Health-E You/Salud iTu is an mHealth contraceptive decision support tool for adolescent girls. Through an interactive, youth-centered approach, the App provides accurate information (that can be updated in real-time), individually tailored feedback/messages, and a user-driven experience. Based on the youth’s preferences, and experiences, the App provides contraceptive recommendation(s) while also presenting the youth with all of the possible options including videos of providers and youth. Youth can then share information from the App with their provider to help them communicate their needs, interests and questions. In turn, the provider is better prepared for the face-to-face encounter. Pilot testing shows it is feasible to implement, acceptable to adolescents and providers; improves health knowledge; and visit quality. It is being evaluated at 14 school-based health centers using a longitudinal, cluster randomized control trial research design.

1. Preventing Unintended Pregnancy Among
Adolescents: Using Health-E You to
Promote a Patient-Centered Approach to
Selecting Appropriate Contraception
Presenters: Rosario Rico, MPH, The L.A. Trust for Children’s Health
Robert Renteria, The L.A. Trust for Children’s Health
Felicia Rodriguez, MA, UCSF
Principal Investigator: Kathleen Tebb, PhD, UCSF
Funded by the Patient Centered Outcomes Research Institute (PCORI): #AD-1502-27481

2. Unintended Pregnancy Among Adolescents
• Rates of teen pregnancy, birth and abortion have
steadily declined
• Historically low rates of teen pregnancy in the U.S
• Contraceptive use driving lower pregnancy rates as
sexual activity remains relatively constant
(Guttmacher, 2016)

3. Unintended Pregnancy Among Adolescents
• Despite declines, rates remain higher in US vs. all
other developed nations
• Teen pregnancy is associated with poorer
educational, economic, and social outcomes for teen
parents and their children
• Most (80%) of teen pregnancies are unintended
• Major racial & ethnic disparities remain

4. Births per 1,000 Females 15-19 yrs by Race/ Ethnicity

5. Adolescents and LARCs
• Information and access is key
• Safe, effective, easier to keep confidential,
do not require daily adherence or frequent
visits for refills
• Highly recommended in the U.S and
globally for adolescents
• LARC use among adolescents is only 3.2%
(JAH, 2016)

6. Barriers to LARC use
• Providers’ knowledge and
attitudes
• Adolescent knowledge and
misconceptions

7. Health-E You
Salud iTu
An iPad based research study in partnership with UCSF &
the L.A. Trust for Children’s Health
Funded by PCORI

8. Aims of Health-E You / Salud iTu
A computer-based intervention to:
Aim 1
Support adolescents in
making decisions about
using an effective
method of
contraception & protect
themselves from
STIs/HIV
Aim 2
Improve the
effectiveness &
efficiency of the clinical
encounter
Aim 3
Reduce the incidence
of unprotected sexual
intercourse over time

9. Study Design
• 18 Wellness/SBHCs
• Over 1700 Latina youth
• Complete iPad-based app at clinic
• Sent post-visit survey within
48 hrs of visit
• 3 & 6 month follow-up surveys online
• $70 for completing all 3 surveys

10. Adolescent and Clinician Centered
Developed in partnership with adolescents &
providers
• Advisory Boards
• Focus groups
• Interviews
• Interactive “usability” testing

11. ▪ Youth selects language:
English or Spanish
▪ App assesses eligibility &
obtains consent
▪ Gamification of contraceptive
facts (Mythbusters)
Health-E You / Salud iTu

12. ▪ Provides personalized
contraceptive
recommendations
▪ Efficacy-based
(WHO guidelines)
▪ Opportunity to learn
about each method
Personalized Recommendations

13. Contraceptive Information

14. Integrated into Clinical Setting
• Supplements health
education and assessments
• Provides individually tailored
education & decision support
for teen prior to encounter
• Queues provider on teen’s
interest/needs prior to face-
to-face encounter (print-out)

15. Clinic Integration
• Obtain buy-in
• Study and observe existing clinic flow
• Create clinic specific workflows + scripts
• Protect iPad security
• Conduct staff/provider training
• Conduct in person clinic visits &
monthly QI calls

17. Integration Challenges
• Staff comfort/ turnover
• Technology issues
• Workflow implementation
• Consistent/reliable champion
• Large geographical area

19. Overcoming the Challenges
• Importance of local
leadership (L.A. Trust)
• Building relationships &
engaging clinic staff
• Incentivizing staff & youth
• On-going in-person support
• Thinking outside the box

20. Preliminary Findings: Baseline
• 305 Female, Latina Adolescents (Intervention arm only)
• Sexually active
• Mean age = 16.4 years
• Few used effective contraceptive at baseline:
– >20% did not use any method
– Nearly 50% of participants who avoided pregnancy in the past 3 mo
used least effective methods
• Condoms only
• Withdrawal
• Fertility Tracking

21. Preliminary Findings: Post App
Significant improvements in:
• Sexual health knowledge
• Intentions to use more
effective & LARC method
• Efficiency & effectiveness of
visit
89%
11%
Efficacious methods Other methods

22. What are youth saying?
"I only thought there was the pill to
prevent pregnancy. I didn't even know
all those other methods existed.”
~ Student participant

23. What are providers saying?
“Having the app is really helping me out,
especially when I’m busy…when they [the
students] finish, they already have a list of
informed questions. This makes my counseling
visit more productive and a lot shorter.”
~ Provider, SBHC

24. What are providers saying?
“I’ve noticed that there has been an increased
interest and questions about LARCs from
students that have completed the app.”
~ Provider, SBHC

25. The Future of Health-E You
• Continue recruitment & follow-up survey
• Analyze & publish study results
• Disseminate
• Develop an app for adolescent males

26. Contact information
Felicia Rodriguez, MA Felicia.Rodriguez@ucsf.edu
Rosario Rico, MPH Rosario@thelatrust.org
Robert Renteria Robert@thelatrust.org
Kathleen Tebb, PhD (Study PI) Kathleen.Tebb@ucsf.edu

27. Acknowledgements
L.A. Trust Co-Investigators: UCSF Co-Investigators
Maryjane Puffer, Executive Director Claire Brindis, DrPH, UCSF
Sang Trieu, Programs Director Elizabeth Ozer PhD, UCSF
Lance Pollack PhD, UCSF
UCLA Sally Adams, PhD, UCSF
Loris Hwang, MD, Co-investigator
Rebecca Dudovitz, MD, Consultant
All of the LAUSD Wellness & School Based Centers participating in this study
Kim Uyeda, MD, Medical Director, LAUSD
Funded by the Patient Centered Outcomes Research Institute (PCORI)
Contract #AD-1502-27481