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Gazibara T, Cakic M, Cakic J, Grgurevic A, Pekmezovic T. Familiarity with the internet and health apps, and specific topic needs are amongst the factors that influence how online health information is used for health decisions amongst adolescents. Health Info Libr J 2024; 41:283-297. [PMID: 35652454 DOI: 10.1111/hir.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many adolescents believe that online health information is reliable, particularly when they are familiar with the source of information. OBJECTIVE To analyse the degree of influence of online health information on high school students' health decisions and examine whether socio-demographic characteristics, digital literacy, use of different websites and interest in specific health topics are associated with a stronger influence of online health information on adolescents' health-related decisions. METHODS Participants were students from four public high schools in Belgrade, Serbia. Socio-demographic and behavioural questionnaire as well as the e-health literacy scale (eHEALS) were used to collect data. RESULTS The study sample comprised 702 students. A total of 79.6% of students reported that online health information influenced their health decisions to a certain extent (from 'a little' to 'a lot'). Being a boy, using the internet since younger age, better self-perceived e-health literacy, using health apps, Google, health forums, websites of health institutions, social media and YouTube, being interested in diet/nutrition, sexually transmitted infections and cigarettes were the characteristics associated with a stronger influence of online health information on students' health decisions. CONCLUSION This study provides clues about how online health-related information can be used to adjust and enhance health promotion amongst adolescents.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Cakic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Cakic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anita Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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2
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McCrimmon J, Widman L, Javidi H, Brasileiro J, Hurst J. Evaluation of a Brief Online Sexual Health Program for Adolescents: A Randomized Controlled Trial. Health Promot Pract 2024; 25:689-697. [PMID: 37013260 PMCID: PMC10966929 DOI: 10.1177/15248399231162379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Adolescents are at increased risk of acquiring sexually transmitted infections (STIs) and experiencing unintended pregnancy. In particular, adolescents from marginalized communities experience significant sexual health disparities compared to their more advantaged peers. Digital sexual health programs, such as HEART (Health Education and Relationship Training), may be effective in reducing these risks and addressing these disparities. HEART is a web-based intervention focused on the promotion of positive sexual health outcomes, such as sexual decision-making skills, sexual communication skills, sexual health knowledge, and sexual norms and attitudes. The current study evaluates the efficacy of HEART, and examines whether effects were moderated by gender, socioeconomic status (SES), race, English as a second language, and sexual orientation to ensure the program is effective for diverse groups of adolescents. Participants were 457 high school students (Meanage=15.06, 59% girls, 35% White, 78% heterosexual, 54% receive free or reduced-price lunch). Students were randomized to HEART or an attention matched control and assessed at pretest and immediate posttest. HEART was effective in increasing sexual assertiveness, sexual communication intentions, HIV/STI knowledge, condom attitudes, and safer sex self-efficacy compared to the control condition. There were no significant interactions by gender, SES, race, English as a second language, or sexual orientation, suggesting the program worked equally well for all groups of youth. The findings of this study suggest that HEART may be a promising avenue for the promotion of positive sexual health outcomes for diverse groups of youth.
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Affiliation(s)
| | - Laura Widman
- North Carolina State University, Raleigh, NC, USA
| | - Hannah Javidi
- Indiana University Bloomington, Bloomington, IN, USA
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3
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Yarger J, Gutmann-Gonzalez A, Borgen N, Romero J, Decker MJ. In the Know: A Cluster Randomized Trial of an In-person Sexual Health Education Program Integrating Digital Technologies for Adolescents. J Adolesc Health 2024; 74:1019-1025. [PMID: 38323966 PMCID: PMC11218833 DOI: 10.1016/j.jadohealth.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/03/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Integrating digital technologies into sexual health education can offer advantages for connecting with adolescents, particularly populations who may be underserved through common school-based approaches. This study assessed the effectiveness of In the Know, an in-person, group-based sexual health education program integrating digital technologies, codesigned with adolescents. METHODS The study design was a cluster randomized trial with 1,263 adolescents aged 13-19 in 95 cohorts, implemented in community-based organizations and schools throughout Fresno County, California. Participants completed a baseline survey and a follow-up survey 3 months later. Two-level mixed-effects regression models with random intercepts for cohort were used to estimate the intervention's impact on unprotected sex, use of clinical health services, knowledge of local sexual health services, technology use to find or schedule services, and sexual health knowledge at the 3-month follow-up. RESULTS The average age of participants was 15.7 years, and the majority identified as Hispanic (71%). In adjusted analyses, intervention group participants were more likely to use clinical services (42.7% vs. 33.2%, p = .009) and reported greater sexual health knowledge at 3 months (57.6% of items answered correctly vs. 50.7%, p = .001). No significant differences were observed in the other outcomes by study group. DISCUSSION In the Know participants demonstrated greater use of clinical health services and sexual health knowledge at 3 months. The study findings show the potential for incorporating user-centered design and technology into sexual health education to better support adolescents who may have limited access to this important information.
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Affiliation(s)
- Jennifer Yarger
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
| | - Abigail Gutmann-Gonzalez
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Natasha Borgen
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Julio Romero
- Fresno Economic Opportunities Commission, Fresno, California
| | - Martha J Decker
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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4
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Versloot-Swildens MC, de Graaf H, Twisk JWR, Popma A, Nauta-Jansen LMC. Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands. J Youth Adolesc 2024; 53:998-1014. [PMID: 38055133 DOI: 10.1007/s10964-023-01903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).
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Affiliation(s)
- M C Versloot-Swildens
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands.
| | - H de Graaf
- Rutgers, Dutch Centre of Expertise on Sexual and Reproductive Health and Rights, Utrecht, the Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - A Popma
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands
| | - L M C Nauta-Jansen
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands
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Javidi H, Widman L, Maheux AJ, McCrimmon J, Evans-Paulson R, Becker W. PACT: Developing and Evaluating a Digital Sexual Consent Program for Youth. JOURNAL OF SEX RESEARCH 2024; 61:466-480. [PMID: 37186689 DOI: 10.1080/00224499.2023.2208560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Understanding affirmative sexual consent is crucial for violence prevention and health promotion, yet few adolescents receive adequate consent education. The current study aimed to evaluate the acceptability and preliminary efficacy of a brief online program designed to teach adolescents information and skills about communicating and interpreting affirmative sexual consent (PACT: Promoting Affirmative Consent among Teens) in a randomized controlled trial with a national sample of 833 U.S. adolescents (ages 14-16; 42% White, 17% Asian, 17% Black, 13% Latinx; 53% girls, 31% boys, 12% non-binary; 45% heterosexual; 29% sexually active). PACT, grounded in health behavior change and persuasion theories, was developed using feedback from youth advisors and usability testers. Participants considered the program generally acceptable. Compared to youth who completed a control program, PACT was efficacious at shifting three measures of affirmative consent cognitions (i.e., knowledge, attitudes, self-efficacy) from baseline to immediate posttest. Youth who completed PACT also demonstrated more accurate affirmative consent knowledge at 3 months post-baseline. PACT's effects on consent cognitions were generally similar among youth with various gender, racial/ethnic, and sexual identities. We discuss next steps for this program, including the possibilities of expanding to include additional concepts and tailoring to address the unique needs of specific youth.
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Affiliation(s)
- Hannah Javidi
- Department of Applied Health Science, Indiana University School of Public Health
- Department of Psychology, North Carolina State University
| | - Laura Widman
- Department of Psychology, North Carolina State University
| | - Anne J Maheux
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
- Department of Psychology, University of Pittsburgh
| | | | | | - Whitney Becker
- Department of Psychology, North Carolina State University
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Vamos CA, Puccio JA, Griner SB, Logan RG, Piepenbrink R, Richardson Cayama M, Lovett SM, Mahony H, Daley EM. Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:477-486. [PMID: 35298353 DOI: 10.1080/07448481.2022.2040517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.
