Be Yourself" Educational Intervention With Web Page and Chatbot to Promote Self-determined Motivation and Prevent Teenage Pregnancy: Pilot Trial.
Phase: NA
Conditions: Prevenir el Embarazo Adolescente
Sponsor: Universidad Autonoma de Nuevo Leon

1 
 
 
 
 
 
 
 
 
 
 
 
 
 
"Be yourself", educational intervention with 
chatbot to promote self-determined motivation 
and prevent adolescent pregnancy: pilot trial 
protocol 
 
 
 
 
 
 
 
 
 
 
 
 
 
January 6, 2025 
 
 
 
 
 

2 
 
 
ABSTRACT 
Introduction: Adolescent pregnancy and early initiation of sexual activity is a serious global public health 
problem, every year, around sixteen million adolescents between 15 and 19 years of age give birth, 
representing 11% of all births globally. Objective: To design a protocol of a pilot Randomized Controlled 
Trial to evaluate the preliminary efficacy of the "Be Yourself" intervention to increase self-determined 
motivation to prevent pregnancy in adolescents in secondary education. Methods: The protocol was 
developed based on the Protocol Items: ecommendations for Interventional Trials 2013 (SPIRIT2013) 
Statement, in the City of Monterrey, Nuevo León, Mexico in 2023. Results: The protocol outlined the 
design of the intervention, structured the content of the sessions using a logic model of intervention, and 
developed manuals for program facilitators and guides for participants. In addition, a website and a chatbot 
with Artificial Intelligence were developed, and the strategy for the application of the evaluation instruments 
was established.  
Keywords: Self-determination; Teenage Pregnancy; Sexual behaviour; Prevention; Randomized controlled 
trial.  
INTRODUCTION 
Adolescent pregnancy continues to be a serious public health problem globally, affecting millions 
of young people every year. The World Health Organization (WHO) and the United Nations 
Population Fund (UNFPA) report that approximately sixteen million adolescents aged 15 to 19 
give birth annually, accounting for 11% of all births. In addition, one in twenty adolescents 
contracts sexually transmitted infections (STIs) and 3.4 million children under 15 years of age live 
with Human Immunodeficiency Virus (HIV)1,2,3. In Mexico, the rate of teenage pregnancies is the 
highest in the world, with more than 90% of new STIs in young women and a notable difference 
in the fertility rate between rural (2.8) and urban (2.01) areas, where 31.2% of young people under 
18 years of age in rural areas are already mothers.  compared to 18.3% in urban areas4,5,6. 
The literature reports that some reasons for risky sexual behaviors at this stage are ignorance of the 
use of contraceptive methods and how STIs are transmitted; lack of communication about sexual 
issues with parents, friends, and partners; lack of confidence in the proper use of condoms; and 
lack of sexual autonomy7,8. Different authors indicate that these reasons lead adolescents to some 
high-risk sexual behaviors, such as the early initiation of sexual relations and sexual relations 
without using a condom, so that at this stage the risk of unwanted pregnancies and STIs increases 
1,9. 
Secondary sexual education remains essential to improving adolescent sexual health, as most 
adolescents attend school, and parents support its inclusion in the curriculum. However, many 

