Interventions to Reduce Health Disparities in Youth of Dual Protection

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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.