Abstract
Two approaches to engaging adolescents in the development of sexual and reproductive health interventions
Aaron Plant, MPH
Sentient Research, West Covina, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Creating effective programs requires an understanding of the values, motivations, behaviors, knowledge, and insights of end-users. We developed two federally-funded, technology-based, teen pregnancy prevention interventions from 2016-2018, using two different approaches to target audience engagement. For the first program, an entertainment-education video called “Plan A,” we needed to define both the problem and the solution during the proposal phase. Our target audience research included three focus groups (n=41) followed by numerous interactions (e.g. in-person, telephone, and email) with a 9-member review panel at various points during script development and video production. The review panel helped make decisions, both large (e.g. what types of scenarios and characters to include) and small (e.g. video title). For our second program, we used human-centered design, which requires deep collaboration with the target audience at every stage of program development. In this approach, we engaged adolescent parents to develop the solution, with the goal of creating a program that is as effective, meaningful, and useful as possible. We conducted multiple rounds of interviews with young mothers and fathers to develop program concepts, and subsequently to test and refine prototypes for a holistic support mobile phone application. The human-centered design approach was ideal in many aspects, yet it may not always be feasible to use (i.e. grant funding usually requires a proposed solution). However, intensive target audience research and an iterative approach can, and should, be employed in all program planning, to ensure that interventions are appropriate, feasible, and acceptable for the intended audience.
Program planning Public health or related research
Abstract
Sexual and Reproductive Health Capacity Building for Foster Care Professionals
Lisa Colarossi, PhD, LCSW and Randa L. Dean, MPH
Planned Parenthood of New York City, New York, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
We will present developmental research that gathered stakeholder data from government and private professionals as well as foster parents and youth to create an innovative model of sexual and reproductive health (SRH) capacity building for foster care organizations. The model uses a systems approach to improving SRH outcomes of foster care youth. This multi-level intervention includes: (1) creating organizational policies and practices, (2) training foster care professionals, and (3) environmental enhancement with sexual health materials, linkages to care, and messages. This model does not train professionals to conduct evidence-based sex ed programs (EBPs); its innovation involves creating a sustainable environment where youth can talk to trusted adults who have medically accurate SRH information and supportive communication skills, and can facilitate access to health care and EBPs. The model is based on a social-ecological foundation for understanding interactions between individuals and their social contexts. The intervention components were created using Tseng and Seidman’s (2007) theory for intervening in social systems, which targets three aspects of social settings: social processes, resources, and organizational structure. We will also describe evaluation methods and outcomes of implementation with foster care agencies in New York City. Methods include longitudinal surveys and field observations over nine months. Outcome analysis is change over time in staff knowledge, attitudes, behaviors; organizational policy; and environmental characteristics.
Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Scaling the Office of Adolescent Health’s (OAH) Teen Pregnancy Prevention Programs in Communities with the Greatest Need to Increase Impact
Amy Margolis, MPH, CHES1, Mousumi Banikya-Leaseburg, MD, MPH, CPH2 and Nicole Bennett, MPH3
(1)HHS Office of Population Affairs, Rockville, MD, (2)Office of Population Affairs, US Department of Health and Human Services, Rockville, MD, (3)Office of Adolescent Health, U.S. Department of Health and Human Services, Rockville, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
From 2015-2018, OAH funded a second cohort of grantees to implement evidence-based teen pregnancy prevention programs (EBPs) to scale in communities with the greatest need. In addition to implementing EBPs to scale in multiple settings, grantees expanded services to include engaging youth and communities, ensuring safe and supportive environments, and providing referrals to health care services. Previously, from 2010-2015, OAH’s first cohort of grantees implemented 1-2 EBPs on a relatively small scale (Median = 750) in communities.
