Abstract
Learning from someone who knows: Design and testing of a social network-based contraceptive education intervention for adolescents
Edith Fox, MPH, Reiley Reed, MPH, Whitney Wilson, MPH and Christine Dehlendorf, MD MAS
University of California, San Francisco, San Francisco, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Drops in teen pregnancy rates in the U.S. since the 1990s are largely attributable to increased contraceptive use among adolescents. However, rates remain high compared with other industrialized countries due to underuse of effective contraception by sexually active teens. Friends and family are valued sources of contraceptive information, particularly among adolescents. We sought to design and test an intervention harnessing social communication among adolescents to facilitate the dissemination of evidence-based information about contraception and increase adolescent contraceptive use. We conducted 24 semi-structured interviews and two focus groups (n=11) about preferences for social communication about contraception with female adolescents aged 15 to 19 in Northern California. We used content analysis to examine themes. Qualitative results informed the design of SpeakOut, a clinic-based social communication intervention about contraception. We then designed a randomized control trial (RCT) to test the impact of SpeakOut on recipients and their peer groups. Qualitative research participants placed value on hearing from friends about their personal contraceptive experiences, as well as method efficacy and side effects. Most participants preferred private one-on-one or text conversations about contraception with peers over public communication on social media. SpeakOut is designed to help facilitate the kind of private conversations desired by participants, providing recipients with digital and print resources they can share with friends. We designed our RCT to examine one-on-one social communication about contraception as an avenue of knowledge, attitude, and behavior change. Trial results will indicate whether SpeakOut successfully influenced social communication to affect outcomes among recipients and their peers.
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 Public health or related research
Abstract
Voices of young black men are critical in the design and testing of sexual and reproductive health programs for young black men
Archana Bodas LaPollo, MPH, Heather Batson, MA, Alex Peters and Nana Nimako, BA
Public Health Management Corporation, Philadelphia, PA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Most teen pregnancy prevention (TPP) interventions target young women in schools. However, young women’s male partners are often older, and young men have less access to reproductive health information. TPP interventions for young men are needed, but programs must be highly relevant to their lives and concerns.
BrotherSpeak is a cluster randomized control trial testing an innovative theater-based, 4-session, group-level TPP intervention (PALMS-TPP) for young black men (15-22 years) in 10 community settings (recreation centers and community-based centers serving out-of-school teens/young adults). PALMS-TPP is an adaptation of an evidence-based HIV prevention intervention and incorporates theater, music, interactive games/activities, didactic information, and facilitated discussions to reduce young men’s risk for unplanned pregnancy and strengthen protective factors. Adaptations were informed by qualitative research with the target population; input from community partners, our youth advisory board (YAB), and subject matter experts; and pilot testing.
Intervention skit character development and storylines emerged directly from focus groups, which also informed adaptions to the original sexual health curriculum (e.g., adding goal setting, communication skills, fatalism/hopelessness, and resilience; expanding from three to four sessions). The YAB assisted with staff hiring, developing the study name and logo, intervention activity trial runs, recruiting formative research participants, and interpreting formative research findings. Community partners informed study design and engagement strategies, and pilot testing was used to refine the curriculum. Participation satisfaction is assessed continually.
We will demonstrate that male-focused TPP requires innovation and community engagement strategies to build young men’s trust, and ensure program/study relevance, validity and reliability, and effectiveness.
Administer health education strategies, interventions and programs Assessment of individual and community needs for health education Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Evaluating a teen pregnancy prevention program for Hispanic and African American men, ages 16-22
Jenita Parekh, PhD, MPH1, Jennifer Manlove, PhD1, Maekedah Johnson1, Aapta Garg2 and Jane Kato-Wallace2
(1)Child Trends, Bethesda, MD, (2)Promundo, Washington, DC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The Manhood 2.0 project aims to rigorously evaluate an innovative pregnancy and relationship violence prevention curriculum, designed for racial and ethnic minority young men. Manhood 2.0 encourages adolescent and young adult men to discuss harmful gender norms related to masculinity and the pressures to conform to rigid definitions of manhood, as a gateway to broader discussions about contraceptive use, relationship violence, and teen pregnancy prevention. The project team – Child Trends, Promundo, and the Latin American Youth Center – is collecting data to rigorously evaluate Manhood 2.0 to determine whether it has an impact on reducing sexual behaviors that could lead to early and unintended pregnancy among young African American and Latino men (ages 16-22) in after-school and community-based settings in Washington, DC. We will present lessons learned based on the first 10 months of data collection.
First, we will discuss challenges we faced in employing a randomized control design in a community setting, particularly as it relates to recruiting and retaining participants, as well as our solutions that increased program retention and survey response rates.
