Assessing the effectiveness of a patient-centred computer-based clinic intervention,<i>Health-E You/Salud iTu,</i>to reduce health disparities in unintended pregnancies among Hispanic adolescents: study protocol for a cluster randomised control trial

Tebb, Kathleen; Rodriguez, Felicia; Pollack, Lance M.; Trieu, Sang Leng; Hwang, Loris Y.; Puffer, Maryjane; Adams, Sally; Ozer, Elizabeth M.; Brindis, Claire D.

doi:10.1136/bmjopen-2017-018201

Cited by 13 publications

(12 citation statements)

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“…In another example, the L.A. Trust partnered with researchers to develop and evaluate a mobile health application to provide patient-centered evidence-based comprehensive contraceptive information and access to reduce disparities in unintended pregnancies among Latina adolescents. 20 Other programs such as the Door and MSACH also incorporate teen pregnancy prevention efforts that are multifaceted and include educational, medical, and social/economic approaches.…”

Section: Resultsmentioning

confidence: 99%

Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults

et al. 2018

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Background: Social determinants are the leading causes of health disparities. Yet health care systems have not systemically addressed social determinants of health as it pertains to adolescents and young adults (AYAs), among other populations in need. This study identified promising innovative programs across the United States.Methods: Thirteen representatives from 10 programs completed a 45-min telephone interview. Transcripts were reviewed and analyzed to identify cross-cutting themes.Results: Strategies included increasing access to quality, comprehensive and confidential health services, addressing the holistic needs of AYAs, collaborations across the health care delivery systems and other community services, and leveraging technology.Conclusion: This study showcased innovative approaches to inform future efforts.

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Section: Resultsmentioning

confidence: 99%

Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults

et al. 2018

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“…This study is part of a larger, cluster randomized control trial (CRCT) conducted at 18 school-based health centers (SBHCs) across Los Angeles County, California, to evaluate the effectiveness of Health-E You on its ability to reduce health disparities in unintended pregnancies among sexually active Latina adolescents [29]. All clinics are SBHCs that are operated and managed independently, cover a very large area of Los Angeles County, serve a large proportion of Latina students, and are centered in areas with high rates of sexual health morbidities according to the Los Angeles County Department of Public Health.…”

Section: Methodsmentioning

confidence: 99%

A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers

Tebb

Trieu²,

Rico³

et al. 2019

JMIR Mhealth Uhealth

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Background Health care providers are a trusted and accurate source of sexual health information for most adolescents, and clinical guidelines recommend that all youth receive comprehensive, confidential sexual health information and services. However, these guidelines are followed inconsistently. Providers often lack the time, comfort, and skills to provide patient-centered comprehensive contraceptive counseling and services. There are significant disparities in the provision of sexual health services for Latino adolescents, which contribute to disproportionately higher rates of teenage pregnancy. To address this, we developed Health-E You or Salud iTu in Spanish, an evidence-informed mobile health (mHealth) app, to provide interactive, individually tailored sexual health information and contraception decision support for English and Spanish speakers. It is designed to be used in conjunction with a clinical encounter to increase access to patient-centered contraceptive information and services for adolescents at risk of pregnancy. Based on user input, the app provides tailored contraceptive recommendations and asks the youth to indicate what methods they are most interested in. This information is shared with the provider before the in-person visit. The app is designed to prepare youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. Despite the promise of this app, there is limited research on the integration of such interventions into clinical practice. Objective This study described efforts used to support the successful adoption and implementation of the Health-E You app in clinical settings and described facilitators and barriers encountered to inform future efforts aimed at integrating mHealth interventions into clinical settings. Methods This study was part of a larger, cluster randomized control trial to evaluate the effectiveness of Health-E You on its ability to reduce health disparities in contraceptive knowledge, access to contraceptive services, and unintended pregnancies among sexually active Latina adolescents at 18 school-based health centers (SBHCs) across Los Angeles County, California. App development and implementation were informed by the theory of diffusion of innovation, the Patient-Centered Outcomes Research Institute’s principles of engagement, and iterative pilot testing with adolescents and clinicians. Implementation facilitators and barriers were identified through monthly conference calls, site visits, and quarterly in-person collaborative meetings. Results Implementation approaches enhanced the development, adoption, and integration of Health-E You into SBHCs. Implementation challenges were also identified to improve the integration of mHealth ...

