Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York.
Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York.
J Adolesc Health. 2021 Apr;68(4):705-712. doi: 10.1016/j.jadohealth.2020.07.020. Epub 2020 Sep 15.
Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]).
We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation).
We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35).
Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.
寻求急诊部（ED）护理的女性青少年怀孕的风险很高，主要是因为没有使用避孕措施；然而，当被转介到生殖护理部门时，很少有 ED 患者进行随访。本队列研究的目的是确定基于个人和互动的 ED 妊娠预防移动健康干预措施（改善青少年护理的急诊室干预措施[Erica 博士]）的可行性、可接受性、采用率、保真度和潜在疗效。
我们进行了一项前瞻性队列研究，纳入了年龄在 14-19 岁之间、未使用高效避孕措施的有性行为的女性 ED 患者。Erica 博士由一个基于循证性性健康课程、社会认知理论和动机访谈技术的 10 周自动双向短信干预措施组成。在 12 周时，我们通过在线调查和电话随访来衡量可行性、可接受性、采用率、保真度和初步疗效数据（避孕措施的开始）。
我们对 209 名女性 ED 患者进行了筛查以纳入 42 名患者。平均年龄为 17.5 岁（标准差±1.4）；大多数为西班牙裔（n=37，88%），并拥有初级保健提供者（n=40，95%）。有 1 名参与者选择退出（1/42，2%），共有 35 名参与者（83%）完成了随访。尽管随着时间的推移互动性有所下降，但 83%的参与者（42/42）回复了一条或多条短信。94%的参与者（29/31）喜欢这些信息，83%的参与者（25/30）会推荐该项目。46%的参与者（16/35）开始使用激素避孕药。
Erica 博士在女性青少年 ED 患者中是可行和可接受的，并且表现出了高度的保真度和采用率。该干预措施也显示出了在高危女性中增加高效避孕措施使用的潜力。