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adolescent pregnancy prevention programs, created decades ago, address only a limited range of 
risky behaviors. To increase effectiveness, technology has been integrated into these programs, 
although evaluations have not always demonstrated the specific impact of these technological 
components. In addition, it has been noted that programmes that rely solely on in-person education 
may not be in line with young people's current communication preferences10,11. 
Recent studies have evaluated technological adaptations in sexual and reproductive health 
programs, finding that access to websites, apps, and text messages may be promising, although 
more evaluation is required. Systematic reviews and meta-analyses have comprehensively 
analyzed interventions to reduce risky sexual behaviors in adolescents, highlighting the importance 
of psychological approaches based on theories such as Social Cognitive Theory, Planned Behavior 
Theory, Reasoned Action Theory, and Self-Determination Theory. While most reviews have 
focused on HIV and STI prevention, some have also addressed pregnancy prevention, often 
integrating both aspects into their approaches11,12. 
Global evidence indicates that psychological interventions can be effective in reducing risky sexual 
behaviors and preventing unwanted pregnancies. Adolescent sexual and reproductive health is 
therefore a national priority. In this context, Rodríguez's Self-Determination Model for Sexual 
Behavior for the Prevention of Pregnancy in Adolescence (MACSPEA)13 has proven to be useful 
in explaining and predicting pregnancy prevention behaviors, considering personal factors such as 
age, the beginning of sexual life and knowledge about prevention, as well as contextual factors 
such as sexual communication with parents, friends and partner. In addition, the model includes 
psychological factors such as intrinsic goals, satisfaction and frustration of basic psychological 
needs, and self-determined motivation14,15,16. 
For all the above, an educational intervention was developed based on the MACSPEA model, the 
six steps of Bartholomew's intervention mapping17 and the stages of the Transtheoretical Model 
of Change (MTTC) proposed by Prochaska and DiClemente18, in addition to a website that uses 
artificial intelligence (AI) through a chatbot as a delivery method. This intervention is aimed at 
adolescents aged 12 to 15 years, with the aim of evaluating the preliminary efficacy of the 
intervention called "Be yourself" to increase self-determined motivation and prevent pregnancies 
in secondary school adolescents.   
 
 
 

4 
 
MATERIAL AND METHODS  
Studio Design 
A randomized controlled pilot trial protocol has been developed following the guidelines of the 
Declaration SPIRIT19 2013 and CONSORT20 criteria, which provides a checklist to ensure quality 
and completeness in the development of protocols. This protocol corresponds to a randomized 
controlled pilot trial (RCT) with a pretest-posttest design, which will include a control group (CG) 
and an experimental group (EG) (Table 1). 
Table 1. Outline of the design of the Pilot RCT 
Participants 
 
Assigned 
Group 
Measurement   
Application 
Measurement 
1 
Measurement 
2 
Teens 
 12 to 15 years 
 
 
GE-1 
Before 
Intervention 
"Be yourself" 
At the end 
3 months 
 
 
 
 
 
 
 
GC- 2 
Before 
Habitual 
At the end 
3 months 
  
Population Characteristics and Eligibility Criteria  
The target population of the "Be Yourself" program are adolescents between 11 and 15 years old 
in secondary schools in Santa Catarina, Nuevo León. Eligibility criteria include being enrolled in 
a public school with access to a computer lab and internet, residing with your parents, and having 
become sexually active or not. The sample will be of 150 randomly selected participants. 
Participation will be assessed using a filter questionnaire, and adolescents will be required to 
register on the program's website throughout the intervention, with the option to withdraw at any 
time. 
Sample size  
To determine the sample size, the nQuery Advisor statistical package will be used. The aim is to 
have 150 participants, of which 75 will belong to the CG and 75 to the EG, applying a simple 
random probability sampling. The sample will be calculated with an error level of .05, a power of 
90%, a moderate effect size of .3, considering a loss of 20%. 
Design of the Intervention "Be yourself" 
The "Be Yourself" educational intervention was designed to prevent sexual risk in high school 
adolescents through self-determined motivation. Based on MACSPEA, the model of stages of 
change and competency-based learning uses a website (https://www.s-t-mismo.com/) and a chatbot 
for monitoring and activities (Table 2). The intervention consists of three sessions that address the 
prevention of adolescent pregnancy and the strengthening of skills. It includes hands-on activities, 

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role-plays, and interactive sessions on contraceptive methods, effective communication, and 
informed decision-making. To do this, specialized human resources and specific materials are 
required for its execution. Manuals were designed for the intervention and training of the facilitator, 
and activity guides for adolescents21,14-18. 
Table 2.  Summary of the content of each session and components of the intervention 
Thematic content 
Time  
Components of the intervention  
Pre-test assessment app 
40 min 
Access to the "Be Yourself" page  
First Session 
1. What is self-determined motivation?: 
Discovering our dreams 
60 min 
Personal factors  
1. Sex 
2. Age of onset of sexual life  
3. Pregnancy Prevention 
Knowledge 
 
