Exploring the Use of Technology for Sexual Health Risk-Reduction among Ecuadorean Adolescents

How to decrease teenage pregnancy: rural perspectives in Ecuador

Introduction

This study aimed to understand the sociocultural context of teenage pregnancy in an Ecuadorian city with a large indigenous population, to gauge the acceptability of a multifaceted pregnancy prevention program for adolescents, and to elicit perspectives on the optimal program design from adolescents and adult key informants.

Methods

We ascertained qualitative data via an online, electronic survey administered from August to September 2020. Open- and closed-ended questions elicited perspectives relating to burden of adolescent pregnancies, acceptability of pregnancy prevention programs, and optimal design of future programs. Twenty-four adolescents (13-19 years of age) and 15 adult key informants working in the healthcare, business, and education sectors in Cotacachi completed the survey. Survey responses were analyzed using a structural and in vivo coding, and an inductive approach to consensus-building around key themes.

Results

Most adolescent survey respondents (75%) believed that teen pregnancy is "fairly common" in Cotacachi, and 41.7% believed differences in teen pregnancy rates are not associated with ethnicity. In comparison, 66.7% of adult survey respondents said teen pregnancy disproportionately occurs among indigenous teenagers. Additionally, 45.8% of adolescent and 80% of adult survey respondents believed that a comprehensive sexual education program would help reduce teenage pregnancy rates by imparting reliable sexual health knowledge. Adult respondents noted that the past programs were unsuccessful in preventing teenage pregnancy because of these programs' inability to fully engage teenagers' attention, very short time duration, or inappropriate consideration of cultural context.

Discussion

In Cotacachi, Ecuador, a sexual health education program is both desired and feasible according to adult and teenager key informants. A successful program must adapt to the cultural context and engage youth participation and attention.

PACT: Developing and Evaluating a Digital Sexual Consent Program for Youth

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.

Towards responsive policy and actions to address non-communicable disease risks amongst adolescents in Indonesia: insights from key stakeholders

Background

Non-communicable diseases (NCDs) such as cancer, diabetes, heart disease, mental disorder and chronic lung conditions are the leading cause of death and disability in Indonesia. Adolescence is when risks for NCDs emerge and it is also an important life stage for intervention, yet young people are often at the margins of NCD policy and actions. This study aimed to understand how policies and actions should address NCD risks (tobacco smoking, inadequate physical activity, and diet) for adolescents in Indonesia, and how young people can be meaningfully involved.

Methods

Qualitative in-depth interviews over videoconference (n = 21) were conducted in English or Bahasa with stakeholders in Indonesia. Participants included policymakers, implementation partners, and advocates who were focused on adolescent health or NCDs. Interviews were recorded, transcribed, translated, and thematically analysed using NVivo12. Findings were disseminated to participants for validation and feedback. Youth participants (n = 7) attended an additional workshop and considered recommendations and actions arising from this research.

Findings

Participants identified that government and non-government organisations are acting on NCDs in Indonesia, but few of the existing initiatives target adolescents, and adolescent services rarely addressed NCD risks. Participants also felt that policies to protect adolescents from NCD risks (i.e., smoke-free areas in public) were not always enforced. For programs or initiatives focused on adolescent health, those that had engaged adolescents as co-creators and leaders were perceived to be more successful. As such, participants recommended more meaningful engagement of young people, including young people's leadership of initiatives. Additional recommendations included the need for intersectoral engagement and a 'whole-of-government' approach to prevention given the complex determinants of NCD risks, and the need for evidence-based actions that are underpinned by quality data to enable monitoring of progress.

Interpretation

There is a recognised need to strengthen policies and actions to address NCD risks amongst adolescents in Indonesia. Meaningful youth engagement that allows young people to take the lead, intersectoral actions, and evidence-based data driven responses were key strategies identified.

Funding

UNICEF East Asia and Pacific Regional Office.

Client experiences with telehealth using LINE for consultation and assessment of adverse effects of contraceptive implants during the COVID-19 pandemic in Thailand

Objective

This study aimed to examine clients' experiences with telehealth use for contraceptive implant consultation.

Methods

An online, self-administered survey was conducted with women who used contraceptive implants and faced adverse effects, inquired about side effects, or had concerns. Clients received consultations via LINE, which is a free chat application widely used in Thailand. Participants completed a questionnaire regarding their experiences and satisfaction within 7 days after using the service and a follow-up questionnaire to inquire about the need for in-person services 30 days after using the service.

