Online Peer Influence on IUD Behaviors and Attitudes
Condition: Contraception
Study type: Interventional

Summary: 
      This study will look at women's social communication about IUDs (intrauterine devices) and
      their attitudes and behavior related to IUD use. The researchers will design an online
      community where women can talk to each other about their experiences with birth control. We
      will examine whether social exposure to IUD users in this setting is associated with change
      in attitudes and behavior among women who have never had an IUD.
    

Detailed description: 
      Study Design:

      University of Pennsylvania researchers will conduct a randomized controlled trial to examine
      whether there is an association between social exposure to women who use intrauterine
      contraception (IUC) as their method of birth control and change in IUC attitudes and behavior
      among women who have never used IUC. The intervention used to test this association will be
      an online social community, designed by the researchers, in which women will be invited to
      share their personal experiences with birth control methods they have used. Non-IUC user
      participants will be randomized to either the intervention or control conditions. The
      intervention condition will consist of small online social groups in which non-IUC user
      participants will interact with IUC user participants. The control condition will consist of
      online groups identical to intervention groups, except that no IUC user participants will be
      in these groups. Participants will interact within small groups for twelve days each. Non-IUC
      user participants will complete surveys before and after the twelve-day intervention that
      measure IUC attitudes and behavior. UCSF researchers will conduct analysis on deidentified
      data obtained from this study.

      Hypothesis:

      It is hypothesized that among women who have never used IUC, there is an association between
      social exposure to IUC users and change in attitudes and behavior related to IUC use. It is
      also hypothesized that exposure to IUC users is associated with positive change in knowledge
      of IUC use and efficacy and positive change in IUC-related information-seeking.

      Aims:

      The study has three aims:

      Aim 1: To determine whether exposure to IUC users in an online community is associated with
      change in women's attitudes and behavior related to IUC use.

      Aim 2: To determine whether an association between exposure to IUC users and change in
      women's IUC attitudes and behavior varies by women's race/ethnicity.

      Aim 3: To observe the content of women's interactions about IUC and other birth control
      methods in an online social community.

      Data analysis:

      In order to address Aim 1, we will first conduct univariate analysis and obtain descriptive
      statistics (including mean, median, mode, variance, and range) on demographic characteristics
      and IUC attitudes and behaviors among participants in the intervention and control groups. In
      bivariate analysis, we will use chi-square tests to examine the relationship between study
      condition and IUC-related behaviors, as measured on the post-survey. We will use t-tests to
      examine relationships between condition and post-survey IUC attitudes, and matched t-tests to
      examine the relationships between conditions and changes in IUC attitudes. If data on
      attitudes is not normally distributed, we will use the appropriate non-parametric tests
      instead of t-tests.

      We will conduct multivariate analyses for those outcomes associated with intervention
      condition in bivariate tests. Multivariate analysis for Aim 1 will include mixed-effects
      regression to examine associations at both the individual and cluster levels. We will use
      multiple linear regression for continuous outcomes and multiple logistic regression for
      binary outcomes. Regression models will test associations between intervention and control
      conditions and outcome IUC attitude and behavior variables. We will obtain regression
      coefficients from linear regression models and odds ratios from logistic regression models in
      order to describe the associations between study arms and outcomes.

      In order to address Aim 2, we will examine bivariate relationships between the racial/ethnic
      categories of participants and outcome attitude and behavior variables, using chi-square
      tests for binary outcomes and t-tests or appropriate non-parametric tests for continuous
      outcomes. We will use multiple linear and/or logistic regression to test possible
      associations between race/ethnicity and outcome variables, controlling for other background
      variables. Resulting regression coefficients and odds ratios will describe whether the effect
      of the intervention was greater for women in some racial/ethnic groups as compared to others.

      In order to address Aim 3, we will perform qualitative analysis of conversations that take
      place among group members in the online social groups, using grounded theory methodology. We
      will examine qualitative data from both the intervention and control groups.

      Privacy:

      Recruitment and participation in the study will occur online. Participants will only interact
      with the study from remote locations, so they will not be seen entering or leaving any
      location affiliated with the study, or interacting with any study personnel. Once registered
      in the study, participants will only be contacted via secure email that does not indicate the
      nature of the study in the subject line. The study website will be password-protected to
      prohibit access to Internet users not participating in the study. Participants' screen names
      on the site will not contain their real names, and they will not be identifiable to other
      study participants.

      There is minimal risk of privacy loss. Study participants may not want others to know about
      their interest in or use of birth control, and may have feelings of embarrassment or shame in
      the event of a loss of study privacy. Additionally, birth control use may be a sensitive
      topic in the personal relationships of some study participants, and a loss of privacy could
      lead to strain or conflict in these personal relationships.

      Confidentiality:

      Data collected by researchers at the University of Pennsylvania will be stored on a secure
      network at their site. Only University of Pennsylvania study staff will have access to data
      on this network. University of PEnnsylvania staff will remove all identifiers from the data
      and export the data to researchers at UCSF via secure email. Deidentified data will be stored
      at on a secure UCSF server. Only the study staff will have access to the data, and we will
      not have access to the key.
    

Intervention name(s): Interaction with users of IUC and non-IUC users; Interaction with non-IUC users only
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Birth Control Connect is an online community where women will be invited to share their personal experiences with birth control. Birth Control Connect group sessions will last for twelve days. Each day, participants will be prompted to respond to questions in the group (e.g. "If you're using a birth control method right now, how did you choose it?"). Participants will also be able to pose questions to other members of the group and respond to other members' questions. Half of participants in Birth Control Connect intervention groups will be current IUC users.; Birth Control Connect is an online community where women will be invited to share their personal experiences with birth control. Birth Control Connect group sessions will last for twelve days. Each day, participants will be prompted to respond to questions in the group (e.g. "If you're using a birth control method right now, how did you choose it?"). Participants will also be able to pose questions to other members of the group and respond to other members' questions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: IUD; IUC; birth control; contraception; online