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Affiliation(s)
- Cheryl A Vamos
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Joseph A Puccio
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Stacey B Griner
- University of North Texas Health Science Center at Fort Worth, School of Public Health, Fort Worth, TX, USA
| | | | | | | | - Sharonda M Lovett
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Helen Mahony
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Ellen M Daley
- University of South Florida, College of Public Health, Tampa, FL, USA
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Danielson CK, Moreland A, Hahn A, Banks D, Ruggiero KJ. Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study. JMIR Form Res 2024; 8:e52835. [PMID: 38236634 PMCID: PMC10835591 DOI: 10.2196/52835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non-trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. OBJECTIVE The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. METHODS Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. RESULTS In total, 4 overarching themes emerged from the participants' answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users' favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: "This app has much that is of interest to me." Adolescents generally found the app easier to use than did caregivers and clinicians. CONCLUSIONS The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. TRIAL REGISTRATION ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720.
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Affiliation(s)
- Carla Kmett Danielson
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Angela Moreland
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Austin Hahn
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Devin Banks
- Department of Psychology, University of Missouri-Saint Louis, Saint Louis, MO, United States
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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8
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Sileo KM, Reynoso G, Torok K, Moreno AN, Miura LN. Balancing career goals and parenthood desires: results from a survey of undergraduate pre-health students at a hispanic-serving institution in Texas. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-11. [PMID: 38227926 PMCID: PMC11250931 DOI: 10.1080/07448481.2023.2299420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To examine family planning and fertility experiences and views, as well as desired parenthood timing and career plans, of diverse undergraduate pre-health students. PARTICIPANTS 266 pre-health undergraduate students attending a Hispanic-Serving Institution in South Texas. METHODS We conducted a cross-sectional, online survey with a purposive sample of undergraduate students and analyzed data descriptively. RESULTS Most students desired children in the future but were concerned about planning the timing of parenthood against their career training. The results highlight the need to improve both family planning and fertility knowledge, based on a high unmet need for contraceptives, low perceived knowledge about fertility/infertility treatment, and a desire to learn more about planning the timing of their career training alongside parenthood. CONCLUSIONS This study highlights potential gaps in reproductive health information and services among diverse, health-focused students needed to inform choices about the timing of their families and career training.
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Affiliation(s)
- Katelyn M. Sileo
- The University of Texas at San Antonio, Department of Public Health, One UTSA Circle, San Antonio, TX 78249
| | - Gabriella Reynoso
- The University of Texas at San Antonio, Department of Public Health, One UTSA Circle, San Antonio, TX 78249
| | - Kendle Torok
- The University of Texas at San Antonio, Department of Public Health, One UTSA Circle, San Antonio, TX 78249
| | - A. Nicole Moreno
- The University of Texas at San Antonio, Department of Public Health, One UTSA Circle, San Antonio, TX 78249
| | - Lisa N. Miura
- Oregon Health & Science University, Division of General Internal Medicine and Geriatrics, Portland, OR 97239
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Leos C, Chen E, Jagannathan V. Using Human-Centered Design Strategies to Identify Unmet Adolescent Sexual Health Wants and Needs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:174-184. [PMID: 37351667 PMCID: PMC10764404 DOI: 10.1007/s11121-023-01559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
This paper describes a human-centered design approach to investigate unmet adolescent sexual health wants and needs among youth of color in low-income and rural communities in Texas, North Carolina, and Connecticut (n = 149). The approach involved gathering qualitative data through in-depth interviews and other human-centered design activities between April 2016 and August 2016. Data were analyzed using thematic content analysis after each round of data collection. Themes were triangulated across multiple data sources to identify key insights. Results highlighted several important unmet wants and needs. Participants shared that schools were not the preferred place to learn about sexual health and healthy relationships, due to uncomfortable and sometimes even hostile environments. When discussing the potential to use internet- and technology-based sexual health resources, participants expressed concerns over privacy, safety, and credibility of information available. Similarly, participants preferred mobile apps over websites due to the privacy of the experience. Most importantly, key emotions impacting adolescents' access to and use of sexual health resources were identified. Results indicated a preference for consuming story-based information in a text message format that described diverse experiences related to sexual health topics. Together, these findings led to the development of an innovative, mobile health intervention for adolescents, the Real Talk mobile app. This human-centered approach can support researchers and practitioners in strengthening intervention development efforts to improve the reach, adoption, and implementation of sexual health interventions.
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Affiliation(s)
| | - Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
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Antonishak J, Suellentrop K, Steiner RJ, Lloyd L, Axelson SM. Catalyzing Technology-Based Innovation in Teen Pregnancy Prevention: an Implementation Model and Findings from a Human-Centered Design Initiative. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:185-195. [PMID: 37466808 PMCID: PMC10764401 DOI: 10.1007/s11121-023-01523-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 07/20/2023]
Abstract
From 2015 to 2021, the US Department of Health and Human Services' Teen Pregnancy Prevention (TPP) program funded Power to Decide, a national reproductive health nonprofit organization, to catalyze innovation in adolescent sexual and reproductive health through the development of technology-based interventions. Power to Decide's initiative, Innovation Next, supported twenty innovation teams in using human-centered design (HCD) to develop new products, services, and programs. We describe the Innovation Next implementation model, which can inform future efforts to develop innovative, technology-based TPP programs using HCD. To that end, we draw on quantitative and qualitative data collected for program improvement to summarize key implementation findings.
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11
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Zervos AP, Hensel DJ, Cope-Barnes D, James R, Ott MA. Effectiveness of Youth Risk Prevention Programs When Virtually Adapted. J Adolesc Health 2023; 73:910-916. [PMID: 37578405 DOI: 10.1016/j.jadohealth.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE COVID-19 forced many youth risk prevention programs to be adapted to virtual formats. It remains unclear whether virtual programming is as effective as in-person programming. This study examined program logistics, differences in reach of at-risk youth and risk reduction in a youth substance use prevention program before and after being adapted to a virtual platform due to COVID-19. METHODS Rural high school students in a substance use prevention program completed baseline and follow-up surveys. Data were included from two program cohorts, one in 2020 (In-person; N = 331) and the second in 2021 (virtual; N = 426). Survey data were analyzed to compare differences between cohorts in ability to reach at-risk youth and effects on risk reduction. Data on program logistics were drawn from open-ended facilitator questionnaires and site observation reports. These data were analyzed to understand benefits and challenges with virtual program implementation. RESULTS In-person participants were older, in a higher grade, and reported higher rates of substance abuse, reported higher rates of substance use, sexual behaviors, and risky sex. Virtual program participants reported higher rates of unprotected sex and future intentions of unprotected sex. Neither program showed significant reduction in risk intermediary factors. Positive attitudes about the benefits of substance use increased during the virtual program. Thematic analysis revealed problems with implementing the virtual program, including low attendance and technology issues. DISCUSSION In-person programs moved to virtual delivery may be less effective at reaching at-risk youth, may have smaller impact on risk prevention and may encounter logistical problems. Because previous research has found that technology-based interventions can be effective, future research should seek to evaluate how to strengthen evidence-based practices when delivery modality changes.
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Affiliation(s)
- Andrew P Zervos
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Devon J Hensel
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Rebecca James
- Health Care Education and Training, Inc, Indianapolis, Indiana
| | - Mary A Ott
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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12
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Brasileiro J, Widman L, Hurst JL. Sexual self-efficacy and sexual communication among adolescent girls: moderated mediation results from a randomized controlled trial. Psychol Health 2023; 38:1273-1287. [PMID: 34905990 PMCID: PMC9210825 DOI: 10.1080/08870446.2021.2012573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/28/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Guided by the Operating Conditions Framework, the goal of this study was to identify how and for whom an online sexual health program called Health Education and Relationship Training (HEART) worked. DESIGN Data come from a randomized controlled trial among 198 U.S. high school girls who completed HEART or an attention-matched control. We conducted mediation and moderated mediation models to determine if sexual self-efficacy was a mediator and if program acceptability and sexual activity status were moderators of HEART efficacy. MAIN OUTCOME MEASURE Sexual communication skills were assessed with a behavioral role-play task. RESULTS HEART significantly improved sexual communication skills. These effects were fully mediated through sexual self-efficacy. Specifically, HEART improved sexual self-efficacy which in turn increased sexual communication skills. Also, when participants liked the program more, the effect of HEART on sexual self-efficacy was stronger. Further, among girls who had engaged in sexual activity, sexual self-efficacy was significantly associated with sexual communication skills. CONCLUSION This study provides insights into the mechanisms of behavior change underlying HEART. Results highlight the need to further 'unpack' the effects of other sexual health programs, as we showed that programs may work better under certain conditions.
