Each month the Elsevier Atlas Award recognizes research that could significantly impact people's lives around the world.
Lynae Brayboy, Alexandra Sepolen, Taylor Mezoian, Lucy Schultz, Benedict Langren-Mills, Noelle Spencer, Carol Wheeler, Melissa Clark
Journal of Pediatric and Adolescent Gynecology
Volume 30, Issue 1, February 2017, Pages 23-28
Teen pregnancy rates in the United States have declined in recent years, and yet estimates from the Centers for Disease Control and Prevention (CDC) show that more than 200,000 American girls between the ages of 15 and 19 still give birth every year. Similar trends can be seen in countries all over the world.
Atlas Award-winning researchers reporting in the Journal of Pediatric and Adolescent Gynecology think they may have a way to help more girls get the information and support they need to help avoid an unwanted, early pregnancy. Their solution is Girl Talk: a sexual health education app that girls could download freely and reference privately on their own personal smartphones. While the app has so far been tested only in the US, it could help to reach and empower girls around the globe with information that is essential for avoiding unwanted pregnancies, including contraception use, body image, and healthy lifestyles. The smartphone approach is particularly promising given the many challenges of providing a quality sexual health education for young people of either gender in many countries and regions. About half of the world’s population now has a smartphone and those numbers continue to grow.
(In the United States), there are recommendations from the American College of Obstetricians and Gynecologists that girls come in for a talk visit with their doctors between the ages of 13 and 15, but that rarely ever happens,” said Lynae Brayboy of the Warren Alpert Medical School at Brown University in Providence, Rhode Island. “Doctors rarely see girls early unless they are having a problem. As a result, girls never receive anticipatory guidance—information before an event occurs. They are left on their own and, when there’s a bad outcome, they are blamed. I thought that was completely unfair.”
As Brayboy and her colleagues report, Girl Talk was built to incorporate four guiding principles: trusted sexual health information, visually appealing graphics, compatibility with iPhones, and age-appropriate, straightforward content. The content was adapted from trusted sources, including the CDC, Department of Health and Human Services’ Office of Adolescent Health, Planned Parenthood, and others. The information provided covers many topics, including anatomy and physiology, sexuality and relationships, contraception, sexually transmitted infections, and body image.
Once the app was built, the researchers wanted to find out whether girls would actually be inclined to use it. They enlisted 39 girls between the ages of 12 and 17 from Rhode Island to participate in a study. In the first phase, 22 girls completed a sexual health questionnaire. In the next phase, 17 girls with iPhones used Girl Talk for two weeks, answering sexual health and interview questions both before and after.
The girls who used the app reported using it for an average of 48 minutes during their free time on weekends. They typically spent about 10 to 15 minutes with the app at a time. After spending time with the app, girls said they found the app useful and thought their friends would use it.
Girl Talk is an “innovative intervention related to comprehensive sexual health education that has the potential to help combat unintended pregnancy and STDs,” added Paula J Adams Hillard, Editor-in-Chief of the Journal of Pediatric and Adolescent Gynecology.
While their demonstrated knowledge of sexual health improved slightly, those gains in knowledge were not significant with short-term use of the app. However, the findings show that such an app has potential to reach its intended audience and to make a real difference in girls’ lives.
"We found that a smartphone application is a feasible sexual health educational tool that is appealing to teenage girls," Brayboy said. "In fact, our participants recommended the application as a valuable resource to learn about comprehensive sexual health."
Brayboy said the app is not yet available for download. They’d first like to develop a more sophisticated version that could be continuously updated with new information. They’d also like the app to come equipped to help young girls find “adolescent-friendly” doctors close to home. Ultimately, they’d also like to conduct a study to show whether girls who use such an app have better outcomes, as measured by lower rates of pregnancy and STIs.
“Building an app takes a lot of money—at least $150,000 to $200,000,” Brayboy said. “Conducting a study takes money, too. That’s the only barrier now.”
A Conversation with Lynae Brayboy
We spoke with Lynae Brayboy about Girl Talk, a smartphone app to teach adolescent girls about sexual health. Listen now!.
Atlas: How are girls learning about their own sexual health now?
Lynae Brayboy: Traditionally, there has been in many schools some type of health program. Usually it’s introduced at the middle school level. In Rhode Island, there’s legislation that encourages schools to discuss sexual health topics and review them in high school. The majority of girls in our study had some sexual health education, but it wasn’t comprehensive. What we found is it wasn’t standardized or uniform in any way, so you could go to school A and get one set of information and go to school B and get very different information. There isn’t a training module for the teachers teaching it.
Atlas: What led you to the realization that we needed a better way to reach girls?
Lynae Brayboy: I think the defining moment that made me decide to do this happened about a decade ago. At that time, I was an OB-GYN resident and I delivered a 12-year-old girl. She was having a baby and I was the doctor taking care of her. It was a very traumatic delivery for everyone involved because she was 12. She didn’t grasp what was happening to her. It seemed to me this shouldn’t happen. I have never forgotten that delivery. I’ve delivered many babies and I don’t recall the details, but that delivery was so traumatic. Even now when I think about it, I get emotional.
