The Young Woman's Reach Project: Trial of an Intervention to Impact Contraceptive Behavior, Unintended Pregnancy, and Sexually Transmitted Infections (STIs) Among Adolescent Females
Condition: Contraceptive Behavior; Sexually Transmitted Diseases
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      The New Generation Health Center/University of California, San Francisco (UCSF) will
      implement an intervention to impact contraceptive behavior and reduce unintended pregnancy
      and sexually transmitted infections (STIs) among adolescent females who receive services at
      the New Generation Health Center (NGHC)/UCSF in San Francisco. Study subjects will be
      randomized into either standard reproductive health services or standard services plus
      follow-up motivational counseling telephone calls. Outcomes will be evaluated by ETR
      (Education, Training, Research)Associates, who will conduct follow-up surveys with all study
      participants at baseline, 6 months, 12 months and 18 months.
    

Detailed description: 
      The United States has one of the highest teen pregnancy rates of any western industrialized
      nation. In 1999, the last year for which state pregnancy data are available, California had
      the seventh highest pregnancy rate in the country. Within San Francisco, the Mission and
      Bayview Hunters Point districts have rates that are almost three times and two times higher
      than the state average respectively. In addition to high rates of unintended pregnancy,
      residents in the Bayview Hunters Point district experience STI transmission rate much higher
      than that of other neighborhoods.

      Currently there is very little research on the impact of different types of reproductive
      health clinic protocols on adolescent contraceptive use. Different outcomes have been found
      in the few studies that do exist on this topic. Hercog-Baron found that follow-up phone calls
      did not affect contraceptive use; however, explained that most youth stopped using
      contraception after the first three months of supply had run out and no calls were made
      beyond that time-frame. Authors suggested that the intervention may be more effective with a
      longer duration of follow-up. Alternatively, another study reported that their program
      substantially reduced teen pregnancy rates over time. Although the intervention had many
      components, the authors reported that the staff credited the positive relationships they
      created between the health educator and each student, and the frequent reminders contributed
      to the reduction in sexual risk-taking and pregnancy.

      A review by Miller and Sanchez concluded that the following seven elements of brief
      interventions induced positive change in a variety of health areas:

        1. feedback and counseling on personal risk,

        2. emphasis on personal responsibility for change,

        3. clear message about behavior change,

        4. a menu of behavior change options,

        5. therapist/counselor empathy,

        6. facilitation of client self-efficacy and

        7. use of a "motivational interviewing style".

      To the extent feasible, these elements will be incorporated into the Project REACH phone
      calls. Although there is very little data available in this area, the studies summarized
      above suggest that multiple contacts over time, even though brief, can have an impact.

      The NGHC will improve its reproductive health services by expanding current services to
      include a series of follow-up phone calls. The main purpose of these calls will be to assess
      how well patients are doing, to discuss any questions or problems they have had with their
      methods, and to enforce the four main messages:

        1. encourage condom use,

        2. encourage patients to return to the clinic for hormonal methods of contraception if they
           are likely to remain sexually active or want to change their method of contraception,

        3. get STI tested annually or if at risk and

        4. use the clinic as a resource and return for reproductive health needs.

      Clinics in San Francisco and around the country do not know whether conducting follow-up
      calls improves contraception compliance, increases STI testing or decreases unintended
      pregnancy. This study will significantly increase the field's knowledge of the feasibility
      and impact of conducting follow-up calls with youth over an extended period of time after
      they come to the clinic.
    

Intervention name(s): follow-up phone counseling
Intervention type(s): Behavioral
Intervention description(s): 9 calls over 12 months
Other intervention name(s): Intense phone follow-up using motivational interviewing
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Contraception behavior; Condoms; Unsafe sex; Pregnancy unwanted; Adolescent pregnancy; Condom use; Unprotected sex; Unintended pregnancy