Interventions to Reduce Health Disparities in Youth of Dual Protection

描述（由申请人提供）：预防包括艾滋病毒（STI/HIV）在内的性传播感染和意外怀孕对于改善非裔美国人的性健康和生殖健康以及生活结果至关重要。生殖健康方面的差距十分严重。我们需要新的干预措施来解决年轻的非裔美国女性所面临的独特挑战，将性传播感染/艾滋病毒和怀孕预防工作结合起来。拟议的研究提倡双重保护，将避孕套与高效的避孕措施（如宫内节育器、植入物、注射剂）结合起来，通过制定降低风险的行为目标，帮助年轻女性采取最佳（如“双重方法”）和次优但有效的行为（如单独使用避孕套——一种提供“双重保护”的单一方法）。多媒体咨询干预miPlan运用跨理论模型和计划行为理论来鼓励行为改变。此外，动机性访谈将告知妇女接受的避孕咨询和附带的印刷教育材料将帮助妇女维持和防止新行为的复发。该项目将分两个阶段进行。在第一阶段，我们将组建一个由10名利益相关者组成的咨询团队，对PreCounselor应用程序进行调整，该应用程序最初是作为人口事务办公室赠款的一部分开发的，重点是双重保护。我们将培训生殖健康咨询师，并编写相应的印刷教育材料。在第二阶段，将通过前后测试来评估干预措施的可行性、可接受性和有效性，检查双重方法使用的改善、避孕依从性和持续性的增强、避孕套使用的增加以及性传播感染/艾滋病毒感染的减少。我们假设使用miPlan应用程序的年轻非洲裔美国妇女会发现它是全面的，适合文化的，并且参与干预将最终改善双重方法的使用，避孕依从性和连续性，并减少STI/HIV感染。如果证明是可行和有效的，随后将提交R01申请，使用大规模多诊所RCT设计来评估miPlan。

DESCRIPTION (provided by applicant): Preventing sexually transmitted infections including HIV (STI/HIV) and unintended pregnancies is critical to improving sexual and reproductive health and life outcomes for African Americans. The reproductive health disparities are severe. There is a need for novel interventions that address the unique challenges faced by young African American women, contextualizing both STI/HIV and pregnancy prevention efforts within their lives. The proposed research promotes dual protection, combining condoms with a highly effective contraceptive (e.g., intrauterine device, implant, injectable), by framing behavioral targets in terms of risk reduction, helping young women adopt optimal (e.g., "dual method") as well as suboptimal but effective behaviors (e.g., condoms alone -a single method that offers "dual protection"). The multimedia counseling intervention miPlan operationalizes the Transtheoretical Model and the Theory of Planned Behavior in order to encourage behavior change. In addition, motivational interviewing will inform the contraceptive counseling women receive and concomitant printed educational materials will help women maintain and prevent relapse for new behaviors. The project will proceed in two phases. In Phase I, we will assemble a 10-member stakeholder advisory team to adapt the PreCounselor app, originally developed as part of a grant from the Office of Population Affairs, to focus on dual protection. We will train reproductive health counselors and create concomitant printed educational materials. In Phase II, the feasibility, acceptability, and effectiveness of the intervention will be assessed through pre- and post-testing examining improvement in dual method use, enhancement of contraception adherence and continuation, increase of condom use, and decrease of STI/HIV infection. We hypothesize the young African American women who use the miPlan app will find it to be comprehensive, culturally tailored, and engaging, and that participation in the intervention will ultimately improve dual method use, contraceptive adherence and continuation, and decrease STI/HIV infection. If proven to be feasible and effective, a subsequent R01 application will be submitted to assess miPlan using a large-scale multiple clinic site RCT design.