1. My Body: Anatomy, Physiology, and 
Sexual Health. 
60 min 
2. Navigating relationships: preventing 
unplanned pregnancy in adolescents. 
60 min 
Second Session 
3. Exploring Goals and Values to Prevent 
Unintended Pregnancies  
60 min  
Contextual factors 
1. Sexual communication with 
parents 
2. Sexual communication with 
friends 
3. Sexual communication with a 
partner 
 
4. Be yourself: stop, think and act; 
Introduction to Troubleshooting 
60 min 
5. Role-play: open dialogue about sexuality 
60 min 
Third Session 
6. Navigating the Sea of Healthy Choices: 
Exploring Our Motivation 
60 min 
Psychological factors 
1. Intrinsic and extrinsic motivation 
2. Satisfaction and frustration: 
autonomy, relationships and 
skills  
3. Self-determined motivation, 
4. Behavioral Intent and Sexual 
Prevention Behavior  
7. My Space, My Decisions Exploring Our 
Needs 
60 min 
8. Negotiating Healthy Choices: Preventing 
Pregnancy and STIs 
60 min 
Keep
i
i
9. Building Self-Determined Motivation in 
Teens: Strengthening Session on Website 
and Chatbot 
Continued 
individual  
Post-test assessment app 
40 min 
Access to the "Be Yourself" page 
Total, hours  
10 hours 20 minutes more 
 
Description of the control treatment 
For the GC, two theoretical sessions are planned. In the first, an orientation on sexual health for 
adolescents will be offered through a one-hour PowerPoint presentation. Topics of anatomy, 
physiology, biological changes in adolescence and contraceptive methods will be addressed, 
highlighting their appropriate use and the prevention of teenage pregnancy. In the second session, 
also one hour, sexual health self-care skills will be developed, discussing the importance of self-
care, self-respect, and informed decision-making. There will be a Q&A session to address concerns 
and reflect on how self-care contributes to a healthy and safe sex life. 

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Control measures  
Randomization of participants  
Participants will be thoroughly selected to represent the EG. Software will perform a simple, 
blinded randomization, assigning participants to control or experimental groups. Managers will be 
informed about the "Be Yourself" sessions, the dates and locations of which will be published on 
the website and communicated verbally. The sessions will be group, with individual activities on 
the website and through a chatbot. 
Recruitment  
Recruitment for the intervention will take place in February 2025, after the authorization of the 
educational authorities. Adolescents from the educational institution will be openly invited and 
their suitability will be evaluated according to inclusion criteria. Those selected will be recorded 
and assigned to control and experimental groups using an ID to ensure data integrity. 
With informed consent, participants will access the website and the chatbot for information and 
registration. After accepting, they will answer filter questions and receive a detailed explanation of 
the process. Those who do not qualify will receive a transparent explanation. 
On the website, participants will record their personal data for effective communication and 
reminders. They will be informed about the royalties of the program at the end of the project, 
motivating them to participate in all activities. The information will be stored securely for one year. 
Measurements and data collection 
Data collection for the study will include the use of a specifically designed Personal Data Card, 
which will collect information about the sexuality, marital status, and education of the participants. 
A variety of scales will be used to measure aspects related to adolescent sexual health and behavior. 
The Sexual and Reproductive Health Knowledge Scale, Cronbach's alpha between .77 and .8121, 
will assess knowledge in these areas, while the Sexual Issues Communication Instrument, 
Cronbach's alpha from .89 to .95, will analyze sexual communication between parents, friends, and 
partners22. The Aspirations Index, alpha greater than .78 and .94, will measure life goals, and the 
Basic Psychological Needs Satisfaction and Frustration Scale will have alphas of .90 and .8623. 
The Behavior Regulation Questionnaire, adapted to the Mexican context, will assess behavior 
regulation to prevent pregnancy, with alphas between .66 and .9324. Likewise, the Sexual Activity 
Intention Scale and the Sexual Activity Scale will assess sexual intentions and behaviors, 
respectively, with alphas from .83 to .88 and .74 to .8625. The Sexual and Reproductive Health 

