Effects of mHealth intervention on sexual and reproductive health in emerging adulthood: A systematic review and meta-analysis of randomized controlled trials

Interventions for adolescent mental, sexual and reproductive health in West Africa: A scoping review

Objectives

A quarter of West Africa's population are adolescents 10-19 years. Their mental, sexual, and reproductive health is inter-related. We therefore aimed to examine published evidence on effectiveness of interventions for adolescent mental, sexual and reproductive health in the Economic Community of West African States (ECOWAS) to inform development, implementation and de-implementation of policies and programs.

Study design

The study design was a scoping review.

Methods

We considered all qualitative and quantitative research designs that included adolescents 10-19 years in any type of intervention evaluation that included adolescent mental, sexual and reproductive health. Outcomes were as defined by the researchers. PubMed/Medline, APA PsycINFO, CAIRN, and Google Scholar databases were searched for papers published between January 2000 and November 9, 2023.1526 English and French language papers were identified. After eliminating duplicates, screening abstracts and then full texts, 27 papers from studies in ECOWAS were included.

Results

Interventions represented three categories: service access, quality, and utilization; knowledge and information access and intersectionality and social determinants of adolescent health. Most studies were small-scale intervention research projects and interventions focused on sexual and reproductive or mental health individually rather than synergistically. The most common evaluation designs were quasi-experimental (13/27) followed by observational studies (8/27); randomized, and cluster randomized controlled trials (5/27), and one realist evaluation. The studies that evaluated policies and programs being implemented at scale used observational designs.

Conclusion

Research with robust evaluation designs on synergistic approaches to adolescent mental, sexual and reproductive health policies, interventions, implementation and de-implementation is urgently needed to inform adolescent health policies and programs.

Examining within-person associations between alcohol and cannabis use and hooking up among adolescents and young adults in the United States

OBJECTIVE

This study examined daily associations between alcohol use, cannabis use, and simultaneous alcohol and cannabis/marijuana (SAM) use with the likelihood of hooking up (uncommitted sexual encounter that may or may not include intercourse).

METHOD

We used a longitudinal measurement burst ecological momentary assessment (EMA) design with 3-week EMA bursts with daily measurements repeated quarterly across 12 months. 1,009 (57 % female, Mean age = 20.00 [SD = 3.21]) Texan adolescents and young adults ages 15-25 participated in the study. Mixed effects logistic regression models were estimated using maximum likelihood estimation to evaluate the associations between substance use and hooking up.

RESULTS

Within-person results indicated that participants were more likely to hook up on days with alcohol use and on days with cannabis use, but not on days with SAM use. Participants were also more likely to hook up on drinking days with higher-than-usual alcohol use. Between-person results indicated that participants who used alcohol more often or cannabis more often on average were more likely to hook up, and participants who tended to drink more on drinking days were more likely to hook up.

CONCLUSIONS

Given the significant daily-level associations between alcohol and cannabis use and hooking up behavior, public health initiatives should focus on developing interventions to reduce alcohol and cannabis use and promote safer hooking up behavior among adolescents and young adults.

Efficacy of mobile-based educational intervention using Instructional Systems Design in promoting preventive behaviors for sexually transmitted infections among Iranian women: a randomized controlled trial

BACKGROUND

Women who are sexually active are at risk of sexually transmitted infections (STIs), which can cause serious difficulties for their reproductive health. However, despite the high global burden of STIs, most infections are preventable with education for behavioral change. The purpose of this study is to investigate the Efficacy of Mobile-Based Educational Intervention Using Instructional Systems Design in Promoting Preventive Behaviors for Sexually Transmitted Infections among Iranian Women.

METHODS

This randomized controlled trial aimed at promoting preventive behaviors related to STIs in Iranian women with an educational intervention based on the Instructional Systems Design (ISD) in 2022. The participants in this study were recruited from a single center, specifically the Health House No. 3 located in District 11 of Tehran Municipality. Two instruments were used in the present study: a) a valid scale titled: "Four-Scale of STI Preventive Behaviors", and b) a researcher-made Questionnaire titled: "Social perception affecting sexually transmitted infections (SOPESTI)". These tools contain 8 demographic items and specific questions with a total of 68 five-point Likert scales. The intervention comprised three phases: a pre-test (baseline), a training program, and two follow-up assessments (4 and 12 weeks after the start of the training program). The experimental group received education through a mobile app, while the control group received no intervention. SPSS v.26 was used, with a significance level of P < 0.05. The chi-square test, Fisher's exact test, independent t-tests, analysis of covariance (ANCOVA), and repeated measures ANOVA were used to analyze the data.

RESULTS

A total of 80 women, with a mean age of 36.524 ± 6.91 (experiment group) and 34.78 ± 8.20 (control group), respectively, participated in the trial. The study revealed a statistically significant difference in the mean score for eight domains, including STIs Knowledge, STIs Vulnerability, STIs Preventive Self-efficacy, STIs Prevention intentions, STIs Perceived social exclusion, STIs Perceived cognitive barriers, STIs Perceived social support, and STIs Perceived risks in the experiment group following the intervention compared to before the intervention (p < 0.05).

CONCLUSION

The results of this study showed that a mobile-based educational intervention based on the ISD model had a significant effect on the preventive behaviors of STIs in Iranian women. These results highlight the potential benefit of mobile health in enhancing reproductive health.

