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Reducing health disparities in unintended pregnancies among Hispanic adolescents using a patient-centered computer-based clinic intervention
Investigator (PI): Tebb, Kathleen
Performing Organization (PO): (Current): University of California, San Francisco, School of Medicine, Department of Pediatrics, Division of Adolescent and Young Adult Medicine / (415) 476-6106
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2015
Final Year: 2020
Record Source/Award ID: PCORI/AD-1502-27481
Funding: Total Award Amount: $1,998,469
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: While teen pregnancy rates have declined in the United States over the past two decades, rates among Hispanic/Latina girls remain high, and these women experience a disproportionate burden of adverse health and economic consequences. Most of these pregnancies are unintended--that is, the adolescent did not plan for or desire a pregnancy. Compared with other adolescents, Hispanic teens are less knowledgeable about and less likely to use effective contraceptives. The number of contraceptive options can seem overwhelming, and these teens often avoid sexual health care because of discomfort, stigma, and confidentiality concerns. Clinicians often lack the time, skills, and comfort to provide comprehensive education and counseling for Hispanic teens. Our team of researchers, clinicians, community partners, and Latina youth developed an innovative, interactive, individually tailored computer application (APP), Health-E You, to address these barriers. It is designed to allow users to self-determine their readiness and need for contraception; support their personal decision making process in selecting an effective method; and improve the quality of the health visit. Objectives: The goal is to improve Latina adolescents' knowledge of, attitudes about, and use of effective methods of contraception that fit with their personal needs. The long-term goal is to reduce the incidence of unprotected sexual intercourse (and associated unintended pregnancies and sexually transmitted infections [STIs]) over time. Methods: Latina adolescents who are seeking care at high school-based health centers (SBHCs) in Los Angeles Unified School District and who are at risk of becoming pregnant or of acquiring STIs will be invited to participate in the study. In this design, 12 SBHCs will be randomized, with equal chance, to either the intervention or comparison group, with six clinics in each group. The intervention clinics will provide the Health-E You APP to adolescent girls; the control clinics will provide usual care. A total of 1,200 Latina teens will be selected to participate in the study--600 at intervention clinics and 600 at the control clinics--and will receive up to $70 for their participation. We will compare the intervention group with the control group--prior to receiving the intervention, and at three- and six-month follow-up periods--in terms of adolescents' knowledge of, attitudes about, and use of contraceptives. Patient and stakeholder engagement: We partnered with Latina youth, clinicians, community partners, and SBHCs over the past three years to develop and pilot test the APP. Pilot tests at SBHCs show that Health-E You is feasible to implement and acceptable to Latina adolescents, who increased their sexual health knowledge and implemented plans to use an effective method of contraception. We will continue this collaboration to ensure the success of this study.
Abstract Archived: Lay Abstract: This research project is in progress. PCORI will post the research findings on the PCORI website within 90 days after the results are final. What is the research about?  Most teen pregnancies in the United States are unintended. Latinas have higher rates of teen pregnancy than whites. Teens who have babies may face health problems and challenges finding jobs or finishing school. This study is testing ways to help Latina teens learn about birth control methods and choose a method that works well for them. Who can this research help? This research can help Latina teens learn about birth control options to avoid unplanned pregnancies and sexually transmitted infections. It can also help clinicians provide Latina teens with health services that meet teens' needs. What is the research team doing? The research team worked with doctors, nurses, clinic staff, Latina teens, and community groups to develop and test a computer app called Health-E You/Salud iTu. The app can be used on tablets, smartphones, or computers. The app helps teens decide if they need birth control, gives them information about birth control, and helps them choose a birth control method that is best for them. The health care provider gets information from the app about the teens' preferred birth control method before their visits. The research team is working with 18 school health centers in Los Angeles, California. The team is recruiting 1,400 Latina teens who are at risk of becoming pregnant. The team is assigning the 18 health centers to one of two groups by chance. The first group provides the teens with the Health-E You/Salud iTu app. The second group provides usual care. The research team gives surveys to the teens when they start the study, and e-mails or texts the links to the teens to complete follow-up surveys again at three and six months after their health care visits. The surveys ask teens about their knowledge of birth control and their attitudes about and use of birth control. The surveys also ask whether the teens like the app and how satisfied they were with their clinic visit. The research team is partnering with Latina youth, school-based health centers, and community groups throughout the study. Research methods. Research design: The study design is a randomized controlled trial. Population: The study population is Latina adolescents ages 14 to 18 years who are at risk of becoming pregnant or getting sexually transmitted infections. Interventions/comparators are the Health-E You/Salud iTu app and usual care. Outcomes: Outcomes are (1) primary: the type of birth control currently being used and birth control use during the past 3 months and (2) secondary: satisfaction with the app and clinic visit. The timeframe is 6-month follow-up for primary outcomes.

MeSH Terms:
  • Adolescent
  • Adolescent Behavior
  • Contraception
  • Female
  • * Health Status Disparities
  • Hispanic Americans
  • Humans
  • Patient Education as Topic
  • Patient-Centered Care
  • Pregnancy
  • Pregnancy in Adolescence /*prevention & control
  • * Pregnancy, Unplanned
  • Randomized Controlled Trials as Topic
  • Sexual Behavior
  • Sexually Transmitted Diseases /prevention & control
  • Telemedicine /methods
  • United States
Country: United States
State: California
Zip Code: 94118
UI: 20162007
CTgovId: NCT02847858
Project Status: Completed
Record History: ('2017: Project extended to 2019.',) ('2018: Project extended to 2020.',) ('2020: Included Lay Abstract in Abstract Archived 1 field. Alternate Title: Increasing knowledge and use of birth control among Latina adolescents using a computer-based app--The Healthy-E You/Salud iTu Intervention',)