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Practices Scale, which examines pregnancy prevention behavior, with alphas of .92, .77, .81 and 
.87 in its different adaptations26. 
The "Scale for the Assessment of Change on Sexual Behavior in Adolescents"27 will be adapted 
and validated, ensuring its reliability. To assess the acceptability and feasibility of the "Be 
Yourself" intervention, aspects such as participant satisfaction, meeting expectations, and 
facilitator quality will be analyzed, along with participant recruitment, screening, randomization, 
and retention procedures. 
Participant Retention Plan and Follow-Up 
The retention plan for the "Be yourself" intervention includes the delivery of T-shirts and caps 
with the logo of the program at the end, weekly sessions to avoid information saturation and a 
three-month follow-up. Data collection will be done through the website using digital tools to 
assess the effectiveness and acceptability of the program. The fidelity of the intervention will be 
ensured by training the principal investigator in self-determination theory and developing 
supporting manuals and guides. Figure 1 presents diagram CONSORT20, which details the 
eligibility criteria, intervention, and evaluation of sessions before, after, and during follow-up at 
three months. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Figure 1. CONSORT diagram of the "Be yourself" intervention 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ethical considerations  
Identification 
Secondary evaluation  
First evaluation  
Pre-test evaluation  
Application of 10 instruments 
Second evaluation  
Post-Est Evaluation 
Application of 10 instruments 
 
Randomization  
Pilot Test 
Evaluation of intervention sessions, 
manual design, session content,  
Pretest and Posttest Application  
 
Eligible Participants 
Ineligible Participants 
 
Intervention Group  
"Be Yourself" Program  
(n=75) 
3 sessions/3 weeks  
First evaluation  
Pre-test evaluation  
Application of 10 instruments 
Second evaluation  
Post-Est Evaluation 
Application of 10 instruments 
1 instrument for assessing the acceptability 
of the intervention. 
Follow-up evaluation  
3 months post-procedure 
Verification of participant eligibility criteria  
Eligibility  
Allocation  
Primary Assessment  
Identifying Potential Participating Schools 
Identification of potential participants in each school 
Eligible participants who refuse 
to participate in the study  
 
Control group  
Regular sexual health briefings  
(n=75) 
2 sessions/ 2 weeks  
 
Eligible Participants Who Agree to 
Participate 
Presentation of the study and 
signing of the informed consent  

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This study complies with the ethical regulations of the Regulations of the General Health Law, 
ensuring respect for the dignity and rights of the participants. The protocol has been approved by 
the Ethics and Research Committee of the Faculty of Nursing of the Autonomous University of 
Nuevo León, with registration number FAEN-D-2021. Informed consent will be obtained from the 
parents and assent from the adolescents. Participation will be explained in detail to parents and 
teens, including risks and benefits. The research will be suspended if there is a risk to the health of 
the participants or if they wish to withdraw 28. 
Data analysis plan  
The research will use statistical software SPSS version 26.0 for data processing. The analysis will 
begin with the Kolmogorov-Smirnov test to evaluate the distribution of the data and determine the 
suitability of applying parametric or nonparametric tests. The statistical analysis will include a 
descriptive level, using percentages, means, and standard deviation, to assess feasibility and 
acceptability. For hypotheses, inferential tests such as paired  sample t-test, ANOVA, and Mann-
Whitney U will be used to examine knowledge about pregnancy prevention, sexual 
communication, motivation, satisfaction of psychological needs, sexual intention, pregnancy 
prevention behavior, and stages of change in sexual behavior29. 
Table 3 describes the objectives and hypotheses proposed in this study, both descriptive and 
inferential statistics will be used 
Table 3. Statistical analysis by objective and/or hypothesis  
Objective  
Analysis 
Statistical 
1.- Examining feasibility  
Descriptive 
Measures of frequency, central tendency, 
and dispersion: percentages, means, 
ranges, Standard Deviation, confidence 
intervals, recruitment and retention rates. 
2.- Analyze acceptability  
Descriptive 
Percentages, means, ranges, Standard 
Deviation, confidence intervals, 
recruitment and retention rates 
Hypothesis 
Analysis  
Statistical  
3.- Hypothesized results:  
  
 
 
 
̵ 
H 1. Knowledge about Pregnancy Prevention 
Inferential 
t-test of paired or ANOVA samples 
Test de Friedman  
Test de Wilcoxon 
U de Mann-Whitney 
 
