Baseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program

Background: Growing evidence suggests that text messaging programs are effective in facilitating health behavior change. However, high dropout rates limit the potential effectiveness of these programs. Objective: This paper describes patterns of early dropout in the HealthyYou text (HYTxt) program, with a focus on the impact of baseline motivation quality on dropout, as characterized by Self-Determination Theory (SDT). Methods: This analysis included 193 users of HYTxt, a diet and physical activity text messaging intervention developed by the US National Cancer Institute. Descriptive statistics were computed, and logistic regression models were run to examine the association between baseline motivation type and early program dropout. Results: Overall, 43.0% (83/193) of users dropped out of the program; of these, 65.1% (54/83; 28.0% of all users) did so within the first 2 weeks. Users with higher autonomous motivation had significantly lower odds of dropping out within the first 2 weeks. A one unit increase in autonomous motivation was associated with lower odds (odds ratio 0.44, 95% CI 0.24-0.81) of early dropout, which persisted after adjusting for level of controlled motivation. Conclusions: Applying SDT-based strategies to enhance autonomous motivation might reduce early dropout rates, which can improve program exposure and effectiveness.