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You Geaux Girl!, A randomized control trial of an Internet-based

pregnancy prevention intervention for young African American women

Jakevia L. Green Tulane University

Department of Epidemiology

Sixth Annual Conference on Youth + Tech + Health

April 7,8 & 9, 2013 San Francisco, CA

Background

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Unintended Teen Pregnancy • UTP in the US has significantly declined among youths

in their early teens, but has continued to remain high among older teens – One-half to two-thirds of teen pregnancies are to teens 18-201

• 2005:

– Pregnancy rate among African American teens 15-19 2: 123 per 1000 compared to 43 per 1000 for non-Hispanic white teens 15-19

• Half of UTPs occur among contraception users, resulting

from either inconsistent or incorrect use.3

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Louisiana State Data4 • 2005:

– Pregnancy rate among 18-19 year old teens: 118 per 1000 vs. national teen birth rate of 53.9 births per 1000

• 2008:

– 28% of teens 16-19 years-old live in poverty – 11% of teens 16-19 years-old not in school – 10% of teens 16-19 years-old dropped out of

school

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Problem • Most prevention programs are school-based and

implemented at younger ages – Older teens who may no longer be in school have little

to no access to such programing

• Competing priorities among older teens transitioning to adulthood – Need for innovative approaches to administer health

information to even the busiest individual

Translating SiHLE to e-SiHLE

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Goal & Aims • To reduce unintended pregnancy (UTP) among older

teenage African American women in the Greater New Orleans area

1. To adapt EBI SiHLE for delivery via the internet

2. To test the feasibility and acceptability of the internet-based intervention

in AA teen women 18-19years • completion rate of 80% or greater of modules by the end of the study

3. To test the hypothesis that women who receive the intervention will have

a 35% increase in their use of effective contraception compared to attention controls

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From SiHLE to e-SIHLE • SiHLE (Sisters Informing, Healing, Living, and Empowering)

– HIV/STI EBI developed by DiClemente Wingood of Emory University5 – Target audience: AA teens,14-18 yrs – 4-module curriculum given in four, 4-hour interactive group sessions – Administered in a randomized controlled trial (RCT) alongside a general health program

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From SiHLE to e-SIHLE • e-SiHLE

– Worked with creators of SiHLE and used the ADAPT-ITT model to translate • ADAPT-ITT is a guide to translate an evidence-based

intervention into a new intervention with a new sample, for a new setting, or using a new implementation format6

– Target audience: AA teens,18-19 years

– Self-paced 8-module curriculum in 4 week period

– Administered in a randomized controlled trial (RCT) alongside a general health promotion program

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Innovation of e-SiHLE

•Web-based delivery affords youth the freedom to access this valuable health information when convenient for them

•Could provide a model for UTP programs that could be conveniently disseminated to organizations nation-wide

Curriculum Development & Formative Research

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Curriculum Development • The intervention:

– Main focus is reproductive health and contraceptive options

– Relevant SiHLE modules and activities translated to electronic medium

– New content was developed that focused on contraceptive choices and STIs

• The control: – A nutrition and wellness attention control – Similar in length and appearance to the reproductive

health intervention.

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Formative Research • Formative work to identify key elements of

intervention development

– Worked with SiHLE developers and their staff

– Formed a Community Advisory Panel (CAP) • African American women provided feedback regarding

recruitment strategies, intervention content and design, motivation for participation and retention in the study, and more

• Research on electronic delivery options, website development, video/audio production, etc

Curriculum/Production • Content would be delivered through the stories of 4

young women – Diversity of characters (physical and situational) – Each facing specific reproductive health challenges – Addition of a moderator – a slightly older woman who could

provide information from an objective viewpoint

• Once curriculum was outlined scripts had to be created for each of the actors

• Production teams were assembled

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Production • Local production companies

provided video/audio services

• Local graphic artist created logos with CAP

• Local actors and actresses portray relatable characters who work through true-to-life circumstances

• Website developers used by the University created sites

Pilot Testing

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Pilot Testing • 13 AA women were recruited to pilot-test both

the intervention and control websites prior to launch of the RCT – 7 BUtiful; 6 DIVAS – Allotted one month to engage in their respective websites – Asked to provide qualitative feedback of their experiences in a

follow-up interview • Feedback was used to complete final edits of the websites before

publishing to the Internet

“You Geaux Girl!,” a randomized control trial

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“You Geaux Girl!” • Marketing alias for e-SiHLE

– Used to mask the names of the intervention and control websites pre-randomization

• Promoted as a health education and empowerment program for African American teen women

YGG!

