75. Use Of Youth-Centered Mobile Health Application, Health-E You/Salud iTu, To Reduce Disparities In Contraceptive Knowledge, Access And Unintended Pregnancy Among Sexually Active Latina Adolescents

Abstract

There are significant disparities in contraceptive knowledge, access and use among Latina adolescents. More than half Latinas become pregnant before age 20 and face a disproportionate burden of adverse consequences. Health-E You/Salud iTu is an interactive, individually tailored mobile health application (app) in Spanish and English to increase Latina adolescents’ access to comprehensive contraceptive information, patient-centered decision-making support and uptake of effective contraception to reduce disparities in unintended pregnancies. This study examines participants’ contraceptive knowledge, self-efficacy and interest in effective contraception at baseline and immediately after using the app. This is part of a larger longitudinal, cluster randomized control trial (CRCT) in 18 school based health centers (SBHCs) serving high need communities across Los Angeles County. App development was based on social cognitive theory and informed through iterative prototyping with Latina adolescents and clinicians. All adolescent girls receive an iPad upon registration. Controls complete a sexual health survey. Health-E You obtains consent and eligibility: Latina, aged 14-18 years, sexually active, not currently pregnant and not using long acting reversible contraception (LARC). The app assesses common contraceptive misconceptions/knowledge (via a myth-busters game) and self-efficacy. It provides decision-making support by assessing attitudes about life planning, preferences, prior experience, barriers to use, and potential contraindications that are important when considering contraception. Participants can choose to learn more about any method and watch video vignettes of clinicians and youth. Upon completion, the user selects the method(s) most interested in. Information from the app is printed for the clinician prior to seeing the youth. The study enrolled 1,374 sexually active Latinas (697 intervention; 677 control) with a mean age of 16.4 years; 90% spoke Spanish; 97% reported it was very or somewhat important to avoid becoming pregnant. Yet at baseline, 30% used nothing or an ineffective method (withdrawal/rhythm), 41% condoms, 30% pills, patch or ring and 0% LARCs. Of the 98% who completed the app, 75% were recommended a LARC and 25% the pill, patch or ring. After app use, interest in using an effective method significantly increased to 62% for pill//patch/ring; and to 28% for LARCs (p<.001). Contraceptive non-use (nothing/withdrawal/rhythm) declined by 61%. There were also significant increases in contraceptive knowledge (3.38 to 4.94 items answered correctly out of 7, p<.001) and self-efficacy in talking with their doctor about birth control (7.96 vs 8.37; p<.001); having the information needed to choose birth control (7.90 vs 8.41; p<.001) and using birth control correctly (8.03 vs 8.45; p<.001). The app recommends condoms to everyone; however, there was no increase in condom use self-efficacy. Health-E You/Salud-iTu was isuccessfuly integrated into SBHCs as a “clinician extender” to provide personalized contraception education and decision making support prior to the face-to-face encounter. There were significant increases in app users' knowledge, self-efficacy and interest to use effective contraception. Qualitative data indicate the app better prepares adolescents to discuss contraception with their provider and improves the efficiency and effectiveness of patient-centered contraceptive care.