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Affiliation(s)
- Julia Brasileiro
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Jeffrey L Hurst
- Department of Psychology, North Carolina State University, Raleigh, USA
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13
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Jang HJ, Lee J, Nam SH. Psychometric Evaluation of the Korean Version of the Perceived Costs and Benefits Scale for Sexual Intercourse. Healthcare (Basel) 2023; 11:2166. [PMID: 37570406 PMCID: PMC10418783 DOI: 10.3390/healthcare11152166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to evaluate the psychometric properties of the Korean version of the perceived costs and benefits scale (K-PCBS) for sexual intercourse to deepen our understanding of the complex psychosocial and interpersonal elements influencing young people's sexual decision-making. The study participants were 227 college students in South Korea aged 18-25 years. Two factors were extracted through factor analysis, accounting for 61.05% and 58.18% of the variance for perceived costs and perceived benefits, respectively, and showed a good model fit in the K-PCBS. Reliability was high, as indicated by Cronbach's alphas of 0.87 and 0.84 for the perceived costs and perceived benefits subscales, respectively. The results indicate that the K-PCBS may serve as an appropriate instrument for measuring South Korean youth's cost and benefit analysis regarding their sexual decision-making. Our study makes a significant contribution to the literature and field because it identifies the underlying feelings and attitudes of young adults toward engaging in sexual activities using the K-PCBS for sexual intercourse, which has good reliability, validity, and internal consistency.
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Affiliation(s)
- Hee-Jung Jang
- School of Nursing, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea;
| | - Jungmin Lee
- School of Nursing, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea;
| | - Soo-Hyun Nam
- Department of Nursing, Andong National University, Andong 36729, Gyeongsangbuk-do, Republic of Korea;
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14
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Crowley T, Petinger C, van Wyk B. Effectiveness, acceptability, and feasibility of technology-enabled health interventions for adolescents living with HIV in low- and middle-income countries: A systematic review protocol. PLoS One 2023; 18:e0281894. [PMID: 36800371 PMCID: PMC9937495 DOI: 10.1371/journal.pone.0281894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Adolescents living with chronic conditions such as HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology offers a promising platform to deliver behaviour-change interventions to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa; yet little is known about the effectiveness, feasibility and acceptability of technology-enabled interventions to deliver and support health care to ALHIV in resource-constraint settings. This study aims to explore the literature and synthesise the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar will be searched to identify technology-enabled health interventions for ALHIV in LMIC published from 2010-2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10-19 years) will be included. The review will be performed, and findings reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols. A two-stage process of screening titles and abstracts, and then full-text, will be performed independently by two reviewers. The quality of the included studies will be assessed using the Critical Appraisal Skills Programme checklists, and the Risk of Bias in Non-randomised Studies of Interventions tool will be used to assess the risk of bias. The review will involve publications already in the public domain; therefore, ethics approval is not required. The results will be disseminated through a peer-reviewed journal publication and/or conference proceedings. PROSPERO registration number: CRD42022336330.
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Affiliation(s)
- Talitha Crowley
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Charne Petinger
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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15
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Crowley T, Petinger C, Nchendia AI, van Wyk B. Effectiveness, Acceptability and Feasibility of Technology-Enabled Health Interventions for Adolescents Living with HIV in Low- and Middle-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2464. [PMID: 36767831 PMCID: PMC9916219 DOI: 10.3390/ijerph20032464] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adolescents living with HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology-enabled interventions can be used to optimize healthcare delivery to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa. This review synthesized the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). METHODS Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar were searched to identify studies in LMIC published from 2010 to 2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10-19 years) were included. The review was performed, and findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols. The review was registered with PROSPERO: CRD42022336330. RESULTS There is weak evidence that technology-enabled health interventions for ALHIV in LMIC improve treatment outcomes. However, most interventions appear to be acceptable and feasible. CONCLUSION There is a need to ensure that technology-enabled interventions have a strong theoretical base. Larger studies with rigorous evaluation designs are needed to determine the effects of these interventions on the health outcomes of ALHIV in LMIC.
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Affiliation(s)
- Talitha Crowley
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Charné Petinger
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Azia Ivo Nchendia
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
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16
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Huang KY, Kumar M, Cheng S, Urcuyo AE, Macharia P. Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review. BMC Health Serv Res 2022; 22:1373. [PMID: 36401323 PMCID: PMC9675248 DOI: 10.1186/s12913-022-08673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
AIM Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. METHODS An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. RESULTS Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. CONCLUSIONS Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs.
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Affiliation(s)
- Keng-Yen Huang
- Department of Population Health, New York University School of Medicine, 227 East 30Th Street, 7Th Floor, New York, NY 10016 USA
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Sabrina Cheng
- Department of Population Health, New York University School of Medicine, 227 East 30Th Street, 7Th Floor, New York, NY 10016 USA
| | - Anya Elena Urcuyo
- Department of Psychology, Florida International University, Miami, USA
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17
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Mazza D, Buckingham P, McCarthy E, Enticott J. Can an online educational video broaden young women's contraceptive choice? Outcomes of the PREFER pre-post intervention study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:267-274. [PMID: 35228303 DOI: 10.1136/bmjsrh-2021-201301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Contraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women's contraceptive knowledge and their long-acting reversible contraception (LARC) preference and uptake. METHOD We used Facebook advertising to recruit young women aged 16-25 years. Participants completed the pre-video survey (S1), watched the 11-min video, then completed surveys immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression (generalised estimating equations). RESULTS A total of 322 participants watched the video, completed S1 and S2, and 88% of those completed S3. At S1 only 6% rated their knowledge about every method as high. Knowledge improved at S2 for all methods (OR 10.0, 95% CI 5.9 to 17.1) and LARC (OR 4.2, 95% CI 3.1 to 5.7). LARC preference increased at S2 (OR 1.7, 95% CI 1.4 to 2.1) and S3 (OR 1.4, 95% CI 1.2 to 1.7), as did LARC uptake at S3 (OR 1.3, 95% CI 1.11 to 1.5). LARC uptake was driven by a 4.3% (n=12) absolute increase in intrauterine device (IUD) use, but there was no change in contraceptive implant use (p=0.8). The use of non-prescription methods such as condoms and withdrawal did not change (OR 0.92, 95% CI 0.76 to 1.11). CONCLUSIONS Many young women in Australia do not feel well informed about their contraceptive options. The contraceptive education video, delivered via social media, increased their self-reported contraceptive knowledge and IUD preference immediately after viewing, and their IUD uptake 6 months later. Focus should be given to how young women navigate contraceptive access after internet-based education, and strategies to increase access to preferred methods.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Pip Buckingham
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edwina McCarthy
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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18
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Gómez AG, González CA, Lindenberg CS, Majano SB, García VM, Guillen LF, Romanjek MH, Coffman M. Harnessing the Power of Technology to Improve Sexual and Reproductive Youth Health in Nicaragua: A Randomized Field Study. HISPANIC HEALTH CARE INTERNATIONAL 2022:15404153221125171. [PMID: 36154311 DOI: 10.1177/15404153221125171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Nicaragua is among the poorest countries in Latin America and has one of the highest adolescent pregnancy rates in the region. One in four of pregnancies are adolescents and they are more likely to experience poverty and gender and economic inequality. Method: This pilot randomized field study assessed use, satisfaction, and impact of a brief e-learning short-term intervention to improve the sexual and reproductive health (SRH) knowledge, skills, motivations, and behaviors among 14-17-year-old Nicaraguan youth. Results: While access to technology and internet were significant barriers, App and email delivery channels were feasible means for communicating with youth who had access to the internet and mobile devices. Youth who used the app were most likely to complete the entire intervention. Youth were very satisfied with the intervention (98%) and significantly improved SRH knowledge, skills and motivations, and delayed age at the first sexual encounter. Conclusion: Results are promising and indicate potential for the scalability of this type of intervention.
