A Multi-Media Digital Intervention to Improve Female Adolescent Sexual and Reproductive Health of Adolescent Female Emergency Department Patients.

Background Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED. Methods We conducted a pilot randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multi-media messaging. We assessed the feasibility, adoption and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome. Results We enrolled 146 patients; mean age was 17.7 (SD+/-1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%; on Likert scale) and recommending (83.7%) the program. 87.5% adopted the program, responding to ≥1 text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference (ARD) =2.7%, 95% CI -12.4%, 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% (27/41) than controls ((30.0%;15/50); ARD =35.9%, 95% CI 16.6%, 55.1%). Conclusion(s) A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients, and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision-making.