Second, we will discuss study sample descriptive statistics including: demographics, gender norms, partner communication behaviors, pregnancy intentions, healthy relationships, contraceptive knowledge, and sexual and contraceptive use behavior. We will discuss the implications of these data for future research and programming.
Third, we will present quantitative and qualitative data that describes “what works” from the perspective of Manhood 2.0 participants. Topics include perceptions of the program, what they learned, and how the program impacted them.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Structuring Innovation in Teen Pregnancy Prevention using Systems and Design Thinking
Kelly Wilson, PhD, MCHES, Whitney Garney, PhD, MPH, Kristen Garcia, MPH, Jennifer Farmer, MS, CHES, Christi Hays Esquivel, MS, Jordan Nelon, MPH, Daenuka Muraleetharan, MS and Caitlin Holden, MS, CHES
Texas A&M University, College Station, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Purpose: Leaders that develop adolescent health initiatives spend a substantial amount of time identifying and adopting evidence-based programs to meet the needs of their target population. However, novel programs or adaptations are needed to embrace a person-centered approach that meets the target populations’ needs. Much of the research that examines innovation in public health focuses on the rigorous evaluation and adoption of programs, however, these programs lack the ability to report on key components and characteristics that made them innovative in the early stages of development.
Methods: In this session, we will describe the genesis of a teen pregnancy prevention innovation model, highlighting key constructs of innovation. We will highlight the methods used to engage teams in design and systems thinking as a component of their program design and development.
Results: We will review the experiences learned and highlight innovation projects from two cohorts of grantees that provided valuable lessons in the development of their programs.
Conclusions: The iTP3 program designed a model using programs that were in the early stages of program development, to better understand the influences of innovation through systems and design thinking in teen pregnancy prevention. The goal of this program is to encourage program developers and planners to go beyond understanding individual behavior change to better understand adolescents’ needs and impact teen birth rates and unplanned pregnancy. Our ultimate objective is to create linkages among program developers to encourage the utilization of insights, ideation and iteration to develop an innovative program that meets adolescents’ needs.
Administer 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
Designing and testing Girl2Girl: An innovative text messaging-based pregnancy prevention program for 14-18 year old LGB+ girls
Michele Ybarra, MPH PhD, Tonya Prescott, BA and Myeshia Price-Feeney, PhD
Center for Innovative Public Health Research, San Clemente, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Developing culturally appropriate and salient teen pregnancy prevention programming for lesbian, gay, bisexual and other sexual minority (i.e., “LGB”+) girls necessitates that researchers engage with the target population throughout the development process.
Method: We conducted 1) eight focus groups (FGs) with 14-18 year-old LGB+ girls to inform the content; 2) three online content advisory teams (CATs) to gain feedback on program messages; and 3) a pilot test of the randomized control trial to confirm the protocol. Youth were recruited nationally through Facebook and enrolled by telephone.
Results: FG data highlighted several opportunities to guide content, including messages that address reasons why someone might start using contraception even if she was not having sex with someone who had a penis; how dental dams could be used during sex – including how male condoms could be used to make dental dams; and norming the idea that commitment in a healthy relationship means a commitment to each other’s health, including using barriers.
Girls in the CATs said the tone of program messages was acceptable and the information was useful, although they suggested that messages needed to be more gender-inclusive and should provide more context around why barriers were needed when having sex with girls.
The pilot test confirmed the performance of the randomization and the acceptability of the content. 100% were retained, supporting a hypothesis of program acceptability.
Conclusions: Iteratively developing Girl2Girl with ongoing feedback from LGB+ teen girls helped to ensure that the intervention content was acceptable and relevant to this population.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Sex Ed + Tech: Using innovation to evaluate a sex ed digital intervention
Genevieve Martinez, PhD1, Jennifer Manlove, PhD2, Milagros Garrido, MA1, Elizabeth Cook, MSPH2, Maekedah Johnson2 and Nicholas Suffrinko, BA1
(1)Healthy Teen Network, Baltimore, MD, (2)Child Trends, Bethesda, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Pulse is a teen pregnancy prevention mobile-based intervention that was fully implemented and evaluated online without direct interaction with participants. While using technology offers opportunities for innovation in recruitment and evaluation, it also presents challenges that can hinder effective assessment. To test its efficacy, we employed a randomized-control trial design. We recruited 1,304 18-20 year old mostly Black and Latinx women through social media, screened them for eligibility online, and completed enrollment and randomization online. Throughout the intervention, evaluators sent frequent MMS text messages to engage and retain participants, and monitored their program participation via a WordPress platform. We also interviewed 16 participants about their program experiences.
We will discuss challenges, solutions, and successes when recruiting participants though social media, creating a control intervention comparable to the real intervention, creating an effective enrollment and screener website, identifying “fake” participants, and monitoring participant’s compliance with required program dose.
