Abstract
Mental illness in adolescence is associated with high-risk sexual behaviors including multiple sex partners, infrequent or inconsistent condom use, and nonuse of contraception. Inpatient psychiatric care represents a promising setting to provide sexual health education. This pilot study investigates the feasibility and acceptability of online sexual health education in this group by assessing usability and impact on short-term psychosocial outcomes. We administered online modules on healthy relationships, pregnancy prevention, condom use, and sexually transmitted infection (STI) prevention to youth. We evaluated outcomes using a single group, pre/post-intervention design. One quality improvement session assessed staff acceptability of the programming. Participants included 51 inpatients (mean age = 15.3; 61% female; 57% Hispanic or Latino; 55% heterosexual). Overall, the program was feasible to administer and highly acceptable to youth (84-89% liked the modules, 98-100% found them easy to use, 96-100% found them credible, 91-98% said information would lead to healthier dating relationships, and 78-87% would refer to a friend). Youth who completed modules demonstrated improvement in several outcomes: attitudes and norms towards violence (p < 0.001), intention to use a method of birth control other than condoms if having sex in the next 3 months (p < 0.001), condom knowledge (p < 0.001), condom use self-efficacy (p < 0.001), condom beliefs (p = 0.04), HIV/STI knowledge (p < 0.001), and perceived susceptibility to STI (p < 0.01). The quality improvement session revealed high acceptability by nursing staff on the unit. This intervention could be useful and efficacious in an inpatient setting and larger studies are warranted to understand its full impact.
Highlights
Youth ages 13 to 24 years account for 21% of all new HIV diagnoses in the United States; ethnic and sexual minority youth represent additional risk populations (Centers for Disease Control and Prevention CDC, 2020)
Oral sex in the past 3 months Condom use at last oral sex Ever had anal sex sexually transmitted infections (STI)/HIV testing behaviors Lifetime history of STI test Number of times tested for STI Lifetime history of HIV test Number of times tested for HIV
Youth with mental illness are at higher risk of negative sexual outcomes, but few interventions have been evaluated to reduce this risk
Summary
Participants eligible to volunteer were adolescent inpatients (ages 13–17 years) recruited from a large, urban county psychiatric center between September and December 2020. Based on age and diagnosis, the unit admitted n = 99 eligible patients during the study period. Clinic staff invited participants using a convenience sample (n = 63), based on presence at time of admission as well as if youth would remain on the unit through the days of module administration. Staff excluded patients whose primary language was not English (n = 5), who carried a diagnosis of moderate to severe intellectual disability (n = 1), or who were too psychotic, disorganized, or combative/aggressive to participate in group activities on the inpatient unit (n = 2). Due to changes in hospital procedures during the COVID-19 pandemic, we adapted study protocols to adhere to appropriate guidelines outlined by the CDC and our partner unit
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