Department of Pediatrics, University of California San Francisco, CA, USA.
Department of Pediatrics, University of California San Francisco, CA, USA.
Contraception. 2021 Sep;104(3):246-253. doi: 10.1016/j.contraception.2021.03.004. Epub 2021 Mar 17.
To evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit quality, and app satisfaction.
This study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents' contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models.
A total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users' demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38-2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04-10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70-18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality.
While data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls.
Despite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers.
评估 Health-E You/Salud iTu 移动健康应用程序（app）在增加拉丁裔青少年知识、自我效能感和避孕措施使用方面的有效性，评估其对就诊质量和应用程序满意度的影响。
本研究采用 18 个学校保健中心（SBHC）的整群随机对照试验（CRCT）。在就诊前，干预组参与者接受了以患者为中心的避孕决策支持应用程序，对照组则在 iPad 上回答性健康问题。参与者在就诊前完成了一份调查问卷，并在就诊后 48 小时、3 个月和 6 个月进行了 3 次随访调查（其中干预组参与者完成了应用程序）。采用广义混合效应回归模型评估青少年在 6 个月随访期间避孕知识、自我效能和使用情况的差异。
共有 1360 名拉丁裔青少年参与了研究；57.2%的人对 48 小时的调查做出了回应，50.1%对 3 个月的调查做出了回应，49.7%对 6 个月的调查做出了回应，42.3%对 3 个月和 6 个月的调查都做出了回应。Health-E You 用户在知识方面表现出显著的前后差异（p<0.001）。完成随访调查的干预组参与者报告说，他们的自我效能感从基线到 6 个月时（23.2 名干预者对 22.5 名对照组）显著提高（b=1.58，95%CI 0.38-2.77，p=0.01），并且在 3 个月到 6 个月时（26.1 对 23.4；b=1.58，95%CI 0.38-2.77，p=0.01）和 6 个月时（26.1 对 23.4；b=1.58，95%CI 0.38-2.77，p=0.01），非障碍性避孕措施的使用也有所增加。从基线到 3 个月时（63%对 45%；OR=3.29，95%CI 1.04-10.36，p=0.04）和 6 个月时（63%对 44%；OR=5.54，95%CI 1.70-18.06，p=0.005），干预组参与者的非障碍性避孕措施使用率更高。提供者和青少年报告了对应用程序的高度满意度，并表示应用程序提高了就诊质量。
尽管数据表明 Health-E You 改善了结果，但这些发现必须谨慎解释。与对照组相比，干预组参与者在就诊前的性活动率更高，因妊娠测试、紧急避孕或节育而就诊的次数更多，完成随访调查的比例更低。
尽管美国青少年怀孕率有所下降，但与白人女性相比，拉丁裔青少年的怀孕率仍然过高。Health-E You 应用程序可能是 SBHC 中青少年和提供者的有效支持工具，也可能是美国其他临床环境中的有效工具，它可以增加避孕措施的使用，从而减少意外怀孕，有可能减少青少年怀孕的差异，并为客户及其提供者创造更高效的就诊时间。
