Evaluation of an Inpatient Sexual Risk Behavior Assessment Program
Condition: Adolescent Behavior; Sexual Behavior
Study type: Interventional

Summary: 
      This is an exploratory pilot study to evaluate the feasibility and potential effects of an
      innovative, individualized electronic inpatient sexual health intervention (iRAP) for
      adolescent females. The central hypothesis is that the electronic intervention, a sexual
      health questionnaire with tailored feedback based on the Trans Theoretical Model (TTM) of
      behavior change, will significantly increase adolescent females' requests for sexually
      transmitted infection (STI) screening and sexual health management during their hospital
      admission.
    

Detailed description: 
      Sexually transmitted infections (STIs) are disproportionately common among 15-24 year-old
      females, and can have detrimental effects including pelvic inflammatory disease and
      infertility. Most STI's are asymptomatic, especially for females, making screening programs
      essential. Current guidelines recommend HIV screening for all adolescents, and yearly
      chlamydia and gonorrhea screening for sexually active females under 25 years-old. Yet only
      one-third of primary care physicians report screening asymptomatic adolescents. Most
      adolescents report no sexual health discussion during preventative healthcare visits.
      Furthermore the majority do not regularly attend preventative healthcare visits. Therefore,
      urgent healthcare visits, often in emergency departments (ED) and inpatient settings, provide
      an important point of contact.

      Given adolescents infrequently obtain outpatient sexual health services, the inpatient stay
      may serve as a critical intervention point. Other studies have found success with STI
      screening programs in the ED; none to our knowledge examined the efficacy of an inpatient
      sexual health screening protocol. Previous pilot data demonstrated, however, significant
      interest in sexual health information and desire for STI testing among adolescents admitted
      to a children's hospital.

      Investigators conducted an exploratory study to evaluate the feasibility and potential
      effects of an innovative, individualized electronic inpatient sexual health intervention
      (iRAP) for adolescent females. The central hypothesis is that the electronic intervention,
      based on the Trans Theoretical Model (TTM) of behavior change, will significantly increase
      adolescent females' requests for STI screening and sexual health management.

      Investigators enrolled 70 14-18 year-old, medically stable female inpatients admitted to the
      hospitalist service at Hasbro Children's Hospital for a randomized control trial during a
      one-year period. Participants were randomized to receive an electronic sexual risk assessment
      with or without real-time tailored feedback. Feedback was based on the TTM, utilizing
      readiness for change to determine appropriate messaging. Participants were then able to
      electronically request sexual health management options, including STI testing, discussion
      with their inpatient or outpatient physician, or technology-hosted information on
      contraception. Investigators conducted a chart review of enrolled adolescents to determine if
      sexual health topics were addressed.

      The investigators are examining participation rates, length of time to perform all study
      elements, and proportion of teens that obtain requested service. Additionally, the
      investigators are comparing participants' perceived reproductive health risk and uptake of
      offered services between the intervention and control groups.
    

Intervention name(s): Tailored feedback
Intervention type(s): Behavioral
Intervention description(s): Electronic feedback based on participants "stage of change" which provided risk reduction behavior regarding their sexual health including use of condoms, contraceptions, and STI testing.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Investigator)
Primary purpose: Prevention