Authors
Yusi Aveva Xu, Jace D Pierce, Lenna Dawkins-Moultin, Ashley Canright, Maria Borjas, Dalnim Cho, Suellen Hopfer, Yisheng Li, Lois M Ramondetta, Qian Lu
Published in
Journal of health communication. Volume 31. Issue sup1. Pages S5-S20. Epub Nov 12, 2026.
Abstract
Digital health interventions offer promising opportunities for behavioral change among young adults, but maintaining longitudinal trial engagement is difficult. This study examined the adaptive layered communication strategies (ALCS) developed collectively through aniterative loop with community members in the Student Health Initiative for Eliminating HPV Diseases (SHIELD) study. These strategies included welcome videos, personalized messages (e.g., thank-you texts, birthday messages, exam period check-ins), and memes. Compared to the period/phase before ALCS, participants exposed to ALCS demonstrated significantly higher survey completion rates at 6 months (76.09% vs. 60.51%, p = .01) and 9 months (78.08% vs. 65.64%, p = .05). Moderation analyses revealed a phase×school type interaction (p = .04): completion rose from 50.05% to 75.95% among public school students (p = .03), while private school rates remained stable ( > 75.00%), suggesting a ceiling effect (p = .41). While automated reminders remain valuable, researchers developing longitudinal digital health interventions should consider a "cocktail" approach, which combines reliable automation with authentic, timely, and culturally tuned human touches, to sustain engagement, particularly in lower-engagement contexts (e.g. public schools).
PMID:
43018254
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.
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