To help grantees shift from small- to large-scale implementation, OAH defined its purpose for scaling, instructed grantees to implement programs system-wide across multiple settings and establish formal partnerships to support implementation, increased the amount of funding per grantee, and tied funding to reach. By taking programs to scale, OAH reached almost 2.5 times as many youth with EBPs per year in Cohort 2 (n = 203,107) compared to Cohort 1 (n = 88,811), and reduced the cost per youth served by an average of $176 per youth ($469/youth in Cohort 1 versus $293/youth in Cohort 2), all while expanding services provided. Grantees were successful scaling programs across diverse communities (e.g., rural, suburban, urban), diverse settings (e.g., schools, clinics, community-based), and across diverse States. In addition to presenting data on the impact of scaling across grantees, this presentation will share the results from an in-depth implementation study that identified successful strategies and lessons learned from the scaling-up experiences of grantees trying to reach communities and populations with the greatest need.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related public policy
Abstract
Promoting Seuxal Health Among Oregon Juvenile Offenders
Staci Wendt, PhD1, Anthony Petrosino, PhD2, Pamela MacDougall2, Rebeca Cerna, MPH1, Lucyna Klinicka1, Colleen Carter1, Jonathan Nakamoto, PhD1, Trevor Fronius2 and Sarah Guckenburg3
(1)WestEd, Los Alamitos, CA, (2)WestEd, Woburn, MA, (3)WestEd, Woburn
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Implementing sexual health education programs with justice-involved youth is challenging. Youth living apart from their families in residential settings administered by foster care or juvenile justice systems face risk factors including abuse and neglect, substance abuse, mental health, and behavioral issues that have been linked to sexual risk-taking behavior. (James et al. 2009; McGuinness et al. 2002). These youth report having first sexual intercourse at earlier ages with more sexual partners compared with other youth. This high need population is at greater risk for teen pregnancy, STDs and HIV which tax communities and public health and yet few resources are available to meet their needs and circumstance.
Twenty-two states have mandated sex education and or HIV/STD for school aged youth. Studies show however, that youth in this high-priority population have interrupted schooling and are likely to have missed school-based sexual health education courses.
WestEd is currently evaluating a tablet-based app specifically designed to educate young males (ages 14-19) in juvenile justice facilities across Oregon on puberty, sexual health, sexual consent, and healthy relationships through games, interactive scenarios and short videos. This app is one of the first such interventions designed specifically for young males in a juvenile justice environment.
This presentation will discuss how system-involved youth contributed to the development of the app and how it was tailored to work within the facilities. We will also discuss current study findings on the impact of youths’ perceptions of the impact of Healthy U.
Conduct evaluation related to programs, research, and other areas of practice
Abstract
Developing a multi-level pregnancy prevention intervention for young women with depression: Engaging stakeholder communities
Cassandra Jonestrask, BA1, Allegra Gordon, MPH, ScD1, Sabra L. Katz-Wise, PhD1, Pamela J. Burke, PhD, RN, FNP, PNP2 and Lydia A. Shrier, MD, MPH1
(1)Boston Children's Hospital, Boston, MA, (2)Northeastern University, Bouve’ College of Health Sciences, Boston, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Young women with depression have elevated rates of unintended pregnancy, unintended first birth, and sexually transmitted infections. Through a comprehensive formative process that included input from members of the target population, we developed the Momentary Affect Regulation–Safer Sex Intervention (MARSSI) to offer an intensive, individualized intervention to affected young women being seen in clinic settings. MARSSI combines brief clinic-based sexual risk reduction counseling and cognitive-behavioral skill teaching with mobile self-monitoring and responsive messaging upon report of poor affective states and maladaptive cognitive states. Although adolescent teen pregnancy prevention interventions often consider environmental factors, many do not provide intervention beyond the individual level. To address provider and organization factors that may facilitate or impede successful uptake and implementation of MARSSI, we are designing a clinic-level intervention component of MARSSI to be integrated with the individual-level component. We sought perspectives from key stakeholders in clinic systems of primary care for adolescent and young adult women. Through a comprehensive vetting process, we identified a diverse set of clinics, including community health centers, a hospital-based clinic, a school-based health center, a storefront clinic, and a health care van serving different subpopulations of high-risk depressed young women, including urban, rural, African-American, Asian, Latina, immigrant, sexual and gender minorities, and homeless youth, and conducted interviews with key informants. In this symposium, we will describe strategies for identifying and engaging with patients, providers, and clinic staff, and lessons learned from the process of partnering with these stakeholder communities with the goal of developing an innovative multi-level intervention.
Assessment of individual and community needs for health education Implementation of health education strategies, interventions and programs Public health or related research Social and behavioral sciences
Abstract
Round Table Discussions: How Might We Design and Test Innovative Interventions to Improve Adolescent Sexual and Reproductive Health?
