156 - Implementation of a digital contraception decision-making tool into the pediatric primary care setting

Publication Number: 156.5547

Brittany K. Badal, University of Louisville School of Medicine, Louisville, KY, United States; Kathleen Tebb, University of California, San Francisco, School of Medicine, San Francisoc, CA, United States

Background: Kentucky has the sixth highest teen birth rate in the U.S. (23.8 births per 1,000 females 15-19 years of age) and has restrictive bans on abortion. Black, Latino, and LBGTQ youth face disproportionately high rates of unintended pregnancy. Providing adolescents with access to the full range of contraceptive options is essential in helping them achieve their pregnancy-prevention goals and is crucial for achieving health equity. The Health-E You/Salud iTu contraceptive decision-making support app significantly increased the use of non-barrier contraception among sexually active Latina adolescents in school-based health clinics.

Objective: This pilot study evaluates the utilization of a contraceptive decision-making support app in a primary care pediatric practice in Kentucky serving diverse adolescents.

Design/Methods: Health-E You provides patient-centered contraceptive recommendations based on user inputconcludes with a question to select the method(s) the patient is most interested in using, and prepares them to discuss contraception with their clinician. The app extends the clinician’s reach by educating patients prior to the visit and in real-time, the app also sends a confidential patient summary to the clinician prior to the visit. We gathered data from the app to assess participants’ use of contraception prior to the visit and compared that with the method they were most interested in using upon completing the app.

Results: A total of 167 adolescents, mean age of 15.2 years, 63% self-identified as Black, completed the baseline survey and used the app at their office visit. Most, 128 (76.6%) felt it was “very important” to avoid pregnancy right now. Of the 55 (32.9%) who reported being sexually active, 61.9% reported trying to avoid pregnancy; yet 37 (67.2%) of these adolescents were not using any form of non-barrier contraception. After using the app, a quarter (n=14) expressed interest in utilizing a LARC method after using the app.

Conclusion(s): Using the modified RE-AIM framework, barriers to implementation include time to complete the survey and app prior to the visit and IRB requirement to obtain parental consent, which may affect participants' willingness to share information despite reassurances of confidentiality. Facilitators to implementation include the ability to engage key stakeholders, including clinicians and nursing staff and ease of use with this new technology.
In conclusion, utilizing a digital tool such as Health-E You, in conjunction with provider counseling, can empower youth in the contraception decision making process in primary care.