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 ...

The 18-24 age group is experiencing a greater increase in smoking prevalence than any other age group in recent years. This article presents a case study of how a California community college successfully implemented a comprehensive tobacco control program to counter pro-tobacco influences, to reduce exposure to secondhand smoke, and to increase the availability of cessation services. The college strengthened the reasonable distance policy by establishing designated smoking areas to the recent adoption of a smoke-free campus. The Student Health Center led the efforts in creating a student coalition, planned advocacy and educational campaigns, developed partnerships with multiple campus departments, implemented an enforcement program, and revised clinical interventions to reflect the US Public Health Service Guidelines. The project was in collaboration with the local health department and two other college campuses. Successful policy change resulted in affecting social norms and a decreased smoking prevalence of 13% in 2000 to 8% in 2004. We encourage other campuses, particularly community colleges, to address tobacco control issues and use some of the strategies presented.

No abstract

No abstract

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 ...