̵ 
H 2. Sexual Communication Parent, Friends 
& Partner. 
̵ 
H 3. Intrinsic and extrinsic motivation 
̵ 
H 4. Satisfactory and Frustration of NPBs 
(autonomy, relationship and competencies) 
̵ 
H 5. Self-Determined Motivation 
̵ 
H 6. Intention in Sexual Activity  
̵ 
H 7. Pregnancy Prevention Sexual Behavior 
̵ 
H 8. Stages of Change for Sexual Behavior 
 
 
 

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EXPECTED RESULTS  
The protocol of the "Be Yourself" intervention includes the structural design of the sessions, the 
development of two facilitator manuals and a participant workbook, and the creation of a web page 
with a chatbot based on OpenAI's GPT. The intervention is expected to increase adolescents' self-
determination to abstain from sexual activity, improve their positive attitude toward sexuality, and 
expand their knowledge about pregnancy prevention. In addition, a greater adoption of preventive 
behaviors is anticipated compared to those who do not participate, which would suggest a positive 
impact on sexual decision-making. 
FINANCING 
This project did not receive any funding  
DECLARATION OF CONFLICTS OF INTEREST 
The author declares that they have no conflict of interest 
 
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14 
 
Logical Model of the "Be Yourself" Intervention 
 
Problem  
 
Self-determined motivation for adolescent pregnancy prevention. 
 
Meta  
 
That adolescents achieve the stage of action and maintenance of self-determined motivation to prevent 
adolescent pregnancy. 
 
Justificatio
n  
 
Situation-Specific Theory of Self-Determined Motivation for the Prevention of Pregnancy, Transtheoretical 
Model of Change (Prochaska and Di Clemente) and the Competency-Based Learning Model (Herreras, 
1970) 
 
Assumptions                          
 
Entrance 
 
Outputs 
 
Results 
 
Resources  
 
Activities 
Outputs  
 
 
a. 
Adolescents in the precontemplation stage  
may not recognize themselves at risk for 
pregnancy if they lack awareness of the 
associated consequences and risks. 
b. 
If teens don't have enough knowledge about 
pregnancy prevention, condom use, and 
birth control, they're likely to stay in the 
contemplation stage. 
c. 
A lack of self-determined motivation 
toward abstinence and condom use can 
hinder adolescents' transition to the 
preparation stage . 
d. 
A lack of sexual communication with 
parents, friends, and partners can make it 
difficult for teens to move into the action 
stage, 
where 
they 
are 
expected 
to 
implement changes in sexual behavior and 
behavior. 
e. 
Lack of sexual autonomy, inability to 
negotiate condom use, and abstinence may 
be factors influencing adolescents' ability 
to sustain positive changes in sexual 
behavior and behavior. 
f. 
Adolescents are more likely to change their 
sexual behavior and behavior if the 
intervention and prevention messages are 
personalized, affectionate and supportive. 
g. 
Maintaining an effective self-determined 
motivation based on learning is essential 
 
 
 
 
 
 
 
 
Human: 
Researcher, 
research assistant 
Financial: 
Operating budget 
for the production 
of the material. 
Space: Computer 
room of the 
educational 
institution  
Materials: didactic 
and recreational 
materials for the 
intervention. 
Access to the web 
platform 
Interactive digital 
educational 
material. 
Technical support to 
solve possible 
problems. 
 
 
 
Session 1: Getting to know 
yourself, steps to achieve 
your "Be Yourself" goals 
Knowledge and awareness  
1. What is Self-Determined 
Motivation?: Discovering 
Our Dreams 
2. My Body: Anatomy, 
Physiology and Sexual 
Health. 
Problem solving, 
negotiation. 
3. Navigating Relationships: 
Preventing Unwanted Teen 
Pregnancy. 
Session 2: Building Personal 
Commitments: Conduct, 
Behavior, and Sexual 
Communication  
1. Exploring Goals and 
Values to Prevent 
Unintended Pregnancies  
2. Be yourself: stop, think 
and act; Introduction to 
Troubleshooting  
3. Role-Play: Open Dialogue 
on Sexuality 
Session 3: Empowerment 
and Concrete Actions: 
1. "Be Yourself" 
faithfully 
implemented.  
2. Videos viewed on 
web platform 
3. Participants 
discuss condom 
use and 
negotiation  
4. There is a 
discussion about 
abstinence and 
prevention of 
pregnancy  
5. Negotiation and 
rejection skills 
are practiced 
through role 
plays. 
6. Acquired 
problem skills. 
7. Self-confidence 
in decision-
making 
̵ Practice sexual 
communication  
 
