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

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 ...