Using an iPad app in school health centers to support Latina teens making choices about birth control the health-E you/Salud iTu intervention
CONCLUSIONS: Health-E You was effective at increasing knowledge, self-efficacy, and use of nonbarrier contraception among Latina adolescents attending SBHCs. Providers and adolescents reported high app satisfaction and stated that Health-E You improved visit quality and efficiency. LIMITATIONS: This...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
[2020], 2020
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | CONCLUSIONS: Health-E You was effective at increasing knowledge, self-efficacy, and use of nonbarrier contraception among Latina adolescents attending SBHCs. Providers and adolescents reported high app satisfaction and stated that Health-E You improved visit quality and efficiency. LIMITATIONS: This study is limited to sexually active Latina adolescents in an urban setting who use SBHCs, and thus the results cannot be generalized beyond this sample. Retention for follow-up was lower than expected. In addition, although the app was highly acceptable, there were implementation barriers. Understanding barriers and facilitators is critical to enhancing the adoption of new technologies Based on user input, the app provides tailored contraceptive recommendations, and users can explore information about any method(s). The app concludes with a question for the user to select the method(s) that she is most likely to use. App recommendation(s) and user selections are printed for the provider. Thus, the app is designed to prepare the patient for a health care visit and to prompt the provider to discuss contraception. OBJECTIVES: To evaluate the extent to which Health-E You (1) supports Latina adolescents in making decisions about selecting and using effective contraception to avoid an unintended pregnancy (as measured by knowledge, attitudes, and self-efficacy); (2) improves the effectiveness and efficiency of the clinical encounter; and (3) reduces unprotected sexual intercourse over time (by promoting use of effective contraceptive methods). The final aim (4) is to disseminate the Health-E You intervention. Adolescents who used the app responded to 9 items about their experience using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) appended to the end of the 48-hour survey. Providers at the intervention clinics rated their experience with the app using 7 items and the same 5-point Likert scale and impact of app on visit time using a 5-point scale (1 = not any time spent to 5 = a lot of time spent). RESULTS: The sample consisted of 1360 Latina adolescents, with 693 in the intervention group and 667 in the control group; the mean age was 16.4 years. Of these, 57.2% responded to the 48-hour survey, 50.1% responded to the 3-month survey, 49.7% responded to the 6-month survey, and 42.3% responded to both the 3- and 6-month surveys. App users (intervention group) showed significant increases in knowledge (P < .001). The long-term goal of the intervention is to reduce health disparities in unintended pregnancy rates for Latina adolescents. METHODS: This study used a cluster-randomized controlled trial of 18 school-based health centers (SBHCs) with 1360 Latina adolescents over a 6-month follow-up period. SBHCs provided all adolescent girls with an iPad to assess eligibility and obtain consent. Intervention clinic participants received the app, and controls received standard of care sexual health questions. Participants completed a previsit questionnaire and surveys within 48 hours of the clinic visit and then at 3 and 6 months after the visit. Differences in adolescents' contraceptive knowledge, attitudes, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed-effects models to account for repeated measures, a time effect, the time × group interaction, and demographic covariates. BACKGROUND: Despite declines in adolescent pregnancy in the United States, significant disparities remain. Latinas have disproportionality high rates of pregnancy that place them at risk for adverse health, economic, and social outcomes. Adolescents' knowledge of contraception is poor, options are overwhelming, and stigma and discomfort with sexual health are barriers to care, especially for Latinas. Health care providers often lack the time, comfort, or skill to provide comprehensive contraceptive care. Health-E You/Salud iTu is an interactive, individually tailored mobile health application (app) that provides patient-centered contraceptive decision-making support to reduce disparities in knowledge and contraceptive use among Latina adolescents. Health-E You, founded in social cognitive theory, was developed in partnership with adolescents, providers, and community partners to be user driven, culturally relevant, and engaging with games and video vignettes. Increases in self-efficacy in the intervention group from baseline to 6 months were significantly larger than those in the control group (b = 1.58 [b is the standard symbol used to represent a linear regression coefficient]; 95% CI, 0.38-2.77; P = .010). There was also significant reduction in unprotected sex over time with an increase in prevalence of nonbarrier contraceptive use from both baseline to 3 months (odds ratio [OR], 3.29; 95% CI, 1.04-10.36; P = .042) and from baseline to 6 months (OR, 5.54; 95% CI, 1.70-18.06; P = .005). Compared with control participants, intervention participants reported more contraceptive use from baseline to 3 months (OR, 3.29; 95% CI, 1.04-10.36; P = .042) and from baseline to 6 months (OR, 5.54; 95% CI, 1.70-18.06; P = .005). Providers and adolescents reported that the app improved the effectiveness and efficiency of care, and that they were highly satisfied with the app. |
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| Physical Description: | 1 PDF file (73 pages) illustrations, portraits |