Results

The participants were 200 women, with a response rate of 82%. Overall, 94% of participants were satisfied with the consultation. Moreover, 37.5% received a message response within 6 hours, and most (89.5%) got a response within 24 hours. The three most frequently reported symptoms were abnormal bleeding or spotting, mood swings, and itching or pain at the surgical site. Most adverse effects were managed through online consultation. Approximately one-third of the participants required in-person visits 30 days after telehealth consultation.

Conclusions

Telehealth consultation for contraceptive implant follow-up resulted in high client satisfaction. Most adverse effects could be managed using telehealth services. Therefore, telehealth could ensure sustained accessibility to reproductive healthcare during and post-COVID-19.

Zika virus knowledge and vaccine acceptance among undergraduate students in Guayaquil, Ecuador

Purpose

Zika virus (ZIKV) was declared a Public Health Emergency of International Concern (PHEIC) in 2016. Concerns surrounding the effects of ZIKV persist today and several vaccine candidates are currently in various stages of development worldwide. There is limited research on ZIKV vaccine acceptability worldwide, and little research specific to Latin American countries. This research aims to identify the general beliefs and acceptance of a potential ZIKV vaccine in the undergraduate population at Escuela Superior Politécnica del Litoral (ESPOL) in Guayaquil, Ecuador.

Methods

Between January and November 2019, 429 undergraduate students at ESPOL responded anonymously to a ZIKV vaccine survey. Frequencies, percentages, simple correspondence analysis, and bivariate inferential analyses were conducted using Kendall's tau-b test. Tests explored associations between likelihood of receiving a ZIKV vaccine and demographic, ZIKV information seeking, ZIKV psychosocial variables, and ZIKV information source variables.

Results

Among the eligible participants, 241 (56.2%) were willing to receive a ZIKV vaccine if one was made commercially available. Most students were male (61.5%), age 20-25 (63.3%), and of mixed (Mestizo) race (95.3%). Results provided insight into student's knowledge on ZIKV, revealed television as the most common information source, and found most students were willing to receive a ZIKV vaccine were one to become available. Bivariate results revealed most respondents reported feeling neutral or likely to receive a ZIKV vaccine regardless of their agreeability with ZIKV information seeking behavior and psychosocial variables.

Conclusions

This study provides insight into ZIKV knowledge among ESPOL university students and reveals most respondents obtained ZIKV related information from television. The most common reason for not wanting to receive a hypothetical ZIKV vaccine was vaccine hesitancy. Likelihood of receiving a ZIKV vaccine was associated with several information seeking behavior and psychosocial variables. Public health campaigns should focus on comprehensive ZIKV education efforts in this population.

Evaluating the mechanisms and long-term effects of a web-based comprehensive sexual health and media literacy education program for young adults attending community college: study protocol for a three-arm randomized controlled trial

Background

Many community college students experience poor sexual and relationship health outcomes. Young adults consume a plethora of media content, much of which depicts unhealthy sexual and romantic relationships, and research has shown that media exposure can negatively impact health outcomes. Asynchronous, web-based media literacy education (MLE) programs have been shown to improve short-term sexual and relationship health outcomes. However, there is a dearth of research on the mechanisms by which MLE programs impact health outcomes and the long-term effects of MLE programs on sexual and relationship health outcomes among community college students.

Methods

This study will (1) evaluate the unique effects of MLE on primary and secondary sexual and relationship health outcomes; (2) compare the mechanisms underlying the effects of an asynchronous, web-based MLE sexual health program (Media Aware) to the mechanisms underlying the effects of an active control program on health outcomes; and (3) evaluate the long-term efficacy of Media Aware on media literacy skills and sexual and relationship health outcomes compared to active control and delayed intervention control groups. To address these aims, a three-arm randomized controlled trial with young adults attending community college will be conducted. It is expected that around 30 campuses will participate and approximately 67 students from each campus will be enrolled in the study (estimated n = 2010). Campuses will be randomized to either the (1) intervention group (Media Aware); (2) active control group (sexual health education from Media Aware without MLE content or methods); or (3) delayed intervention control group. Students will complete online questionnaires at pretest, posttest, 6-month, and 12-month follow-ups.

