Lauren S Chernick1, Melissa S Stockwell2, Ariana Gonzalez3, Jameson Mitchell3, Anke Ehrhardt4, Susanne Bakken5, Carolyn L Westhoff6, John Santelli2, Peter S Dayan3. 1. Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York. Electronic address: lc2243@columbia.edu. 2. Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York. 3. Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York. 4. Department of Psychology, Columbia University Medical Center, New York, New York. 5. Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, New York. 6. Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York; Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York.
Abstract
PURPOSE: Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). METHODS: We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). RESULTS: We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). CONCLUSIONS: Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.
PURPOSE: Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). METHODS: We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). RESULTS: We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). CONCLUSIONS: Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.
Keywords:
Adolescent behavior; Contraception behavior; Digital health; Emergency medicine; Mobile health; Pregnancy prevention; Sexual behavior; Sexual health; Teenage pregnancy; Text messaging
Authors: Nancy D Brener; Laura Kann; Steven A Kinchen; Jo Anne Grunbaum; Laura Whalen; Danice Eaton; Joseph Hawkins; James G Ross Journal: MMWR Recomm Rep Date: 2004-09-24
Authors: Luciana E Hebert; Brandon J Hill; Michael Quinn; Jane L Holl; Amy K Whitaker; Melissa L Gilliam Journal: Contraception Date: 2018-07-10 Impact factor: 3.375
Authors: Raymond C W Perry; Karen C Kayekjian; Rebecca A Braun; Michelle Cantu; Bhupendra Sheoran; Paul J Chung Journal: J Adolesc Health Date: 2012-02-22 Impact factor: 5.012
Authors: Lauren S Chernick; Carolyn Westhoff; Margaret Ray; Madelyn Garcia; Janet Garth; John Santelli; Peter S Dayan Journal: J Womens Health (Larchmt) Date: 2015-04 Impact factor: 2.681
Authors: Lauren S Chernick; John Santelli; Melissa S Stockwell; Ariana Gonzalez; Anke Ehrhardt; John L P Thompson; Cheng-Shiun Leu; Susanne Bakken; Carolyn L Westhoff; Peter S Dayan Journal: Acad Emerg Med Date: 2021-12-07 Impact factor: 3.451
Authors: Havisha Pedamallu; Matthew J Ehrhardt; Julia Maki; April Idalski Carcone; Melissa M Hudson; Erika A Waters Journal: J Med Internet Res Date: 2022-08-09 Impact factor: 7.076
Authors: Jennifer A Woo Baidal; Kelsey Nichols; Nalini Charles; Lauren Chernick; Ngoc Duong; Morgan A Finkel; Jennifer Falbe; Linda Valeri Journal: Nutrients Date: 2021-12-05 Impact factor: 5.717