Over 500,000 sexual assaults occur in the United States every year, and persons who experience sexual assault are at risk for adverse physical and mental health consequences. Despite this, follow-up care utilization after sexual assault medical forensic exams (SAFEs) remains low. Simultaneously, sexual assault nurse examiner (SANE) programs often lack resources to provide adequate follow-up care, further contributing to gaps in follow-up care.

Text-SAFE is an innovative digital health intervention designed to support recovery, improve health outcomes and empower survivors of sexual assault to self-manage their care and coping strategies. Text-SAFE is a free text messaging program that provides 31 days of information and support about mental and physical health needs following sexual assault. A pilot study was launched across six Houston Methodist Hospital sites, including Houston Methodist West Hospital. Patients who received a SAFE were offered enrollment in Text-SAFE, including personalized, semi-automated texts on health concerns, follow-up recommendations, medications, where to find support resources and coping skills. Through Text-SAFE, participants could also initiate free-form text conversations with a SANE nurse. Responses to participant text messages were managed by three Houston Methodist SANE nurses via a centralized online dashboard, with nurses providing individualized responses and additional support tailored to each patient’s needs.

Preliminary findings suggest that participants were highly engaged with the Text-SAFE program and initiated texts to the SANE nurse to receive nursing support and address increased stress following their SAFE. Importantly, through Text-SAFE, several patients also requested and received follow-up appointments with medical and mental health professionals, as well as requests for additional community supportive resources, demonstrating the positive impact of Text-SAFE on improving follow-up care for survivors of sexual assault. Text-SAFE addresses longstanding challenges in providing timely and consistent follow-up care after a SAFE. This digital solution has the potential to ease the clinical burden on SANE nursing programs by automating text messages tailored to each patient’s experience and by providing time-sensitive education, coping skills and community resources. The use of text messaging, a familiar and accessible digital health tool, also has the potential to improve patient engagement in follow-up care, as patients can read/respond to information and/or initiate a text to a SANE nurse at a time that works best for them, as opposed to the current national standard of a single, nurse-initiated telephone call.

Text-SAFE has the potential to reduce staff workload by automating routine patient education and follow-up information through a highly accessible platform. Allowing bidirectional messaging between patients and SANE nurses through a centralized dashboard promotes staff/providers’ ability to provide intentional, patient-specific follow-up care, as not all patients may require the same frequency or level of care. In summary, Text-SAFE leverages digital technology to provide personalized patient support while reducing workforce burden, demonstrating strong potential for sustained implementation.