaviors in the long-term. Therefore, other forms of communication can also be explored for the same preventive purpose and can be a topic for future research.
Conflict of Interest: None
Source of Funding: The Ratchadaphisek Sompoch Endowment Fund, Chulalongkorn University (CU).
ethical Clearance: Taken from the Ethics Review Committee of Research Involving Human Research Subjects, Science Group, CU.
74 Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2
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