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19
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Fathalian M, Lotfi R, Faramarzi M, Qorbani M. The effect of virtual cognitive-behavioral sexual counseling on sexual function and sexual intimacy in pregnant women: a randomized controlled clinical trial. BMC Pregnancy Childbirth 2022; 22:616. [PMID: 35927705 PMCID: PMC9351073 DOI: 10.1186/s12884-022-04932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background & aim Pregnancy is associated with numerous physical and psychological changes and affects the sexual function of couples. Since the root of many marital problems lies in the quality of the relationship and sexual function, the present study investigates the effect of virtual cognitive-behavioral sexual counseling on pregnant women’s sexual function and intimacy. Methods & Materials This study is a randomized clinical trial, and 80 pregnant women aged 18 to 35 years and in 16–24 weeks of pregnancy were assigned to two intervention and control groups based on randomized blocks from June 2021 to July 2021. The control group received routine prenatal care, but the intervention group, in addition to routine prenatal care, underwent virtual counseling with a cognitive-behavioral approach during eight sessions of 90 minutes. Data were collected using the Female Sexual Function Index (FSFI) and sexual intimacy questionnaire. SPSS software was used for statistical analysis. Results The comparison of mean scores of sexual function and intimacy in the two groups before the intervention was not statistically significant with each other. However, after the intervention, the mean scores of sexual function and intimacy in the intervention group were significantly increased compared to the control group (p < 0.001). The effect size of the intervention was 0.52 for sexual function and 0.272 for sexual intimacy. Conclusion Virtual cognitive-behavioral counseling can be used as an effective treatment to promote sexual function and intimacy of women during pregnancy. Trial registration IRCT20161230031662N10. Registry date: 21/06/2021.
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Affiliation(s)
- Manizheh Fathalian
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Razieh Lotfi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran. .,School of Nursing and Midwifery, Alborz University of Medical Sciences, 1st Golestan- Eshteraki Boulevard- Baghestan, Karaj, Iran.
| | - Mahbobeh Faramarzi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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20
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Okumu M, Logie CH, Ansong D, Mwima S, Hakiza R, Newman PA. Digital technologies, equitable gender norms, and sexual health practices across sexting patterns among forcibly displaced adolescents in the slums of kampala, Uganda. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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de Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions. Psychol Health 2022; 38:675-700. [PMID: 35748408 DOI: 10.1080/08870446.2022.2090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.
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Affiliation(s)
- John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Philippe C. G. Adam
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- Institute for Prevention and Social Research, Bangkok, Thailand
| | - Chantal den Daas
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Kai Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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22
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Chernick LS, Konja A, Gonzalez A, Stockwell MS, Ehrhardt A, Bakken S, Westhoff CL, Dayan PS, Santelli J. Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors. Digit Health 2022; 8:20552076221104660. [PMID: 35707267 PMCID: PMC9189520 DOI: 10.1177/20552076221104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support. Methods We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients. Results Females (n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n = 39) found the images "relatable," "super-realistic," and "educational." Conclusion Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA,Lauren S Chernick, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY, USA.
| | - Alexis Konja
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Melissa S Stockwell
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, NY, USA
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, NY, USA
| | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - John Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
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23
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Kamke K, Stewart JL, Widman L. Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:822-833. [PMID: 36212514 PMCID: PMC9542138 DOI: 10.1007/s13178-021-00594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 06/03/2023]
Abstract
Introduction Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART. Methods This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age=15.62, SD=1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ+, and 58% were sexually active. Results Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services. Discussion We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.
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Affiliation(s)
- Kristyn Kamke
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - J. L. Stewart
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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Chernick LS, Wallace BK, Potkin MT, Bell DL, Dayan PS. Adolescent Male Receptivity of and Preferences for Sexual Health Interventions in the Emergency Department. Pediatr Emerg Care 2022; 38:213-218. [PMID: 35482494 PMCID: PMC9051453 DOI: 10.1097/pec.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Male adolescents frequently present to the emergency department (ED) and many participate in behaviors increasing their risk of sexually transmitted infections and unintended pregnancies. Although the ED visit may represent an intervention opportunity, how best to design and deliver a sexual health intervention matching the preferences of adolescent male users is unclear. Our objective was to explore receptivity to and preferences for sexual health interventions among adolescent male ED patients. METHODS In this qualitative study, we asked sexually active male ED patients aged 14 to 21 years about their attitudes toward ED-based sexual health interventions and preferences for intervention modalities. Participants interacted with an early prototype of a digital intervention to gather specific feedback. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo. RESULTS Participants (n = 42) were predominantly 18 to 21 years (63%) and Hispanic (79%). Although most (71%) had sex in the prior 3 months, 45% did not use a condom at last intercourse and 17% had impregnated a partner. Participants viewed the ED visit as unused time without distracting influences, suitable for educational sexual health interventions. They considered ED-based digital interventions a reliable and confidential source of information. Engaging interventions allowed user control and provided novel and relatable content. CONCLUSIONS Adolescent male ED patients are receptive to ED-based digital sexual health interventions. These identified preferences should be considered when designing future user-informed sexual health interventions for the ED setting.
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Affiliation(s)
- Lauren S. Chernick
- Associate Professor of Emergency Medicine, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center (CUIMC), 3959 Broadway, CHN1-116, New York, NY 10032, USA
| | - Brendan K. Wallace
- Medical Student, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168 St, New York, NY 10032 USA
| | - Maxmoore T. Potkin
- Medical Student, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168 St, New York, NY 10032 USA
| | - David L. Bell
- Associate Professor of Pediatrics, Department of Pediatrics, CUIMC, and Population and Family Health, Mailman School of Public Health, CUIMC, 722 W 168 St New York, NY 10032 USA
| | - Peter S. Dayan
- Professor of Emergency Medicine, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, CUIMC, 3959 Broadway, CHN1-116, New York, NY 10032 USA
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25
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Chernick LS, Santelli J, Stockwell MS, Gonzalez A, Ehrhardt A, Thompson JL, Leu CS, Bakken S, Westhoff CL, Dayan PS. A multi-media digital intervention to improve the sexual and reproductive health of female adolescent emergency department patients. Acad Emerg Med 2022; 29:308-316. [PMID: 34738284 PMCID: PMC8960324 DOI: 10.1111/acem.14411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED. METHODS We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome. RESULTS We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference [ARD] = 2.7%, 95% confidence interval [CI] = -12.4% to 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% [27/41]) than controls (30.0% [15/50]); ARD = 35.9%, 95% CI = 16.6% to 55.1%). CONCLUSIONS A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision making.
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Affiliation(s)
- Lauren S Chernick
- Department of Emergency Medicine, Columbia University Medical Center
| | - John Santelli
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Melissa S Stockwell
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Ariana Gonzalez
- Department of Emergency Medicine, Columbia University Medical Center
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center
| | - John L.P. Thompson
- Department of Biostatistics, Columbia Mailman School of Public Health and Department of Neurology, Columbia University Medical Center
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia Mailman School of Public Health
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center
| | - Carolyn L. Westhoff
- Department of Obstetrics-Gynecology and Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center
| | - Peter S Dayan
- Department of Emergency Medicine, Columbia University Medical Center
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Cartwright AF, Alspaugh A, Britton LE, Noar SM. mHealth Interventions for Contraceptive Behavior Change in the United States: A Systematic Review. JOURNAL OF HEALTH COMMUNICATION 2022; 27:69-83. [PMID: 35255773 PMCID: PMC9133092 DOI: 10.1080/10810730.2022.2044413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ensuring people have access to their preferred method of contraception can be key for meeting their reproductive goals. A growing number of mHealth interventions show promise for improving access to contraception, but no literature review has identified the effects of mHealth interventions among both adolescents and adults in the United States. The purpose of this systematic review was to describe the format, theoretical basis, and impact of mHealth interventions for contraceptive behavior change (contraceptive initiation and continuation) among people of all ages in the US. A systematic review of the literature was conducted using six electronic databases guided by Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data on study design, frequency, duration, mHealth modality, contraceptive method, behavior change theory, and behavioral outcome were extracted to facilitate comparison. Eighteen studies met eligibility criteria. The majority (11; 61%) used SMS (short message service). Twelve studies focused on contraceptive initiation, most (n = 8) of which also measured continued use over time. The remaining six interventions focused on continuation alone, generally through appointment reminders. Very little contraceptive behavior change was identified across studies. Current mHealth interventions may hold promise for some health areas but there is little evidence that they change contraceptive behavior. Future mHealth interventions should focus on assessing person-centered outcomes, including satisfaction, side effects, and reasons for discontinuation, to best support people to use their preferred contraceptive method.