Somehow, the medical field had failed her. I trained outside Philadelphia and you’d be hard pressed to find a place where you could walk in and get questions answered. A lot of girls thought Planned Parenthood was a TV show. They didn’t realize it was a center where they could get information. They didn’t realize it was for them. So, if you’re not getting standardized information at school and you’re not getting it at a center and not at home—a lot of parents are reluctant to talk to kids or maybe parents don’t know the answers—it’s easy for a 12-year-old to become pregnant or exposed to sexually transmitted infections (STIs). Then, when it happens as a society we judge the girl. ‘Oh, she should have known. Someone should have told her.’ But who is that someone?
Atlas: How did you come to the idea of developing a sexual health education app?
Lynae Brayboy: People sometimes ask me why I’m doing this. They say teen pregnancy is going down and that’s great, it is. But it’s not in certain segments of the population. It’s still high in minority populations. And I thought: we’re asking a lot of 12 or 13-year-old girls to come into a doctor’s office and talk. That’s intimidating. I have a 13-year-old and for her to make an appointment to speak to a doctor or even for me as a mother to make an appointment—that’s not really done. It certainly wasn’t an option when I was growing up. I thought: why don’t we try to reach girls where they are? Even if they came in, they might be reluctant to disclose things. They might think we’d tell their parents even though we’re bound not to. So then I thought: what do girls have?
The answer came after a busy clinic day. One of my patients was a teenage girl and I was trying to engage her. She wouldn’t look up because she was on her phone. A lot of colleagues encounter this with teenagers. They were always on their phones. So I thought: we have apps for everything else, why couldn’t we have an app for this? Many people Google information and sometimes that information is good and sometimes it isn’t. So why not take all the reputable information and put it into one compact place for girls to look and get the information they need in real time instead of looking to one website or another? Many girls don’t know how to find the resources or it might be hard to navigate.
Atlas: Tell us about the app.
Lynae Brayboy: We wanted to cover several key themes: anatomy and physiology, pregnancy prevention, STIs and mind-body connection including depression and body image. There are so many pressures girls experience. We wanted to talk more about things that lead us to engage in sexual activity. We address LBGTQ issues and sexuality. We didn’t want to reinvent the wheel. We used resources such as the CDC, Planned Parenthood, and also Bedsider. We relied heavily on those and put in nuggets of information.
In the study, we showed girls these categories and asked what they thought of each. While the app didn’t make a large difference in knowledge, it did influence girls’ opinions about desirability of such an app. We asked girls if they thought an app like this would be good for them and their friends and after using the app their ratings went up significantly. That impressed me. We tried to make it appealing to girls, but we also had a limited budget. We weren’t able to make it as visually interactive as we’d like—that is the future of the app. But girls thought it was a good app to teach sexual health. They thought their friends would use it and they said most of their friends had smartphones. Many people think minority girls don’t have smartphones, but really they are more likely to have a smartphone than a landline or computer. I think many young women would prefer their healthcare information in an accessible, discreet manner via the phone.
Atlas: Is the app available to girls now?
Lynae Brayboy: The app isn’t available now. This was a research app. We are now applying for grant funding for further development and study. Instead of desirability and feasibility, we’d like to look at changes in outcomes. Does girls fund of knowledge change with more exposure? Does that fund of knowledge change their behavior? Do they have fewer episodes of STIs or fewer unplanned pregnancies? Answering those questions requires more funding. This was a phase I, very small study to look at feasibility and desirability. Now we’d like to test girls with and without the app for STIs. We’d like to have access to their medical records. We’d like to recruit girls from various centers across Rhode Island, making sure to capture girls of varying ethnicity, socioeconomic status, educational background, and previous sexual health education and find out how they do with the app compared to the standard brochures.
Atlas: What’s your hope for this approach?
Lynae Brayboy: My hope is that no girl feels they don’t have a resource or a way to find something out. I hope the app will help generate conversations and focus girls back to healthcare resources like school nurses or clinics or primary care so they don’t feel that there’s no resource for them. My future vision for the app is to be universally available and free, supported by ads to make it financially independent of grant funding. I’d like the content to be continually updated as new birth control methods come out or new information about STIs and treatment comes out. I’d like to see a GPS feature where girls can find out where to find adolescent-friendly providers. If a girl lives in Omaha, she could look and see here are five doctors willing to provide a judgment-free zone where girls can get information and care.
Atlas: Anything else you’d like us to know?
Lynae Brayboy: I’d like to convey that the app is just part of it. We really have to change the way society looks at girls who become pregnant or have STIs. It’s a very judgmental climate and that’s very unfair. This app will help empower girls, which is ultimately the problem. A lot of girls may not have the information or know-how, but they are good kids who just need a little bit of direction.
- Reproductive Health: Teen Pregnancy (Centers for Disease Control and Prevention)
- Teens, Social Media & Technology (Pew Research Center)
- Lynae Brayboy
About the Journal of Pediatric and Adolescent Gynecology
Journal of Pediatric and Adolescent Gynecology includes all aspects of clinical and basic science research in pediatric and adolescent gynecology. The Journal draws on expertise from a variety of disciplines including pediatrics, obstetrics and gynecology, reproduction and gynecology, reproductive and pediatric endocrinology, genetics, and molecular biology.
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