Behavioral interventions for improving dual-method contraceptive use

Dual Protection Messaging for Adolescents and Young Adults in the Setting of Over-the-Counter Hormonal Contraception: A Human-Centered Design Approach

STUDY OBJECTIVE

To use human-centered design approaches to engage adolescents and young adults in the creation of messages focused on dual method use in the setting of over-the-counter hormonal contraception access DESIGN: Baseline survey and self-directed workbooks with human-centered design activities were completed. The workbooks were transcribed and analyzed using qualitative methods to determine elements of the communication model, including sender, receiver, message, media, and environment.

SETTING

Indiana and Georgia PARTICIPANTS: People aged 14-21 years in Indiana and Georgia INTERVENTIONS: Self-directed workbooks MAIN OUTCOME MEASURES: Elements of the communication model, including sender, receiver, message, media, and environment RESULTS: We analyzed 54 workbooks, with approximately half from each state. Stakeholders self-identified as female (60.5%), white (50.9%), Hispanic (10.0%), sexually active (69.8%), and heterosexual (79.2%), with a mean age of 18 years. Most strongly agreed (75.5%) that they knew how to get condoms, but only 30.2% expressed the same sentiment about hormonal contraception. Exploration of the elements of the communication model indicated the importance of crafting tailored messages to intended receivers. Alternative terminology for dual protection, such as "Condom+____," was created.

CONCLUSION

There is a need for multiple and diverse messaging strategies about dual method use in the context of over-the-counter hormonal contraception to address the various pertinent audiences as this discussion transitions outside of traditional clinical encounters. Human-centered design approaches can be used for novel message development.

Contraception counseling for adolescents

PURPOSE OF REVIEW

In recent years, pregnancy and birth rates among adolescents in the United States have declined to all-time lows, although adolescents in the United States continue to have the highest rate of unintended pregnancy among developed countries. Contraception is a key component in the prevention of unintended pregnancy. In this review, we outline unique barriers to reproductive healthcare for adolescents and strategies to optimally address the contraceptive needs of adolescents.

RECENT FINDINGS

Adolescents face barriers such as confidentiality, cost, and access when seeking contraception. Counseling about options for contraception may involve parents or guardians when appropriate, but an adolescent's autonomy should be respected in the decision-making process. Contraceptive counseling for adolescents must not be coercive in nature. Adolescents are at an increased risk for acquisition of sexually transmitted infections, and dual use, the use of condoms and an additional method of contraception, is highly recommended. Initiatives that remove the common barriers of cost and access have demonstrated significant success in increasing the use of long-acting reversible contraceptive methods and reducing the rates of unintended pregnancy among adolescents.

SUMMARY

Counseling adolescents about contraception requires acknowledgement of the unique barriers that adolescents face and facilitating decision-making about contraceptive methods in a manner that prioritizes the adolescent's autonomy.

Providing Contraception to Adolescents

Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.