An online recruitment approach was successful for enrolling hard-to-reach older teen, and race/ethnic minority populations who may not otherwise receive a TPP intervention. Employing human-centered design principles exposed participants to a cohesive and seamless interface throughout recruitment, retention, and data collection that alleviated participation burden, boosted engagement, and built trust. However, protocols were needed to monitor and correct system failures experienced by the researcher or the participant such as program interruptions, incomplete data, “fake” participants, or low participation.
Pulse adaptation and evaluation is being supported by the Office of Adolescent Health, Teen Pregnancy Prevention Initiative.
Communication and informatics Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Collaborating to Build Community Capacity to Support the Sexual Health of Youth Experiencing Intellectual/Developmental Disabilities
April Kayser
Multnomah County Health Department, Portland, OR
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Multnomah County’s Sexual Health Equity for Individuals with Intellectual/Developmental Disabilities (SHEIDD) project works collaboratively to build community capacity to provide holistic sexual health education and support to young people (age 14-21) experiencing I/DD so they can make informed decisions about their health, increase safety, and experience healthy relationships. We will share what we've learned about building community partnerships, how we apply a systems approach to our work and how we use a variety of participatory methods to work with community partners to conduct community needs assessments and design interventions.
Assessment of individual and community needs for health education Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Innovation Next: Using Human Centered Design to Develop Sexual Health Programs
Katherine Suellentrop, MPH and Laura Lloyd, MPH
Power to Decide, Washington, DC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
This discussion will highlight the Innovation Next program which aims to support technology-based innovation to address adolescent sexual health. Specifically, we will present information about Human Centered Design (HCD)-the process we selected to support innovation-and the application of HCD in Innovation Next. We will also share information about how HCD was used to create a deep understanding of teen experiences. This session will be particularly relevant for participants who are working with adolescents, seeking to enhance programming with digital tools, and interested in learning more about how to support innovation. Innovation Next is a project aimed at identifying nascent innovation to improve adolescent sexual health outcomes and can provide important lessons learned related to designing and testing innovation in sexual and reproductive health.
Communication and informatics Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Implementing and evaluating Re:MIX: An innovative in-school sexual health education curriculum piloted with Latino adolescents
Jennifer Manlove, PhD1, Jenifer DeAtley, LMSW2, Bianca Faccio1 and Rebecca Shirsat2
(1)Child Trends, Bethesda, MD, (2)EngenderHealth, Austin, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Re:MIX is a comprehensive in-school sexual health education and youth development curriculum for adolescents in largely Latino schools. This innovative program uses young parents as peer educators, who teach alongside professional health educators. The peer educator shares the challenges and drastic life changes of becoming a parent at a young age. Re:MIX also challenges participants to re-think traditional gender norms regarding masculinity, femininity, and gender’s impact on reproductive health outcomes, including unplanned teenage pregnancy. The program connects to youth culture through experiential methodologies and utilizes technology and social media to reinforce health messages.
This presentation will describe the challenges and successes in implementing Re:MIX and will also describe the RCT study design used to evaluate Re:MIX with 8th- to 10th-grade students in charter schools in Austin, Texas. We will present descriptive information about our sample of approximately 550 students from 50 classrooms. For example, three in four students are Latino, about 40 percent primarily speak Spanish at home, and levels of sexual activity vary across school. We will also present lessons learned about obtaining parental consent, implementing with peer educators, maintaining high student involvement, and achieving a high response rate on the post-intervention assessment. The project team will also describe student perceptions of the program as well as treatment- control-group differences in measures of knowledge (about condoms and contraception), attitudes (about equitable gender norms, contraception) self-efficacy (resisting pressure to have unwanted or unprotected sex), and intentions (to use contraception and visit a health clinic).
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice
Abstract
How might we use technology to give Hispanic/Latino parents the tools they need to teach their children about sexual health?
Julie Yegen
Westat, Rockville, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Research shows that Hispanic parents in the U.S. rarely communicate openly about sexuality and contraception with their teens. Yet, those teens are more likely than their peers to view parents as influential in their decisions about sex. Using design thinking, we developed a technology-based, culturally appropriate tool for Spanish dominant parents. Momentos is a weekly text message for Spanish-speaking parents that provides practical advice for communicating with their children about sexual health. This presentation will review how design thinking—a user-centered approach to innovative problem solving—led to Momentos and results from the pilot program that demonstrate behavior change, including 91 percent of survey respondents using content to initiate conversations with their teens. Further, we will highlight our national mobile-first partner, SABEResPODER, who helped Momentos connect to its network of nearly 1 million Spanish-dominant members and achieve click through rates 3X above industry average.
Planning of health education strategies, interventions, and programs