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Affiliation(s)
- Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy Alspaugh
- ACTIONS Program, University of California, San Francisco – School of Nursing, San Francisco, CA, USA
| | | | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jones A, Allison BA, Perry M. Effectiveness of Contraceptive Decision Aids in Adolescents and Young Adults: A Systematic Review. J Pediatr Adolesc Gynecol 2022; 35:7-17. [PMID: 34389463 DOI: 10.1016/j.jpag.2021.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contraceptive decision aids may support adolescents and young adults (AYA) in choosing contraceptive methods that fit their unique reproductive health needs. OBJECTIVE To provide a systematic review of studies examining the effectiveness of contraceptive decision aids in AYA. MATERIALS AND METHODS A systematic search was conducted of studies published between January 1, 2011, and March 31, 2021 using PubMed, Cochrane, and ClinicalTrials.gov. Studies were included if a contraceptive decision aid (ie, paper handout, mobile application, website, or video) was evaluated in AYA populations (age ≤30 years) in the United States. The primary outcome was decision aid effectiveness (ie, change in contraceptive knowledge, interest in contraception, contraceptive use, unintended pregnancies, and satisfaction with the decision aid). RESULTS Seven randomized controlled trials and 3 pre-post studies, reporting on 3725 AYA (range, 11-30 years), met inclusion criteria. No studies were excluded due to risk of bias. The methodologies and results were heterogeneous, but most consistently demonstrated increased contraceptive knowledge. CONCLUSION Ten studies evaluated a range of contraceptive decision aid formats for AYA. Decision aids appear to be effective at increasing contraceptive knowledge temporarily, but their effect on other contraceptive outcomes is unclear. Future research should evaluate decision aids specifically in adolescents.
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Affiliation(s)
- Anna Jones
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
| | - Bianca A Allison
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Martha Perry
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Decker MJ, Harrison S, Price M, Gutmann-Gonzalez A, Yarger J, Tenney R. Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study. JMIR Hum Factors 2022; 9:e31381. [PMID: 35019842 PMCID: PMC8792781 DOI: 10.2196/31381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/22/2021] [Accepted: 11/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula. Objective The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation. Results The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones. Conclusions Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID) RR2-10.2196/18060
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Salish Harrison
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, United States
| | - Melisa Price
- Clinical and Translational Science Center, University of California, Davis, Davis, CA, United States
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Yarger
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, United States
| | - Rachel Tenney
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Gichangi P, Gonsalves L, Mwaisaka J, Thiongo M, Habib N, Waithaka M, Tamrat T, Agwanda A, Sidha H, Temmerman M, Say L. Busting contraception myths and misconceptions among youth in Kwale County, Kenya: results of a digital health randomised control trial. BMJ Open 2022; 12:e047426. [PMID: 34992099 PMCID: PMC8739061 DOI: 10.1136/bmjopen-2020-047426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions. DESIGN AND SETTING A three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya. PARTICIPANTS AND INTERVENTIONS A total of 740 youth aged 18-24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants received standard care. The intervention period was 7 weeks. PRIMARY OUTCOME We assessed change myths believed at baseline and endline using an index of 10 contraception-related myths. We assessed change across arms using difference of difference analysis. RESULTS Across arms, <5% of participants did not have any formal education, <10% were living alone, about 50% were single and >80% had never given birth. Between baseline and endline, there was a statistically significant drop in the average absolute number of myths and misconceptions believed by intervention arm (11.1%, 95% CI 17.1% to 5.2%), contact arm (14.4%, 95% CI 20.5% to 8.4%) and control arm (11.3%, 95% CI 17.4% to 5.2%) participants. However, we observed no statistically significant difference in the magnitude of change across arms. CONCLUSIONS We are unable to conclusively state that the text message intervention was better than text message 'contact' or no intervention at all. Digital health likely has potential for improving SRH-related outcomes when used as part of multifaceted interventions. Additional studies with physical and geographical separation of different arms is warranted. TRIAL REGISTRATION NUMBER ISRCTN85156148.
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Affiliation(s)
- Peter Gichangi
- Administration, Technical University of Mombasa, Mombasa, Kenya
- 4-PSRI, International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Lianne Gonsalves
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Jefferson Mwaisaka
- 4-PSRI, International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Mary Thiongo
- 4-PSRI, International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Ndema Habib
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Michael Waithaka
- 4-PSRI, International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Tigest Tamrat
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | | | - Hellen Sidha
- 4-PSRI, National Council for Population and Development, Nairobi, Kenya
| | - Marleen Temmerman
- 4-PSRI, Aga Khan University - Kenya, Nairobi, Kenya
- 4-PSRI, International Centre for Reproductive Health, Ghent, Oost-Vlaanderen, Belgium
| | - Lale Say
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
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Efeito de intervenção educativa online na qualidade de vida de gestantes adolescentes. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao00366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nwaozuru U, Obiezu-Umeh C, Shato T, Uzoaru F, Mason S, Carter V, Manu S, Modi K, Parker J, Ezechi O, Iwelunmor J. Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes. Implement Sci Commun 2021; 2:126. [PMID: 34742357 PMCID: PMC8572487 DOI: 10.1186/s43058-021-00230-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances and proliferation of technologies such as mobile phones may provide opportunities to improve access to HIV/STI services and reach young people with high risk for HIV and STI. However, the reach, uptake, and sustainability of mobile health (mHealth) HIV/STI interventions targeting young people aged 10-24 years in low- and middle-income countries (LMICs) are largely unknown. To address this gap and to inform implementation science research, a review was conducted to summarize what is known, and what we need to know about implementing mhealth interventions for HIV/STI prevention targeting young people in LMICs. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this review. Drawing upon Proctor's eight implementation outcome measures, we evaluated the acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability of m-health HIV/STI interventions targeting young people in LMICs. The search was performed from September 2020-January 2021 and updated on March 1, 2021, in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, SCOPUS, Global Health, and Web of Science. Eligible studies were required to include an HIV/STI prevention outcome, target young people aged 10-24 years, include a comparison/control group, and reporting of atleast one implementation outcome as outlined by Proctor. RESULTS A total of 1386 articles were located, and their titles and abstracts were screened. Of these, 57 full-text articles were reviewed and subsequently, and 11 articles representing 6 unique interventions were included in the systematic review. Acceptability 6 (100%), appropriateness 6 (100%), and feasibility 5(83%) were the most frequently evaluated implementation outcomes. Adoption 2 (33%), fidelity 1 (17%), and cost 1 (17%) were rarely reported; penetration and sustainability were not reported. CONCLUSIONS This review contributes to implementation science literature by synthesizing key implementation outcomes of mHealth HIV/STI interventions targeting young people in LMICs. Future research is needed on m-health HIV/STI implementation outcomes, particularly the penetration, cost, and long-term sustainability of these interventions. Doing so will enhance the field's understanding of the mechanisms by which these interventions lead or do not lead to changes in high HIV/STI risk and vulnerability among young people in LMICs.
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Affiliation(s)
- Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA.
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Thembekile Shato
- Brown School, Washington University in Saint Louis, 1 Brookings Drive, Saint Louis, Missouri, 63130, USA
| | - Florida Uzoaru
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Stacey Mason
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Victoria Carter
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Sunita Manu
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Karan Modi
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Jessica Parker
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Salus center, 3545 Lafayette Avenue, Saint Louis, Missouri, 63104, USA
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Manlove J, Welti K, Whitfield B, Faccio B, Finocharo J, Ciaravino S. Impacts of Re:MIX-A School-Based Teen Pregnancy Prevention Program Incorporating Young Parent Coeducators. THE JOURNAL OF SCHOOL HEALTH 2021; 91:915-927. [PMID: 34553379 DOI: 10.1111/josh.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Latinx adolescents are at increased risk of teen pregnancy. This study evaluates the impact of Re:MIX, a comprehensive sexuality education program cofacilitated by professional health educators paired with young parent educators implemented with primarily Latinx youth in Texas. METHODS A cluster randomized trial was conducted with students in grades 8-10 in 57 classrooms across three schools. Students completed baseline, post-test, and long-term follow-up surveys to determine the impact of the program on behavioral outcomes-sexual experience and unprotected sex-and on mediating factors including intentions, attitudes, knowledge, and self-efficacy related to sexual activity and contraception. RESULTS Re:MIX was implemented with fidelity and educators were well-received. At post-test, compared to control students, Re:MIX students were more likely to intend to use hormonal or long-acting contraceptive methods if they had sex, had greater reproductive health knowledge, had more confidence in their ability to ask for and give consent, and were more likely to know where to obtain contraception. Most findings were sustained at the long-term follow-up, but there were no impacts on behaviors. CONCLUSIONS The implementation and impact findings highlight the promising approach of pairing young parent educators with experienced health educators for teen pregnancy prevention among Latinx students.
