Effects of a Creative Crowdsourcing Text-Messaging Intervention on Sexual Health Outcomes Among College Students in Eastern China: A Randomized Controlled Trial

Background Creative crowdsourcing may be an effective means to mitigate higher-risk sexual behaviors among college students in China. We conducted an 8-month Randomized Controlled Trial evaluating a crowdsourced health promotion and text-messaging intervention among first-year college students in Eastern China. Methods Participants were randomly assigned to four arms: Active Creative Crowdsourcing Engagement (ACCE) arm that created messages promoting sexual health (n = 129); Text-Messaging Intervention (TMI) arm that received health promotion messages bi-weekly (n = 111); ACCE-TMI arm that both created and received messages (n = 105); and the control arm (n = 135). Sexual health attitudes and behaviors in the past three months were analyzed at baseline and follow-ups. Results Among 480 participants at baseline, 57% identified as male, 8% were sexually active in the past three months and 4% had condomless sex. Proportion of sexually active participants increased in all arms between baseline and last follow-up. A total of 812 messages were submitted throughout the intervention period. Odds of condomless sex were 76% lower in the ACCE arm compared to the control arm (OR = 0.24; p = 0.02, 95% Confidence Interval [0.07, 0.79]). No difference in other sexual activity or attitudes toward condom use was observed between arms. Conclusion Study findings indicate that Active Creative Crowdsourcing is a feasible and potentially effective intervention for promoting safer sexual behaviors among college students in China. Future research should examine using Active Creative Crowdsourcing to promote healthier behaviors in other areas.