Discussion

This project has the potential to advance theory about the potential mechanisms through which MLE has an impact on sexual and relationship health outcomes by directly testing the impact of interventions using a randomized design. Additionally, this study is expected to establish strong evidence for the effectiveness of Media Aware for use with young adults and to help identify strategies to optimize the longer-term impact of the program on health. Students’ satisfaction with programming will be discussed to inform future implementation efforts.

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

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.

m-Health en intervenciones para incrementar el uso de anticonceptivos en adolescentes latinas: revisión de alcance

Objetivo Mapear la forma de uso y el efecto de las tecnologías m-Health en intervenciones a fin de incrementar el uso de anticonceptivos en adolescentes latinas. Métodos Se realizó una revisióón de alcance a partir de Peters M en octubre de 2021; se recuperaron artículos del 2015 a 2021 en EBSCO Host, PubMed y BVS, LILACS, SciELO, Web of Science y Scopus, en inglés, español y portugués. Resultados Se identificaron ocho artículos que emplearon las m-Health como potencializadoras. La forma de uso fue ampliamente heterogénea en dosis, intervalo e interacción. El efecto significativo para el uso de anticonceptivos fue reportado en tres diseños experimentales, con una buena aceptabilidad y viabilidad para futuros experimentos. Discusión Las m-Health ofrecen una oportunidad de incrementar el uso de anticon-ceptivos en adolescentes. Al momento, su efecto es controversial debido a la escasez de intervenciones de este tipo. Por lo tanto, se requieren estudios rigurosos que consideren procesos de adaptación a contextos latinos

Does Digital Literacy Empower Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review

Background: The vast majority (90%) of the world's adolescents aged 10–19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in LMICs.

Methods: We conducted a systematic review of studies following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. The collected data include the design of the study, type of digital literacy intervention, target audience, intervention received, intervention reach, data analysis, and study outcomes. The review is registered with PROSPERO (CRD42020216756).

Results: Thirty-five studies met the eligibility for inclusion and of those, 11 were experimental studies (randomized controlled trial = 6; quasi-experimental = 2; before-after with no control = 3), 11 were cross-sectional/descriptive studies, seven studies used a mixed-method approach, and six were qualitative studies on digital literacy interventions to empower young girls in LMICs. The majority of digital literacy interventions were designed and implemented to improve sexual and reproductive health rights and decision-making of adolescent girls in LMICs (n = 33). Only three papers reported the use of digital media for health-related information and decision making, while only one reported on educational and social empowerment.

Discussion: Our findings suggest that digital literacy interventions such as mobile phones, mobile health tools, media exposure, access to the internet, internet-based educational strategies, social media exposure are effective to empower adolescent girls to access health services and information and also enhance the access to educational resources. However, we found inconclusive evidence on the effectiveness of digital literacy to enhance girls' access to financial services and economic empowerment. More rigorous studies with long-term follow-ups to assess the effectiveness of such interventions to empower adolescent girls in LMICs are urgently needed.

Redeveloping a Digital Sexual Health Intervention for Adolescents to Allow for Broader Dissemination: Implications for HIV and STD Prevention

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 (M_age = 15.06; 64% girls), HEART was highly acceptable and generally feasible to administer, with no differences in acceptability by gender or sexual identity.

Foundations of Erobotics

Technology is giving rise to artificial erotic agents, which we call erobots (erôs + bot). Erobots, such as virtual or augmented partners, erotic chatbots, and sex robots, increasingly expose humans to the possibility of intimacy and sexuality with artificial agents. Their advent has sparked academic and public debates: some denounce their risks (e.g., promotion of harmful sociosexual norms), while others defend their potential benefits (e.g., health, education, and research applications). Yet, the scientific study of human-machine erotic interaction is limited; no comprehensive theoretical models have been proposed and the empirical literature remains scarce. The current research programs investigating erotic technologies tend to focus on the risks and benefits of erobots, rather than providing solutions to resolve the former and enhance the latter. Moreover, we feel that these programs underestimate how humans and machines unpredictably interact and co-evolve, as well as the influence of sociocultural processes on technological development and meaning attribution. To comprehensively explore human-machine erotic interaction and co-evolution, we argue that we need a new unified transdisciplinary field of research-grounded in sexuality and technology positive frameworks-focusing on human-erobot interaction and co-evolution as well as guiding the development of beneficial erotic machines. We call this field Erobotics. As a first contribution to this new discipline, this article defines Erobotics and its related concepts; proposes a model of human-erobot interaction and co-evolution; and suggests a path to design beneficial erotic machines that could mitigate risks and enhance human well-being.