Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA.
Department of Population and Family Health, Columbia Mailman School of Public Health and Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
Acad Emerg Med. 2022 Mar;29(3):308-316. doi: 10.1111/acem.14411. Epub 2021 Dec 7.
Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED.
We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome.
We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference [ARD] = 2.7%, 95% confidence interval [CI] = -12.4% to 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% [27/41]) than controls (30.0% [15/50]); ARD = 35.9%, 95% CI = 16.6% to 55.1%).
A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision making.
前往急诊部（ED）的青春期女性经常不使用避孕药具。我们旨在评估一款以用户为中心、基于理论的数字健康干预措施的实施结果和潜在效果，该干预措施旨在改善 ED 中青春期女性的性健康和生殖健康。
我们对 14 至 19 岁有性行为的女性 ED 患者进行了一项试点随机对照试验。参与者被随机分配到干预组 Dr. Erica（急诊室干预措施以改善青少年护理）或常规护理。Dr. Erica 由基于 ED 的数字干预措施以及 3 个月的个性化和互动多媒体消息组成。我们评估了 Dr. Erica 在青春期女性用户中的可行性、采用情况和保真度。高效避孕的启动是主要的疗效结果。
我们招募了 146 名患者；平均（±SD）年龄为 17.7（±1.27）岁，87%为西班牙裔。Dr. Erica 表现出可行性，同意率（84.4%）和随访率（82.9%）都很高。干预组的参与者认为 Dr. Erica 可以接受，非常喜欢（98.0%，Likert 量表）并推荐（83.7%）该项目。共有 87.5%的人采用了该程序，回复了至少一条短信；共点击了 289 个链接。Dr. Erica 表现出了保真度；只有少数参与者选择退出（6.9%），没有收到短信（1.4%）。在干预组中，有 24.6%（14/57）的人开始使用避孕措施，对照组为 21.9%（14/64）（绝对风险差异 [ARD] = 2.7%，95%置信区间 [CI] = -12.4%至 17.8%）。接受 Dr. Erica 的参与者比对照组更有可能选择一种未来开始使用的方法（65.9% [27/41] 比 30.0% [15/50]）；ARD = 35.9%，95%CI = 16.6%至 55.1%）。
个性化、互动式的数字干预措施是可行的，可以被女性 ED 患者接受，并表现出高度的保真度和采用率。这种基于 ED 的干预措施显示出改善避孕决策的潜力。