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“…This study is part of a larger, cluster randomized control trial (CRCT), being conducted in 18 SBHCs throughout Los Angeles County, California to evaluate the effectiveness of Health-E You/ Salud iTu on its ability to reduce health disparities in unintended pregnancies among sexually active Latina adolescents [26]. The app was implemented in nine of the SBHCs randomly assigned to implement the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…Users are then asked to complete a series of questions to help assess which contraceptive method(s) is the "best choice" for "you". The contraceptive recommendation algorithm used in the app is based on adolescents' preferences and attitudes that could affect their choice and use of contraception as well as concerns for potential side effects (see Tebb 2017 for details about the computer algorithm) [26]. Based on the youth's responses, the app determines which method or methods may be the "top choice(s)" for an individual.…”

Section: Overview Of App Implementationmentioning

confidence: 99%

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A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers (Preprint)

Tebb¹,

Trieu²,

Rico³

et al. 2018

Preprint

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1 BackgroundHealth care providers are a trusted and accurate source of sexual health information for most adolescents. Further, clinical guidelines recommend that all youth receive comprehensive, confidential sexual health information and services. However, these guidelines are followed inconsistently. Providers often lack the time, comfort and skills to provide patient-centered comprehensive contraceptive counseling and services. There are significant disparities in the provision of sexual health services for Latino adolescents, which contributes to disproportionately higher rates of teenage pregnancy. To address this problem, we have developed Health-E You/Salud iTu, an evidence-informed mobile health (mHealth) application (app) to provide interactive, sexual health and contraceptive information and individually tailored, patient-centered, contraceptive decision support in English and Spanish. It is designed to be used in conjunction with a clinical encounter to increase adolescents, at risk of pregnancy, access to patient-centered contraceptive information and services. Based on user input, the app provides individually tailored contraceptive recommendations and asks youth to indicate what method(s) they are most interested in. This information is then shared with the provider prior to the face-to-face portion of the visit. In this way, the app prepares youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. Despite the promise of this app, there is limited research on the integration of such mHealth interventions into clinical practice. ObjectiveThe purpose of this manuscript is to describe efforts used to support the successful adoption and implementation of the Health-E You/ Salud iTu app in clinical settings and to describe implementation facilitators and barriers encountered to inform future efforts aimed at integrating mhealth interventions or other computer applications into clinical settings. MethodsThis study is part of a larger, cluster randomized control trial to evaluate the effectiveness of Health-E You/Salud iTu on its ability to reduce health disparities in contraceptive knowledge, access to contraceptive services and unintended pregnancies among sexually active Latina adolescents at 18 school-based health centers (SBHCs) throughout Los Angeles County, California. App development and implementation was informed by the theory of diffusion of innovation, PCORI principles of engagement and iterative pilot testing with adolescents and clinicians. To assess implementation, the research team used multiple sources of data to identify facilitators and barriers including: monthly conference calls, monthly site visits, and quarterly in-person collaborative meetings. ResultsThe implementation approaches used in this study enhanced the development, adoption and integration of Health-E You into SBHCs. Despite success, there were a number of implementation challenges that are important to understand when ...

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Assessing the effectiveness of a patient-centred computer-based clinic intervention,Health-E You/Salud iTu,to reduce health disparities in unintended pregnancies among Hispanic adolescents: study protocol for a cluster randomised control trial

Cited by 13 publications

References 55 publications

Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults

Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults

A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers

A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers (Preprint)

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