Adolescent Contraception: Communication Training Intervention to Engage Pediatrician-Adolescent-Mother Triads

Study Overview
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Brief Summary
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In order to support the desire of most adolescents to delay pregnancy (parenting) until their own adulthood, pediatricians must be comfortable and skilled in having reproductive health conversations with adolescents and the mothers of adolescents. Artificial intelligence, such as a chatbot, could be programmed to simulate the perspective of the mother or the daughter as a tool for pediatricians to practice communication before interacting with real families. Through human-centered design, an iterative problem-solving approach, our overall goal is to develop and test a communication training chatbot tool that is accurate, developmentally tailored for adolescents and mothers, culturally tailored, and aids pediatricians to manage resistance and conflict about contraception to ultimately close disparities in teen births. The investigator's primary hypothesis is that a communication focused intervention will improve pediatrician interactions with dyads about contraception. Through three stages, the study team will develop an artificial intelligence tool as a behavioral intervention. The study team will gather basic communication data to generate, refine, modify, adapt, and pilot test novel communication tools with real-world encounters while keeping humans at the center of attention

Detailed Description
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In Stage 1 (formative), the investigators will characterize communication content and styles of pediatricians (residents, fellows, attendings) and adolescent-mother dyads on contraception discussions with 50 real-life clinical encounters. Through separate post-encounter surveys of each pediatrician-adolescent-parent triad using validated scales, the investigators will describe the overall quality of the interactions (concordant contraception plans, satisfaction), communication (confidence, comfort, self-efficacy, confidentiality) and decision-making (perceived autonomy, ownership, and power) to determine ideal, moderate and poor communication interactions. Then, separate group interviews (n = 15, with adolescents, mothers and physicians) will review recorded vignettes to identify optimal culturally tailored communication strategies. In Stage 2 (development), the investigators will upload de-identified and anonymized vignettes to an AI communication training tool to develop and refine the tool through prompt engineering and performance evaluation with adolescent, parent and pediatrician advisory boards. Then, the investigators will iteratively test the acceptability and feasibility of the tool on 10 pediatrician learners. In Stage 3 (proof-of-concept), the investigators will test how an AI communication intervention tool can improve reproductive health encounters by comparing evaluation results of 50 pre-training and 50 post-training real encounters. This study will advance pediatrician communication training, empower adolescent sexual health, support mothers' priorities, and test how AI communication training chatbots can improve triadic interactions.

Official Title
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Adolescent Contraception: Communication Training Intervention to Engage Pediatrician-Adolescent-Mother Triads

Conditions
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Communication

Intervention / Treatment
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* Behavioral: chatbot communication training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (pediatricians/providers): Pediatricians (residents, fellows, attendings) Recruited from the Adolescent and Young Adult (AYA) Medicine Clinic at Children's Medical Center of Dallas. Inclusion Criteria (adolescents and young adults): Adolescents (14-17 years of age) Young adults (18-21 years of age) Recruited from the Adolescent and Young Adult (AYA) Medicine Clinic at Children's Medical Center of Dallas. Inclusion Criteria (caregivers): Caregiver (1) of recruited patients who attend the encounter with the patients Recruited from the Adolescent and Young Adult (AYA) Medicine Clinic at Children's Medical Center of Dallas. Exclusion Criteria: Adolescent/young adult is not an active patient Unable to speak or read in Spanish/English

Ages Eligible for Study
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Minimum Age: 14 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: single intervention arm with pre- and post- evaluation.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: chatbot training<br>Ten physician learners will train with the artificial intelligence communication training tool as a behavioral intervention. Before the training, the 10 learners will complete 5 sexual health clinical encounters with adolescent-mother dyads (50 total encounters) where encounters will be audio-recorded and post-encounter surveys competed by each triad member. After training with the tool, the same 10 learners will complete 5 more sexual health clinical encounters with adolescent-mother dyads (50 total encounters) that are audio-recorded and post-encounter surveys completed. The investigators will compare survey results pre and post to evaluate for improvement in communication interactions. | Behavioral: chatbot communication training<br>* Artificial intelligence chatbot that simulates a mother and a daughter for the pediatrician to practice communication about contraception.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Questionnaire | Multiple questions will be aggregated to arrive at one reported value to determine ideal, moderate and poor communication interactions. | Pre-training, baseline. | 
| Questionnaire | Multiple questions will be aggregated to arrive at one reported value to determine ideal, moderate and poor communication interactions after training. | Post-training, through study completion, an average of 1 year. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability Questionnaire | Weiner's implementation outcome measure Acceptability of Intervention Measure (AIM). Items are measured on a 5-point Likert scale (Completely Disagree-Completely Agree). Score is calculated mean with the higher score meaning acceptability. | Through study completion, an average of 1 year. | 
| Feasibility Questionnaire | Weiner's implementation outcome measure Feasibility of Intervention Measure (FIM). Items are measured on a 5-point Likert scale (Completely Disagree-Completely Agree). Score is calculated mean with the higher score meaning feasibility. | Through study completion, an average of 1 year. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Adolescent, Contraception, Training