A multi‐media digital intervention to improve the sexual and reproductive health of female adolescent emergency department patients

Abstract

Background: Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED. Methods:We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr.Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome. Results:We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57

Use of Digital Health Interventions in Sub-Saharan Africa for Health Systems Strengthening Over the Last 10 Years: A Scoping Review Protocol

“…Researchers have demonstrated the potential of DHIs to support health systems globally; the evidence generated is mostly on small scale and targets specific health focus areas. These include but are not limited to: the use of digital technology to support service delivery during disease outbreaks as witnessed during the Covid-19 pandemic (18)(19)(20)(21), to offer sexual and reproductive health services (19,(22)(23)(24)(25), in support of mental health interventions (19), to prevent and manage noncommunicable diseases (26,27) and to improve primary health care services (28). The health workforce has benefited from the enthusiasm for digital technology to enhance performance with positive outcomes (29)(30)(31).…”

Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors

“…Based on our prior work, our adolescent ED population also predominantly identifies with being Hispanic and of “Other” race. 29 …”

“…Information about the intervention has been published previously. 29 Participants were enrolled from the same pediatric ED as described above. Participants were eligible if female age 14–19, sexually active with a male in the prior 3 months, not wanting to become pregnant in the next year, and not used at last intercourse and were not currently using an effective form of contraception.…”

“…Based on our prior work, our adolescent ED population also predominantly identifies with being Hispanic and of "Other" race. 29 We enrolled a convenience sample of sexually active female ED patients aged 14 through 19 years who had ever used effective contraceptives (n = 22). We defined effective contraception as use of an intrauterine or implantable device, injection (Depo-Provera or medroxyprogesterone acetate), ring (NuvaRing), transdermal patch (Ortho Evra), or oral contraceptive pills.…”

“… 26 Interventions can also be tailored to specific subgroups, such as lesbian, gay, bisexual, and transgender (LGBT+) youth, racial/ethnic minority youth, and adolescent girls and boys. 27 – 29 The interventions can also provide privacy, which is particularly important for adolescents. Data shows that these interventions can lead to positive behavior change in the area of adolescent sexual health.…”