Lessons Learned from Icare: A Post-Exam Text Messaging-Based Program with Sexual Assault

Background and Purpose: Sexual assault has a variety of health implications (e.g., sexually transmitted infections [STIs]) and psychological symptoms. Sexual assault survivors who seek a medical-forensic exam do not often seek follow-up care such as therapy or STI testing. A technology-based intervention may be an effective solution to help survivors engage in follow-up care. A Midwest sexual assault nurse examiner (SANE) program developed a four-week post-exam test message program named iCare. The program involves a nurse texting five messages to assess survivors’ safety and emotional wellbeing, if they needed assistance with accessing nPEP (HIV prophylaxis) or scheduling appointments for follow-up pregnancy and STI testing, and their experience with the criminal justice system. The current study examines survivor engagement in iCare.

Methods: The pilot study was conducted within an 18-year old SANE program that provides a variety of domestic and sexual violence services. Over the four-month evaluation period, 69 survivors consented to participate in iCare and the evaluation (58% of eligible patients). However, 29 survivors’ cellular carriers blocked the iCare messages, yielding a final sample size of 40. Data sources included patients’ medical-forensic records from SANE and the text message data from iCare. Due to small sample size, data analysis was limited to descriptive statistics. The frequency counts and percentages for categorical variables were calculated, while means, standard deviations, as well as the minimum and maximum were calculated for continuous variables.

Results: Most survivors were under the age of 24 (53%), white (68%), single (73%), and had attended or graduated college (65%). Most survivors (65%) knew their offender prior to the assault and most (85%) filed a police report. Forty-percent of the survivors reported the use of a weapon or physical force and 40% reported substance-induced incapacitation. During the iCare intervention, 65% of survivors responded at least once, but only two survivors responded to every text. One-fourth of survivors (23%) requested to opt-out before the program ended. More survivors (43%) did not opt-out but stopped replying by the third text. The program was helpful for facilitating post-exam communication between the nurse and survivor, but survivors rarely utilized the nurse’s offers of assistance or referral to the focal agency’s counseling or advocacy services even when their texts indicated emotional distress (e.g., feeling overwhelmed or fearful).

Conclusions and Implications: This study demonstrates the ability of text interventions to relay information and facilitate communication between a nurse and survivor. However, survivors’ rarely utilized the follow-up services offered through iCare. Thus, text interventions may be limited for increasing service utilization. Future research should examine the areas of need for survivors in the weeks and months post-exam that may be addressed through text interventions. The authors will discuss the benefits of social workers rather than sexual assault nurse examiners administering texting interventions that involve assessing and addressing the emotional distress of survivors. Further, the authors will discuss the reasons and implications for cellular carriers blocking texts.