Young African American women carry a disproportionate burden of both unintended pregnancy and STDs. Dual protection strategies offer concurrent prevention of both unintended pregnancy and STDs. Previous efforts to develop clinic-based interventions to promote dual protection have met with limited success. Efforts have been hampered by a poor understanding of the strategies young women employ to protect themselves, the interplay among individual, partner and provider influences on young women's dual protection practices, and provider practices around dual protection. The proposed intervention seeks to build motivation for dual protection use, a multi-layered (self, peers, care team, partners, etc.) culture of support around dual protection use, a social norms shift towards expectation of dual protection use, and an acknowledgement of the influences and challenges of dual protection use as well as management suggestions for these challenges. Methods: This is a randomized controlled trial testing group-based educational and clinical care to encourage dual protection use among young African American women. We will recruit African American females aged 15- 19 who are attending the Grady Memorial Teen Services Clinic for reproductive health care. Young women who consent to enrollment will be randomized to one of two groups. Clinic day will be the unit of randomization. Those randomized to the control arm will receive individual-based clinical care consistent with standard care protocols at the Grady Memorial Teen Services Clinic. Those randomized to the intervention arm will receive the same clinical care, however, participants will access clinic as a group. These participants will receive individual clinical care as needed as well as group-based education with a focus on dual protection with the following approaches: Use of an interactive multimedia platform focused on dual protection strategies and selection of a strategy of Five group based educational sessions focusing on issues relevant to dual protection use (Importance of dual protection, Relationships, Sexual decision-making, Partner communication) A consistent care team (Nursing, Health Educator, Healthcare Provider) providing support and care to individuals attending the group sessions as needed Intercession communication via Facebook This intervention will span 18 months from recruitment to final follow-up. We will test the following hypotheses: H1: Participants in this multi-component intervention will experience lower incidence of biologic outcomes (unintended pregnancy, Chlamydia and/or gonorrhea) than participants in the control group. H2: Participants in this multi-component intervention will report higher adoption and adherence to proven dual protection strategies than participants in the control group.
Young African American women carry a disproportionate burden of both unintended pregnancy and STDs. This project investigates a novel way to access clinical care and education that may increase dual protection use in this population. Increasing dual protection from unintended pregnancy and STDs has high impact potential for individual health, as well as reducing public health burden and improving population health on a large scale.
|Ewing, Alexander C; Kottke, Melissa J; Kraft, Joan Marie et al. (2017) 2GETHER - The Dual Protection Project: Design and rationale of a randomized controlled trial to increase dual protection strategy selection and adherence among African American adolescent females. Contemp Clin Trials 54:1-7|
|Steiner, Riley J; Liddon, Nicole; Swartzendruber, Andrea L et al. (2016) Long-Acting Reversible Contraception and Condom Use Among Female US High School Students: Implications for Sexually Transmitted Infection Prevention. JAMA Pediatr 170:428-34|