16: Female adolescent’s educational choices about reproductive health topics

Abstract

Health care providers are expected to educate teens about abstinence, preventing sexually transmitted diseases (STDs) and contraception. Allowing teens to choose which topics they wish to learn first may enhance receptivity to all three topics. Yet little is known about adolescents’ preferences for these topics. As part of a randomized trial to test a motivational intervention compared to didactic counseling to prevent pregnancy and STDs, we examined the educational choices of female adolescents and their satisfaction with the counseling topic by order of selection preference. We also assessed the relationship between demographic and reproductive variables, educational choice, and satisfaction with choice. As part of a larger trial, female adolescents ages 13 to 21 completed a 60-minute computerized assessment. Those who were randomized to receive didactic counseling were asked to select which topic they preferred to receive (abstinence, STD prevention or contraception) at enrollment, 3 and 6 month counseling visits. Participants could not repeat topics. After each counseling visit, participants rated their satisfaction with the counseling session on a 5-point scale that ranged from “I disliked the counseling,” to “I very much liked the counseling.” To date, 204 participants have been randomized to receive didactic counseling and have completed the enrollment visit; 141 completed the 3 month and 116 completed the 6 month counseling visits. Mean participant age is 17.3± 2.2 years. Most are Black (59%) or White (31%) and 68% are sexually active with a mean age at coitarche of 15.0± 1.8. Among sexually active participants (n=138), 13% had ever been pregnant and 30% had ever had an STD. At the enrollment visit, 26% of the entire sample chose abstinence, 35% chose STD prevention and 39% chose contraception as their first counseling topic. Participants who chose the contraception module were significantly older than those who chose STD and abstinence (F=4.71, p=0.01, pairwise p’s <0.05). Those who had ever had an STD were more likely to choose the STD module, and virginal participants were more likely to choose the abstinence module (p’s ≤0.01). There were not any differences in the first module selected by race or pregnancy history. The counseling topics provided at the 6 month visit were abstinence (49%), STD prevention (20%) and contraception (31%). Most (84%) rated their level of satisfaction with the first session positively as “liked” or “very much liked,” and 86% rated their level of satisfaction with the last session positively. When allowed to choose the order of reproductive health topics, a higher proportion of female adolescents chose contraception followed by STD prevention. Age, sexual and STD history were predictive of the order of the topics that teens wished to learn about. Satisfaction remained high regardless of whether the topic was the first or last choice. Given time limitations for counseling, health care providers may consider age, sexual and STD history when identifying which reproductive health topics teens wish to learn first.