Nicole Bennett, MPH1, Amy Margolis, MPH, CHES2, Amy Farb, PhD3, Tara Rice, MD, MPP3 and JoAnne Jensen, PhD4
(1)Office of Population Affairs, U.S. Department of Health and Human Services, Rockville, MD, (2)HHS Office of Population Affairs, Rockville, MD, (3)HHS Office of Adolescent Health, Rockville, MD, (4)U.S. Department of Health and Human Services Office of the Assistant Secretary of Health Office of Adolescent Health, Rockville, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
How might we design and test innovative interventions to improve adolescent sexual and reproductive health? What have we done, for whom, how, what has been learned, and what could improve? During this Round Table, each presenter, an Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Tier 2 Research and Demonstration grantee or sub-grantee, will share information and lessons learned about their design, testing methods, and/or how they have fostered innovation in adolescent sexual and reproductive health. In addition, emphasis will be on (1) addressing disparities and ensuring equity; (2) co-designing with priority populations (e.g., Latino parents; LGBTQ youth; males in juvenile justice; youth with intellectual/developmental disabilities); and (3) the level of intervention (e.g., individual, interpersonal, organizational, systems). Each table will encourage thoughtful engagement. At some tables, there will be a chance to learn about design-thinking, systems-thinking, and discuss gaps to improve adolescent reproductive and sexual health.
From 2015-2018, OAH funded different types of Tier 2 grantees to address disparities and spur innovation; despite drops in teen pregnancy rates, disparities exist, particularly geographically, among ethnic/racial and sexual/gender minorities. OAH funding created two grantee intermediaries to select, fund, and support early innovation. These grantees subsequently worked with 30 innovator teams, yielding over 13 new programs and technologies. OAH also funded 24 grantees, three in partnership with the CDC Division of Reproductive Health, to develop, test, and package innovative programs addressing disparities and gaps in the field. This round table session will spotlight these projects and lessons learned.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
An Evaluation Toolkit for Wise Guys: A Male Focused Teen Pregnancy Prevention Program
Donna Elliston, DrPH1, Angela Cheung, MPH1, Ben Schoenbachler, MPH1, Tara Earl, DrPH1, Alrick Edwards, MPH1, Cynthia Klein, PhD1 and Lauren Olsho, PhD2
(1)Abt Associates, Atlanta, GA, (2)Abt Associates, Cambridge, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: In 2015, the Office of Adolescent Health (OAH) provided support for the evaluation of teen pregnancy prevention programs to determine their effectiveness in the delay of sexual initiation among adolescents. The lens of teen pregnancy and sexually transmitted infection (STI) prevention has often focused on the female adolescent with many intervention programs disregarding their male partners. Wise Guys takes an innovative approach to this issue by shifting our thought processes to the male adolescent.
Methods: An Evaluation Toolkit was developed to encompass the collective resources and materials used in the assessment of the Wise Guys Teen Pregnancy Prevention Program. The purpose of the toolkit is to serve as a helpful resource for future evaluation work in the content area targeting adolescent males and teen pregnancy prevention.
Results: The development of a toolkit consisting of four sections (Needs Assessment, Recruitment, Evaluation Design, and Lessons Learned) to provide a step-by-step guide in the execution of a randomized controlled trial (RCT) evaluation of the Wise Guys Teen Pregnancy Prevention Program.
Conclusion: Our approach and the tools provided were developed specifically for the evaluation of the Wise Guys Program. It is important for other users of similar male-focused programs to develop approaches and tools that are specific to the objectives and outcomes of their respective programs. These tools can be adapted for other evaluation projects, and it is our hope that this resource fills the gap in the assessment of the underrepresented population of adolescent males in pregnancy prevention
Administer health education strategies, interventions and programs Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning
Abstract
Building the Foundation: The Development and Evolution of the Wise Guys Evaluation Database
Ben Schoenbachler, MPH, Ben Schoenbachler, MPH, Angela Cheung, Donna Elliston, Tara Earl, PhD, MSW, Alrick Edwards, MPH, Cynthia Klein, PhD and Lauren Olsho
Abt Associates, Atlanta, GA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Introduction:
In 2015, the Office of Adolescent Health provided support for the evaluation of the Wise Guys health education program. Wise Guys is a teen pregnancy prevention intervention for adolescent boys in grades 7 through 12. Since few interventions focus on this population and more data-driven studies are needed, it was important to select a user-friendly data monitoring and analysis software system that could be used easily in a school-based setting.
Methods:
We used software that allowed us to build customizable data collection instruments that were quickly updated as school staff and students provided feedback. The software allowed us to limit database access to certain users to adhere to data security measures. Once the database was built, data was collected from 284 students from five schools in Iredell County, NC from August 2016 to February 2018. Both online and offline capabilities of the software were used to track the completion of surveys by participants in real time.