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Affiliation(s)
- Jennifer Manlove
- Reproductive Health and Family Formation, Child Trends, Inc, 7315 Wisconsin Ave, Suite 1200W, Bethesda, MD, 20814
| | - Kate Welti
- Child Trends, Inc, 7315 Wisconsin Ave, Suite 1200W, Bethesda, MD, 20814
| | - Brooke Whitfield
- Child Trends, Inc, 7315 Wisconsin Ave, Suite 1200W, Bethesda, MD, 20814
| | - Bianca Faccio
- Child Trends, Inc, 7315 Wisconsin Ave, Suite 1200W, Bethesda, MD, 20814
| | - Jane Finocharo
- Child Trends, Inc, 7315 Wisconsin Ave, Suite 1200W, Bethesda, MD, 20814
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Prevalence of Sexually Transmitted Diseases in Men of 25 - 60 Years in Iran. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.117767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Sexually transmitted diseases (STDs), especially in men, can lead to multiple morbidities and facilitate the transmission of serious pathogens, such as the human immunodeficiency virus. The present study used the data from a nationwide survey on male morbidities to estimate the prevalence of STDs among men in Iran. Methods: This cross-sectional study used the data from a nationwide project on male reproductive morbidities in 2007. A total of 2296 men within the age range of 25 - 60 years were recruited by systematic cluster sampling from four provinces (i.e., Golestan, Hormozgan, Kermanshah, and Isfahan, Iran). The data on the symptoms of STDs, including genital secretion, pushing out, itching or genital ulcers, and lymphadenopathy of the inguinal area after sexual contact, were collected by trained urologists. Data analysis was carried out using SPSS software (version18.0, Chicago, IL, USA). The independent samples t-test and chi-square test were used for data analysis. Results: A total of 2296 men with a mean age value of 39.95 ± 10.3 years were interviewed in this study. Two-thirds of all the subjects (75%) were aware of using condoms in suspected sexual relationships; however, only 69% of the aforementioned subjects used condoms in those circumstances. Overall, 14 subjects (0.6%) had one type of STDs at the study time. Moreover, 110 subjects (4.7%) answered “yes” to the question of whether they were referred to a physician for sexual problems. Conclusions: The prevalence of STDs is still low among the male population in Iran. Careful and well-designed surveillance systems to monitor the incidence of STDs and proper preventive measures to restrict the spread of sexually transmitted pathogens are among the proposed recommendations.
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Bath EP, Godoy SM, Perris GE, Morris TC, Hayes MD, Bagot K, Barnert E, Tolou-Shams M. Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care. J Health Care Poor Underserved 2021; 32:128-147. [PMID: 34194195 PMCID: PMC8238115 DOI: 10.1353/hpu.2021.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective We gathered the perspectives of girls and young women affected by commercial sexual exploitation (CSE) to understand the acceptability and feasibility of mobile health (mHealth) for enhancing access and engagement in health and social services during judicial involvement. Methods We conducted four focus groups with 14 girls and young women (ages 14 to 21) with self-identified CSE histories. Results Participants perceived mHealth as viable for accessing and engaging providers, and health and social services, and navigating judicial systems. Participants expressed that mHealth tools increased self-efficacy and self-navigation of required services. Recommendations to improve mHealth functionality included push-notification appointment reminders, wellness and safety promotion, enhancement of provider communication, peer-to-peer support, and access to health education and community resources. Conclusions Findings provide insight for how mHealth may be leveraged to increase self-management skills, fulfill judicial obligations, and improve access and engagement in health and social services for CSE-affected girls and young women.
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Affiliation(s)
- Eraka P Bath
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Sarah M Godoy
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Georgia E Perris
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Taylor C Morris
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Madison D Hayes
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Kara Bagot
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Elizabeth Barnert
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Marina Tolou-Shams
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
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Inhae C, Jiwon K. Effects of mHealth intervention on sexual and reproductive health in emerging adulthood: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2021; 119:103949. [PMID: 34004469 DOI: 10.1016/j.ijnurstu.2021.103949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sexual and reproductive health of young people is an international concern with the increasing interest in healthy pregnancy and childbirth. mHealth interventions involve the use of mobile technologies for health support, have wide applications in clinical nursing practice, and play an increasingly important role in disseminating sexual and reproductive health-related information in emerging adulthood. However, there is a lack of evidence on the effects of mHealth intervention programs. OBJECTIVES This meta-analysis systematically assessed the effects of mHealth interventions on contraceptive use and pregnancy occurrence in emerging adulthood to identify the characteristics of a successful mHealth intervention program. DESIGN We conducted a systematic review and meta-analysis of randomized controlled trials. DATA SOURCES Four central electronic databases (PubMed, Embase, CINAHL complete, and the Cochrane Library) were searched for relevant articles published from inception to May 2020. REVIEW METHODS Data extraction and quality appraisal were performed independently by two reviewers. Eleven papers on the effects of mHealth interventions on sexual and reproductive health in emerging adulthood were selected. The included studies were assessed for the risk of bias with the Risk of Bias 2 (RoB 2) tool. Overall and subgroup meta-analyses were conducted using STATA 16.0. Heterogeneity within studies was calculated using I2. RESULTS We tested the effect of mHealth interventions on contraceptive use and pregnancy occurrence to identify the impact of sexual and reproductive health. mHealth interventions improved the use of contraception (OR 1.21; 95% CI: 1.02-1.43, I2 = 20.7%; p = 0.234) although the effect on pregnancy occurrence was not significant (OR 0.80, 95% CI: 0.61-1.05, I2 = 0.0%, p = 0.950). In subgroup analysis, mHealth interventions especially improved oral contraceptive use (OR 1.43, 95% CI: 1.15-1.77, I2 = 0.0%, p = 0.784). Regarding the communication type, two-way communication showed statistically significant results with the mHealth intervention in the experimental group (OR 1.28, 95% CI: 1.06-1.54, I2 = 0.0%, p = 0.872). CONCLUSION This meta-analysis found a positive effect of mHealth intervention on contraception, whereas the impact on pregnancy occurrences was limited. We also confirmed the factors underlying effective mHealth interventions from the results of our review. Our findings demonstrate that mHealth interventions may be suggested as a useful strategy to promote sexual and reproductive health in emerging adulthood.
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Affiliation(s)
- Cho Inhae
- College of Nursing, Korea University, 145 Anam-ro Sungbuk-ku, Seoul 02841, Republic of Korea
| | - Kang Jiwon
- College of Nursing, Korea University, 145 Anam-ro Sungbuk-ku, Seoul 02841, Republic of Korea.
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Javidi H, Widman L, Lipsey N, Brasileiro J, Javidi F, Jhala A. Redeveloping a Digital Sexual Health Intervention for Adolescents to Allow for Broader Dissemination: Implications for HIV and STD Prevention. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:89-102. [PMID: 33821678 DOI: 10.1521/aeap.2021.33.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
HIV/STDs and unintended pregnancy persist among adolescents in the United States; thus, effective sexual health interventions that can be broadly disseminated are necessary. Digital health interventions are highly promising because they allow for customization and widespread reach. The current project involved redeveloping and expanding HEART (Health Education and Relationship Training)-a brief, digital sexual health intervention efficacious at improving safer sex knowledge, self-efficacy, and behavior-onto an open-source platform to allow for greater interactivity and accessibility while reducing long-term program costs. The authors describe the process of adapting, reprogramming, and evaluating the new program, which may serve as a guide for investigators seeking to adapt behavioral interventions onto digital platforms. The final product is an open-source intervention that can be easily adapted for new populations. Among 233 adolescents (Mage = 15.06; 64% girls), HEART was highly acceptable and generally feasible to administer, with no differences in acceptability by gender or sexual identity.