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Inclusion Criteria • African American female • Aged 18 or 19 years • Resides in Jefferson or Orleans Parish • Not currently pregnant or intending to become

pregnant within the next year • Not a woman who has sex exclusively with

women (WSW) • Speaks and reads English • Has access to a computer with internet access

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Recruitment • Sample size: 700 • 5 ‘sites’:

– 2 historically Black universities – A community college – An adolescent drop-in clinic – Community events

• Active and Passive recruitment • Phase-In Model

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Enrollment • Informed consent

• Obtain participant contact information

• Biological testing (urine) – Pregnancy, Chlamydia/Gonorrhea

• Surveys: ACASI [Audio Computer-Assisted Self Interview] – Demographics – Contraception and sexual behaviors – Psychosocial scales

• Randomization – Butiful [Intervention] – DIVAS [Control]

Intervention: BUtiful Be yoU!, Talented, Informed,

Fearless, Uncompromised and Loved

Control: DIVAS Diversity, Individuality, Vitality,

Activity, and Strong

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Intervention Period • 28 days of site access

– Reminders of deactivation at 2 weeks, 1 week, and 1 day prior

• Staff monitoring: – Session progress – Time spent on each session – # of activities engaged in + time spent on

activities – Blogging feature/Shares

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Follow - Up • 3, 6 and 12 months post intervention • Obtain updated participant contact • Surveys • Biological testing

– Pregnancy, Ct/GC

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Incentives $50

+ Swag Bag

$25 + up to

$40 $75 $75 $265

• Baseline: $50 gift card + BUtiful or DIVAS Swag Bag

• 3-Month Follow-Up: $25 gift card + Incentives earned from session completion

• 6-Month Follow-Up: $75 gift card

• 12-Month Follow-Up: $75 gift card

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Summary of Study Period Baseline

28-day Intervention Period

3-Month Follow-Up

6-Month Follow-Up

12-Month Follow-Up

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Communication • Bi-Weekly ‘Fun Fact’ Text Messages • Birthday Cards • Quarterly Newsletter • Weekly posts on Facebook pages created

for program graduates – “We R Butiful” – “We R DIVAS”

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Lessons Learned • Formative research is extremely important.

– Understanding your target audience – Finding out how best to adapt and revise your intervention to

meet the needs of your target audience

• Flexibility and creativity is key. – Recruitment strategies – Working with the often limited availability of this age group

• An e-intervention is by no means a ‘hands-off’ endeavor.

• Session completion: all at once vs. pacing

• Field staff must appeal to target audience.

What’s happening with YGG! now?

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Final Remarks • Methods used for translating an EBI to the

Internet are transferable to other projects • An internet-delivered sexual health intervention

1. presents info in a familiar, easily accessible medium 2. empowers young women with decision-making tools

and strategies for obtaining and adhering to contraceptive choices

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References 1. Guttmacher Institute, U.S. Teenage Pregnancy Statistics: National and State

Trends and Trends by Race and Ethnicity. . 2006, Guttmacher Institute: New York.

2. Kost, K., Henshaw, S., & Carlin, L. , U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity. . 2010, Guttmacher: New York.

3. Mosher, W.D., et al., Use of contraception and use of family planning services in the United States: 1982-2002. Advance Data, 2004(350): p. 1-36.

4. Foundation, T.A.E.C., Kids Count 2008 data book 2008, The Annie E. Casey Foundation Baltimore.

5. DiClemente RJ, Wingood GM, Harrington KF, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. Jama. Jul 14 2004;292(2):171-179.

6. Wingood GM, DiClemente RJ. The ADAPT-ITT model: a novel method of adapting evidence-based HIV Interventions. J Acquir Immune Defic Syndr. Mar 1 2008;47 Suppl 1:S40-46.

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You Geaux Girl! Research Team Patricia Kissinger, PhD.

Co-Principal Investigator

Caroline Johnson, PhD. Co-Principal Investigator

Aubrey Madkour, PhD. Evaluator

Gretchen Clum, PhD. Evaluator

Ralph DiClemente, PhD. Consultant

Gina Wingood, PhD. Consultant

Norine Schmidt, MPH Program Manager

Jakevia Green

Program Coordinator Jen Latimer, MPH

Field Research Analyst

Upama Aktaruzzaman Research Assistant

Emily Flanigan Research Assistant

Braeanna Hillman Research Assistant

Yewande Olugbade Research Assistant

YGG!

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Funding Agency •DHHS Office of Adolescent Health TPP program

– Large federal initiative – $105 million to support evidence-based TPP approaches – Addresses rising teen pregnancy rates

• supporting grantees in replicating evidence-based models • implementation of programs to develop and test additional models

and innovative strategies •5-year grant for Innovative Approaches in Teen Pregnancy Prevention (TPP)

– 9/1/10 through 8/31/15

Thank You