Results:
The user-friendly software package provided lessons learned to collecting data from students in a school-based setting. Capabilities included facilitating concurrent data collection activities at different schools, as well as tracking survey completion and sending survey reminders to decrease participant attrition. The software also allowed data to be exported across a wide range of statistical software packages, which facilitated the data analysis process.
Conclusion:
The software used in this project allowed for the flexibility to gain a better understanding of the underrepresented population of male adolescents in teen pregnancy prevention.
Administer health education strategies, interventions and programs Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning
Abstract
“We can Express Ourselves as a Man”: Voices from Wise Guys, a Teen Pregnancy Prevention Program for Adolescent Males
Angela Cheung, MPH1, Donna Elliston, DrPH1, Ben Schoenbachler, MPH1, Tara Earl, PhD, MSW1, Alrick Edwards, MPH1, Cynthia Klein, PhD1 and Lauren Olsho, PhD2
(1)Abt Associates, Atlanta, GA, (2)Abt Associates, Cambridge, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Introduction: The Wise Guys intervention takes an innovative approach to teen pregnancy prevention by shifting the focus from adolescent females to males. Wise Guys is a health education program for young men that aims to reduce teen pregnancies by promoting healthy concepts of masculinity and fatherhood. Given the lack of interventions designed for males, it is important to assess the acceptability of Wise Guys by listening to the voices of program participants.
Methods: Wise Guys was delivered to 117 male students across 5 high schools in Iredell County, NC. At the end of the intervention, participants completed feedback surveys and focus groups. Mean scores were calculated for three statements in the survey, with scores ranging from 1-4. A higher score indicated higher agreement with each statement. Qualitative data were thematically analyzed to produce key themes.
Results: A total of 90 feedback surveys and 5 focus groups were completed. Participants indicated high agreement with knowing more about preventing pregnancy (mean=3.66, sd=0.50) and learning new information for making decisions about preventing pregnancies (mean=3.68, sd=0.47). Participants also agreed that the content was clear and easy to understand (mean=3.78, sd=0.47). While qualitative data continues to be analyzed, 3 preliminary themes have emerged: genuine conversations about male issues, a safe environment for discussions, and engaging facilitators as strengths of Wise Guys.
Conclusion: These results suggest the high acceptability of Wise Guys and highlight the importance of hearing the voices of male adolescents in teenage pregnancy prevention. Findings have implications for designing other male-oriented programs.
Administer health education strategies, interventions and programs Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning
Abstract
Successful Strategies for Scaling-up Keeping it Real Together, a Community-based Teen Pregnancy Prevention Program
Luanne Rohrbach, PhD MPH1, Kristin Meyer, PhD2, Bret Moulton, MPH1, Elena Hoeppner, MPH1 and Nicole Bennett, MPH3
(1)University of Southern California, Los Angeles, CA, (2)Los Angeles County Department of Public Health, Los Angeles, CA, (3)Office of Population Affairs, U.S. Department of Health and Human Services, Rockville, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
This presentation describes scale-up strategies for Keeping It Real Together (KIR-T), an intervention to reduce sexual risk behaviors in areas of Los Angeles County with high rates of teen births and STDs. Key KIR-T program components were evidence-based sexual health education programs in middle and alternative high schools, parent communication workshops, community mobilization, and dissemination of resources connecting youth to sexual health services. The KIR-T intervention was implemented via a partnership between a university, the county public health department, three local school districts, and several community organizations. Strategies facilitating the scale-up included providing pre-implementation training and on-site technical assistance to teachers; developing a web-based toolkit of resources; identifying a “site lead” teacher in each school to coordinate implementation; training promotoras (community health workers) to deliver parent workshops; training school nurses to disseminate information to students; collaborating with various community-based coalitions on mobilization and community education efforts; and the teacher advisory board, community advisory group, and youth council. From 2011 to 2018, we trained 325 teachers to deliver the programs in 41 middle schools and 11 alternative high school sites, reaching more than 46,000 students. Promotoras trained more than 1200 parents. We will describe school recruitment, toolkit development, how the advisory boards informed program implementation, and structural components (e.g., policies and procedures) that helped integrate sexual health curricula into the school setting. We will present selected results of stakeholder surveys that address the effectiveness of these strategies for sustaining the program and its public health impact.
Administer health education strategies, interventions and programs Implementation of health education strategies, interventions and programs