Primary  
1. Increase in Self-Determined 
Motivation Indices to Prevent 
Adolescent Pregnancy (H5). 
2. Increased Level of Knowledge about 
Pregnancy Prevention (H1). 
3. Improved Communication on Sexual 
Issues (H2. 
4. Change in Life Goals (H3): Significant 
increase in orientation toward intrinsic 
life goals (such as personal and 
academic development). 
5. Satisfaction of Basic Psychological 
Needs: autonomy, relationships and 
competence. (H4). 
Secondarys  
1. Intention to Risk and Protect (H6): 
Significant decrease in intention to risk 
(such as willingness to have 
unprotected sex) and significant 
increase in intention to protect (such as 
use of contraception and protection 
against STIs). 
2. Frequency of Nonsexual Sexual and 
Affection Behaviors (H7): Significant 
decrease in the frequency of risky 
sexual behaviors and increase in the 
frequency of nonsexual affection 
 
 
 

15 
 
 
 
 
 
 
for the consolidation of change in the 
sexual 
conduct 
and 
behavior 
of 
adolescents. 
h. 
Believing in themselves and their abilities, 
feeling valued, and having opportunities to 
practice skills with the support of parents, 
friends, and partners are key factors in 
preventing relapses of risky sexual 
behaviors and behaviors. 
improving negotiation and 
rejection skills 
1. Navigating the Sea of 
Healthy Choices: Exploring 
Our Motivation. 
2. My space, my decisions 
exploring our needs. 
3. Negotiating Healthy 
Choices: Preventing 
Pregnancy and STIs 
behaviors (such as holding hands and 
kissing on the mouth). 
3. Highly preventive behavior with 
favorable attitudes and behaviors 
toward pregnancy prevention (H8) 
1. Intention and Willingness to Change 
Sexual Behavior in the Next Three 
Months (H9) 
 
 
Products 
Session 1: Getting to know yourself, steps to achieve your "Be Yourself" goals (Knowledge and awareness) 
1. 
The adolescent becomes aware of pregnancy prevention and what is involved in increased knowledge of the risks associated with sexual activity, as well as an 
understanding of the importance of family planning and the prevention of unintended pregnancy.  
2. 
Detailed knowledge about the correct use of condoms and awareness of their importance in protecting against STIs are key results in promoting sexual health. 
3. 
Improved negotiation skills are reflected in an increased ability to communicate and reach agreements, accompanied by the development of empathic skills and a 
broader understanding of others' perspectives. 
Session 2: Building Personal Commitments: Conduct, Behavior, and Sexual Communication  
1. 
Exploring Goals and Values: Teens identify personal goals and strategies to prevent pregnancy through hands-on exercises and role-playing. 
2. 
Problem-solving: Communication skills and informed decision-making are developed in relationships, focusing on values and limits. 
3. 
Role play: Open communication about sexuality is practiced with parents, friends and partners, evaluating progress and challenges. 
Session 3: Empowerment and Concrete Actions: improving negotiation and rejection skills 
1. Teens will create a "Negotiation and Rejection Skills Guide." This guide would include specific strategies learned during the session, practical tips for coping with 
challenging situations in preventing unintended pregnancy. 
2. Adolescents participate in the "Motivational Campaign on Sexual Health", promoting the importance of personal empowerment, informed decision-making and 
self-motivation on issues related to sexual health. This campaign could include inspirational messages, testimonials, and helpful resources to foster self-
determination among peers. 
3. "Interactive Simulation with Chatbot", which simulates situations of negotiation and rejection in the context of sexual relations and prevention of unplanned 
pregnancy, allows adolescents to practice and reinforce the skills learned, providing instant feedback on their choices and decisions.