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Affiliation(s)
- Hannah Javidi
- North Carolina State University, Department of Psychology, Raleigh, North Carolina
| | - Laura Widman
- North Carolina State University, Department of Psychology, Raleigh, North Carolina
| | - Nikolette Lipsey
- North Carolina State University, Department of Psychology, Raleigh, North Carolina
| | - Julia Brasileiro
- North Carolina State University, Department of Psychology, Raleigh, North Carolina
| | - Farhad Javidi
- Central Piedmont Community College, Simulation and Game Development, Charlotte, North Carolina
| | - Arnav Jhala
- North Carolina State University, Department of Computer Science, Raleigh, North Carolina
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Ménard AD, MacIntosh HB. Childhood Sexual Abuse and Adult Sexual Risk Behavior: A Review and Critique. JOURNAL OF CHILD SEXUAL ABUSE 2021; 30:298-331. [PMID: 33403939 DOI: 10.1080/10538712.2020.1869878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Childhood sexual abuse (CSA) is a global problem with serious repercussions for survivors in various domains of adult interpersonal functioning, including sexual risk behavior. This review aimed to summarize findings from the recent literature on the connections between CSA and later adult sexual risk behaviors (e.g., unprotected intercourse, sexually transmitted infection [STSI] diagnosis). The sexual risk behaviors consistently associated with CSA were having sex under the influence of alcohol/substances and reports of concurrent sexual partners/infidelity. Notably, studies investigating the links between CSA and history of STI diagnosis and CSA and reports of unprotected sex (with the exception of samples comprised men who have sex with men) produced inconsistent findings. The methodological limitations of existing studies are considered and suggestions for future research are offered.
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Manlove J, Whitfield B, Finocharo J, Cook E. Lessons Learned from Replicating a Randomized Control Trial Evaluation of an App-Based Sexual Health Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3305. [PMID: 33806809 PMCID: PMC8004824 DOI: 10.3390/ijerph18063305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Abstract
This study presents findings from a randomized control trial replication evaluation of Pulse, an app-based pregnancy prevention program implemented with Black and Latinx women aged 18-20, a population with high rates of unplanned pregnancy. We used social media advertisements to enroll 1013 women online across the U.S. and automatically randomized participants to either the Pulse reproductive health app or a general health control app, stratifying by age and race/Latinx ethnicity. Participants received reminder text messages to view the app as well as text messages with app-related content throughout the intervention. Linear probability models were conducted on the analytic sample of 871 participants who completed the six-week survey and 798 who completed the six-month survey and adjusted for permuted block randomization and multiple hypothesis testing. Compared to the control group, intervention group participants had higher contraceptive knowledge (p = 0.000), which replicates findings from an earlier evaluation. However, these impacts were not sustained at six-month follow-up (p = 0.162). We found no other significant program impacts. This contrasts with an earlier evaluation that found intervention participants were less likely to have had sex without a hormonal or long-acting reversible contraceptive (LARC) method and had greater self-confidence to use contraception consistently than the control group. Different demographic characteristics, lower app usage, and more negative attitudes about and usage of hormonal/LARC contraception in the current sample may help to explain fewer impacts than the earlier evaluation.
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Affiliation(s)
- Jennifer Manlove
- Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814, USA; (B.W.); (J.F.); (E.C.)
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Lameiras-Fernández M, Martínez-Román R, Carrera-Fernández MV, Rodríguez-Castro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2555. [PMID: 33806507 PMCID: PMC7967369 DOI: 10.3390/ijerph18052555] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology: We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results: 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion: A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic.
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Affiliation(s)
- María Lameiras-Fernández
- Faculty of Education and Social Work, University of Vigo, 32004 Ourense, Spain; (R.M.-R.); (M.V.C.-F.); (Y.R.-C.)
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Chernick LS. Improving Adolescent Sexual and Reproductive Health: Can Mobile Health Interventions Affect Behavior? Pediatrics 2021; 147:peds.2020-029801. [PMID: 33568492 PMCID: PMC7919106 DOI: 10.1542/peds.2020-029801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lauren S. Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
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Nielsen AM, De Costa A, Gemzell-Danielsson K, Marrone G, Boman J, Salazar M, Diwan V. The MOSEXY trial: mobile phone intervention for sexual health in youth-a pragmatic randomised controlled trial to evaluate the effect of a smartphone application on sexual health in youth in Stockholm, Sweden. Sex Transm Infect 2021; 97:141-146. [PMID: 31628248 PMCID: PMC7892369 DOI: 10.1136/sextrans-2019-054027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/17/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022] Open
Abstract
An estimated 350 million cases of STIs occur globally each year. In Sweden, Chlamydia is the most common STI with approximately 30 000 cases annually, disproportionally affecting youth. National surveys report low condom use among youth. Smartphone coverage is high among this tech-savvy group. In collaboration with youth, we developed an interactive smartphone application comprising games, peer experiences and information snippets to promote condom use. OBJECTIVES To evaluate in a randomised controlled trial, the effectiveness of this smartphone application to improve condom use among youth in Stockholm, Sweden. METHODS This two-arm, individually randomised controlled trial was implemented through the Youth Health Clinics (YHC) in Stockholm, Sweden. Youth aged 18-23 years, who owned a smartphone and had ≥2 sexual partners during the past 6 months were eligible. The intervention delivered the interactive elements described above over 180 days. The control group received a 'dummy' application. Both groups received standard of care at the YHC. The primary outcome was proportion of consistent (100%) self-reported condom use at 6 months. Secondary outcomes included self-reported number of partners, occurrence of STIs/pregnancy and STI tests during the study period. An intention-to-treat approach was used. RESULTS 214 and 219 youth were randomised to the intervention and control groups, respectively. Consistent condom use was reported for 32/214 (15.0%) in the intervention group and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6). No significant differences in secondary outcomes were seen. CONCLUSION We were unable to detect an effect of the intervention. Future research should focus on targeting different subgroups within the overall risk group, with tailored mHealth interventions. The potential for such interventions in settings where sexual health services are unavailable should be evaluated. TRIAL REGISTRATION NUMBER ISRCTN13212899.
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Affiliation(s)
| | - Ayesha De Costa
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Gaetano Marrone
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jens Boman
- Department of Clinical Microbiology, Umea Universitet Medicinska fakulteten, Umea, Sweden
| | - Mariano Salazar
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Vinod Diwan
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Araújo MG, Magalhães GM, Garcia LC, Vieira ÉC, Carvalho-Leite MDLRD, Guedes ACM. Update on human papillomavirus - Part II: complementary diagnosis, treatment and prophylaxis. An Bras Dermatol 2021; 96:125-138. [PMID: 33637397 PMCID: PMC8007546 DOI: 10.1016/j.abd.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/29/2020] [Indexed: 12/26/2022] Open
Abstract
In this nonsystematic review, the complementary diagnosis, treatment, prevention, and control of human papillomavirus are discussed. The histopathology is addressed regarding its indications, main findings and limitations, as a complementary diagnostic method largely used by dermatologists. Electron microscopy is briefly reviewed, along with its contribution to the accumulated knowledge on HPV, as well as the relevance of research in using this technology for future advances in diagnosis and treatment. Molecular information about the virus is continuously increasing, and the practical applications of HPV serology, molecular identification and genotyping are discussed. Vaccines are a valuable tool in primary HPV infection prevention and are now available in many countries; their composition, indications, and adverse effects are revisited. Local and systemic treatment options are reviewed and off-label prescriptions are discussed. Finally, health education focusing on HPV infection as a sexually transmitted infection of worldwide relevance and the many barriers to improve primary and secondary prevention are addressed.
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Affiliation(s)
- Marcelo Grossi Araújo
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Geraldo Magela Magalhães
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Érica Cristina Vieira
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Antônio Carlos Martins Guedes
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Shegog R, Armistead L, Markham C, Dube S, Song HY, Chaudhary P, Spencer A, Peskin M, Santa Maria D, Wilkerson JM, Addy R, Tortolero Emery S, McLaughlin J. A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study. JMIR Serious Games 2021; 9:e23088. [PMID: 33502323 PMCID: PMC7875699 DOI: 10.2196/23088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/03/2020] [Accepted: 11/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health.