TRIAL REGISTRATION

ClinicalTrials.gov IRCT20200602047638N1. Registered on 22 May 2021 with the IRCTID, V1.0. https://www.irct.ir/trial/55632.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies

INTRODUCTION

Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents.

METHODS

A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis.

RESULTS

A total of 15 studies (N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08-0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23-0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31-0.92).

DISCUSSION

Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

Effectiveness of a Culturally Responsive mHealth Gaming Application to Improve Diabetes Health Literacy in India: A Randomized Controlled Trial

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups ( P = .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group ( P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility

BACKGROUND

Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth.

OBJECTIVE

The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria.

METHODS

We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized.

RESULTS

A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit).

CONCLUSIONS

This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach.

A virtual randomized controlled trial of an alcohol-exposed pregnancy prevention mobile app with urban American Indian and Alaska Native young women: Native WYSE CHOICES rationale, design, and methods

BACKGROUND

Fetal Alcohol Spectrum Disorders (FASD) result in lifelong disability and are a leading cause of preventable birth defects in the US, including for American Indian and Alaska Natives (AIANs). Prevention of alcohol exposed pregnancies (AEPs), which can cause FASD, is typically aimed at adult women who are risky drinkers and have unprotected sex. Among AIANs, AEP prevention research has been primarily conducted in reservation communities, even though over 70% of AIANs live in urban areas. Culturally appropriate AEP prevention for urban AIAN young women, regardless of current drinking or sexual behaviors, may maximize the potential for primary prevention at the beginning of the reproductive years for this underserved population.

METHODS

We developed a virtual randomized controlled trial (RCT) - fully implemented through technology - to evaluate Native WYSE CHOICES, a culturally tailored mobile app, with urban AIAN young women ages 16-20 nationally. While virtual RCTs are not new, this is the first engaging a solely urban AIAN population, historically excluded from research. Participants are recruited on a rolling basis through the project social media community, organizational partnerships, and in-person events. Eligible participants complete a baseline survey and are randomized to either the app's intervention or comparison arm - each of which provide about 3 h of content. Follow-up data are collected at 1-, 6-, and 12-months post-baseline.

RESULTS

Our study offers a template for building trust and extending reach to this underserved population while also providing important lessons and insights on advances in virtual or hybrid research approaches.

School-Based Interventions for Promoting Sexual and Reproductive Health of Adolescents in India: A Review

In India, the prevalent stigma and taboos regarding sexuality prevent adolescents from acquiring information about sexual and reproductive health. This review assessed the school-based interventions for adolescents designed to enhance their sexual health knowledge, attitudes, and behaviors. Studies were gathered from 4 online databases: PubMed, DOAJ, Google Scholar, and ScienceDirect. Relevant studies conducted in India among adolescents, published in peer-reviewed journals between 2000 and 2020, available in the public domain and written in English, were considered for the review. 14 studies were selected through database searches that fulfilled the eligibility criteria. Findings highlighted that school-based sexuality education positively influences adolescents to develop their knowledge, attitude, and behavior related to sexual and reproductive health outcomes. Sexual and reproductive health (SRH) programs and interventions are limited to small-scale experiments conducted in a few schools. The researchers recommend educating adolescents about pregnancy prevention, sexually transmitted infections (STIs), sexual hygiene, and reproductive health. Comprehensive reproductive health education programs should be implemented in every school setting to ensure that all school-going adolescents are convinced of the importance of sexual and reproductive health.

Promoting teen-to-teen contraceptive communication with the SpeakOut intervention, a cluster randomized trial

BACKGROUND

To improve teen contraceptive use, the SpeakOut intervention combines structured counseling, online resources, and text reminders to encourage teens to share their experiences using intrauterine contraception (IUC) or an implant with peers.

METHODS

To evaluate the effectiveness of remote delivery of the SpeakOut intervention in increasing teen contraceptive use, we conducted a cluster randomized trial involving female adolescents who were recruited online. Primary participants (n = 520) were randomly assigned to receive SpeakOut or an attention control; each primary participant recruited a cluster of up to 5 female peers as secondary participants (n = 581). We assessed contraceptive communication, knowledge, and use, at baseline, 3 and 9 months after participants enrolled. We examined differences between study groups, controlling for clustering by primary participant and baseline characteristics.

RESULTS

The trial's primary outcome, contraceptive use by secondary participants, was similar between groups at both 3 and 9 months postintervention. Compared to controls, primary participants receiving SpeakOut tended to be less likely to discontinue contraception within 9 months (4.8% vs 7.8%, p = 0.11 for IUC; 7.8% vs 9.8%, p = 0.45 for implants), but this did not reach statistical significance. SpeakOut failed to increase contraceptive communication; regardless of study group, most secondary participants reported peer communication about contraception (86% vs 88%, p = 0.57). Most secondary participants were aware of the hormonal IUC (91.4% vs 90.4%, p = 0.72), copper IUC (92.9% vs 88.6%, p = 0.13), and implant (96.5% vs 96.1%, p = 0.83) 3 months after enrolling, regardless of the intervention their primary participant received. However, contraceptive knowledge remained incomplete in all study groups.

CONCLUSION

Remote delivery of the SpeakOutintervention did not improve contraceptive communication, knowledge or use among participating teens or their peers.

IMPLICATIONS

Efforts to support teen-to-teen contraceptive communication and ensure that teens have accurate information about the full range of contraceptive methods, including highly effective reversible contraceptives, require refinement.