Friends and family are a trusted source of contraceptive information for young people. However, when it comes to IUDs, negative and incorrect information is prevalent in social communication. We developed a multi-technology, peer-led intervention to encourage fact-based communication about the IUD among women. Our intervention, WhyIUD, includes text messages for IUD users and a webpage and pamphlets for IUD users and their friends. WhyIUD is delivered by clinicians to IUD users during their IUD insertion or other clinic visit, and then by IUD users to their friends. WhyIUD aims to accelerate awareness, acceptance and uptake of IUDs among women for whom this method may be a good fit, thus decreasing the rate of unintended pregnancy. WhyIUD's development and evaluation may serve as a model to other behavior change initiatives seeking to harness social influence and spread evidence-based health information by partnering technology and clinical care.

1. A Peer-Led Social Communication
Intervention
Edith Fox, MPH
Program in Woman-Centered Contraception
Department of Family & Community Medicine
University of California, San Francisco

2. Our mission and goal
• The Program in Woman-Centered Contraception is Dr.
Christine Dehlendorf’s research team
• We know that many women and adolescents want to
prevent pregnancy
• We want to help them get the best birth control method
for them
• WhyIUD aims to help the friends of current IUD users
decide if the IUD is a good fit for them, too

3. What’s an IUD?
• T-shaped piece of copper
or plastic that is placed in
the uterus
• May be hormonal or non-
hormonal
• Can stay in for years, but
can easily be removed
• Highly effective – over 99%

4. Who uses an IUD?
• In 2011 – 2013…
• 6% of women 15 – 44 reported using an IUD
• 4% of adolescents 15 – 24 reported using an IUD
Branum, A. M., & Jones, J. (2015). Trends in Long-acting Reversible Contraception Use Among US
Women Aged 15–44. NCHS data brief, (188), 1-8.

5. What have people heard about the IUD?
• Negative and incorrect information based in history of
the IUD
• Ex. IUD leads to infertile; IUD can’t be removed
early
• Often shared by people who have not used the method

6. The WhyIUD intervention
• Delivered by healthcare
providers to current IUD
users during clinic
appointments
• Provides info on the IUD
and encouragement to
share your story
• WhyIUD website
• Weekly text messages for 8
weeks
• Pamphlets

8. WhyIUD and adolescents
• The intervention was designed for women of all
reproductive age
• 43% of participants in our pilot study were aged 15 – 19
• We observed that these participants were more likely
to share WhyIUD with their friends
• Adolescents found the materials engaging
• We are planning to expand WhyIUD for 15- to 19-year-
olds specifically

9. Formative Research
• Interviews and focus groups with women about social
communication around IUDs
• What do women want to hear from their friends
about the IUD?
• How the IUD feels inside
• How it feels for their partner
• Safety
• Side effects
• Casual conversation is the preferred mode of
communication

10. WhyIUD Design
• Peer-led intervention that
reflects formative research
findings
• Collaborators
• National Campaign to
Prevent Teen and
Unplanned Pregnancy
• Dr. Tom Valente, Associate
Professor of Preventive
Medicine at Keck School of
Medicine of USC

13. Pilot Study
• Tested acceptability and feasibility of the intervention
• Some effectiveness data
• We enrolled 10 new IUD users from a San Francisco
clinic and 32 of their female friends and family
members
• Baseline and 3-month surveys on IUD knowledge,
attitudes, communication, and use
• Follow-up interviews to get participants’ feedback

14. Some results
• IUD users listed a mean of 7.1 “social contacts” with
whom they were comfortable talking about birth
control
• Mean of 10.3 among adolescents aged 15 -19!
• Positive feedback on design
• Low text message and website usage, likely due to
lack of provider orientation materials

16. Some more results
• 32% of social contacts said they “strongly liked” the
IUD as a method for themselves, compared to 23% at
baseline
• All IUD users still had an IUD at follow-up; 100% said
they “knew a lot” or “knew everything” about the
IUD at follow-up

17. Conclusions from pilot
• More evidence that people, especially young people,
like to talk to their friends about what birth control
method to use
• WhyIUD is feasible and acceptable
• In a larger trial, WhyIUD could be demonstrated as
effective in increasing knowledge and changing
attitudes about IUDs, ultimately leading to greater
uptake of IUDs and prevention of unintended
pregnancy

18. Next steps
• Currently conducting second pilot in Sacramento,
where fewer people already use IUDs
• Have made initial plans to possibly design a version of
the intervention for the subdermal contraceptive
implant, and conduct a large randomized controlled
trial of both versions’ effectiveness

19. Thank you!