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Affiliation(s)
- Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Sara Dube
- The Widen Lab, University of Texas at Austin, Austin, TX, United States
| | - Hsing-Yi Song
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Pooja Chaudhary
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Angela Spencer
- Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Washington, DC, United States
| | - Melissa Peskin
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Diane Santa Maria
- School of Nursing, University of Texas Health Science Center Houston, Houston, TX, United States
| | - J Michael Wilkerson
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Robert Addy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Susan Tortolero Emery
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
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Berendes S, Gubijev A, McCarthy OL, Palmer MJ, Wilson E, Free C. Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials. Sex Transm Infect 2021; 97:190-200. [PMID: 33452130 DOI: 10.1136/sextrans-2020-054853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. OBJECTIVE To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. METHODS We searched seven databases and reference lists of 49 related reviews (January 1990-February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. RESULTS After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI -0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence. CONCLUSIONS Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.
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Affiliation(s)
- Sima Berendes
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona L McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Wilson
- Population, Policy & Practice Department, Faculty of Population Health Sciences, University College London GOS Institute of Child Health, London, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Yoost J, Ruley M, Durfee L. Acceptability of a Comprehensive Sex Education Self-Study Website for Teaching Reproductive Health: A Pilot Study Among College Students and Obstetrics and Gynecology Resident Physicians. Sex Med 2021; 9:100302. [PMID: 33429242 PMCID: PMC7930856 DOI: 10.1016/j.esxm.2020.100302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction There is a growing interest among adolescents to obtain sexual health information online, which could be helpful in rural areas where adolescents face unique obstacles to contraception access, and medically accurate sex education is not mandated. Aim This study piloted a comprehensive sex education self-study website among undergraduate students and resident physicians to assess the accuracy and feasibility for future use in younger adolescents. Methods A sex education website developed by a board-certified obstetrician-gynecologist (OBGYN) was piloted among a group of OBGYN resident physicians and undergraduates from West Virginia. Groups were chosen to assess the accuracy of information and acceptability for use in younger adolescents. The 30-minute curriculum was a series of short videos (2–4 minutes each) covering anatomy, physiology, sexuality, gender identity, relationship health, contraception, and sexually transmitted infection prevention. Data were obtained on subjects’ past experience and perception of sex education. Subjects also evaluated the website for usefulness and accuracy. Outcomes Main outcomes included a Likert scale assessment of each curriculum session’s usefulness, accuracy, and how easy it was to follow. Results 24 subjects (14 undergraduates and 10 physicians) participated during September and October of 2019. All except for 1 subject had sex education taught in school; 11 (45.8%) reported it to be “low quality”; 23 (95.8%) reported being taught in a classroom. Individual website video sessions were reported to be highly accurate, very easy to follow, and very useful. All subjects (100%) felt that high school adolescents would be interested in the self-study website. Conclusions A self-study website was successfully tested and found to be a well-accepted way to teach sex education among this pilot group. Future work involves testing this tool among younger adolescent subjects. Yoost J, Ruley M, Durfee L. Acceptability of a Comprehensive Sex Education Self-Study Website for Teaching Reproductive Health: A Pilot Study Among College Students and Obstetrics and Gynecology Resident Physicians. Sex Med 2021;9:100302.
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Affiliation(s)
- Jennie Yoost
- Marshall University Joan C. Edwards School of Medicine, Department of Obstetrics and Gynecology, Huntington, WV.
| | - Morgan Ruley
- Marshall University Joan C. Edwards School of Medicine, Department of Obstetrics and Gynecology, Huntington, WV
| | - Levi Durfee
- Vice President Web Services, Bulldog Creative Services, Huntington, WV
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Effects of Multiple Exposures and Ad-Skipping Behavior on Recall of Health Messages on YouTube TM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228427. [PMID: 33202545 PMCID: PMC7696643 DOI: 10.3390/ijerph17228427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
Although measuring exposure to public health messages is key to understanding campaign effectiveness, little is known about how exposure to and avoidance of digital ad messages may influence self-reported ad recall. A sample of 15-24-year-olds (n = 297) received a varying number of forced-view and skippable test ads across multiple simulated YouTubeTM sessions. Each session was coded for whether the participant viewed the ad or skipped it. While a majority of participants recalled the test ad, the odds of ad recall did not vary by number of sessions (opportunities for exposure). Rather, ad recall was sensitive to the number of completed ad views such that odds of ad recall doubled for each additional time the ad was completely viewed. Findings suggest that public health digital message exposure and recall can be optimized with sufficient attention paid to the proportions of forced-view ads aired when aiming to reach younger audiences.
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Fontenot HB, White BP, Rosenberger JG, Lacasse H, Rutirasiri C, Mayer KH, Zimet G. Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study. J Med Internet Res 2020; 22:e22878. [PMID: 33146621 PMCID: PMC7673982 DOI: 10.2196/22878] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices.
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Affiliation(s)
- Holly B Fontenot
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, United States.,The Fenway Institute, Boston, MA, United States.,Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | | | - Joshua G Rosenberger
- College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Hailee Lacasse
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Chokdee Rutirasiri
- Proper Villains, Boston, MA, United States.,School of Arts and Sciences, Boston College, Chestnut Hill, MA, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,School of Medicine, Harvard University, Boston, MA, United States
| | - Gregory Zimet
- Division of Adolescent Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
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The Design, Content and Delivery of Relationship and Sexuality Education Programmes for People with Intellectual Disabilities: A Systematic Review of the International Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207568. [PMID: 33080975 PMCID: PMC7589668 DOI: 10.3390/ijerph17207568] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
There is growing empirical evidence regarding the relationship and sexuality experiences and needs of children, young people and adults with intellectual disabilities. A total of twelve papers met the inclusion criteria regarding relationship and sexuality education (RSE) programmes specific to the needs of this population. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed and quality appraisal undertaken. The four themes identified were principles informing RSE programme development, design and content of RSE programmes, delivery of RSE programmes and evaluation of RSE programmes. The discussion presents areas that need to be addressed to ensure that people with intellectual disabilities, their families, carers and professionals are fully involved in the design and delivery of RSE programmes. Further research is required to identify the impact of the programmes and the sustained outcomes achieved. Recommendations are made regarding the activities required to enable the development of evidence-based and person-centred approaches to relationship and sexuality programmes.
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49
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Brindis CD, Decker MJ, Gutmann-Gonzalez A, Berglas NF. Perspectives on Adolescent Pregnancy Prevention Strategies in the United States: Looking Back, Looking Forward. Adolesc Health Med Ther 2020; 11:135-145. [PMID: 33117030 PMCID: PMC7567553 DOI: 10.2147/ahmt.s219949] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023] Open
Abstract
Attempts to solve the "problem of adolescent pregnancy" have long been a focus of national, state, and local efforts in the United States. This review article summarizes trends and strategies around adolescent pregnancy prevention, provides lessons learned and best practices, and presents ideas for future directions. Over the past decades, a wide variety of policy and programmatic interventions have been implemented - including educational efforts, clinical health services, and community-wide coalitions - accompanied by a growing consensus regarding viable solutions. While notable reductions in adolescent pregnancy and childbearing have occurred across all sociodemographic groups, racial/ethnic, geographic, and socioeconomic disparities persist. Many adolescents who most need sexual health information and services are underserved by current programs and policies. A growing understanding of the role of social determinants of health, the impacts of structural racism, and the need for equity and inclusion must inform the next set of interventions and societal commitments to not only ameliorate the occurrence of unintended adolescent pregnancy but also foster healthy adolescent development. Recommendations for future efforts include improving the content, quality, and sustainability of education programs; actively engaging youth in the design of policies, programs, and clinical services; using technology thoughtfully to improve health literacy; expanding access to services through telehealth and other delivery options; and designing programs and policies that recognize and address structural racism, health equity, and inclusion.
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Affiliation(s)
- Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA94118, USA
| | - Martha J Decker
- Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA94118, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA94118, USA
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA94118, USA
| | - Nancy F Berglas
- Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA94118, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA94118, USA
- Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA94612, USA
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50
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Davis T, DiClemente RJ, Prietula M. Using ADAPT-ITT to Modify a Telephone-Based HIV Prevention Intervention for SMS Delivery: Formative Study. JMIR Form Res 2020; 4:e22485. [PMID: 32831178 PMCID: PMC7576465 DOI: 10.2196/22485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. OBJECTIVE This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator-led phone calling to text-based communication. METHODS The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board's request, this phase included an optional, additional week of text-based PMI messages. RESULTS The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. CONCLUSIONS The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives.
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Affiliation(s)
- Teaniese Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, United States
| | - Ralph Joseph DiClemente
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Michael Prietula
- Goizueta Business School & Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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