Helping clinicians address digital information about contraception with adolescents

Abstract: Adolescents need accurate information about contraception to participate in shared decision-making about sexual and reproductive health, including preventing teen pregnancy. Yet decision-making can be difficult amidst an increasingly vast and complex health information environment—or “infosphere”—driven by the

expansion of the internet and social media. Digital health information about contraception ranges in quality, with social media often circulating incomplete, inaccurate, or misleading information about side effects, impacts on fertility, and rates of effectiveness. Adolescents are an especially high-priority group with whom to engage due

to 1) unique ethical-legal challenges surrounding sexual and reproductive among minors; 2) increasingly restrictive reproductive policies post-Dobbs; 3) racial, ethnic, and socioeconomic health inequities in rates of teen pregnancy and access to comprehensive sexual education; and 4) adolescents’ limited skillset and lack of

supportive relationships to critically engage with sensitive health information online. Clinicians who care for adolescents can fill a critical gap in promoting reliable health information and supporting shared decisions about contraception. Yet studies show that clinicians often avoid extensive engagement with patients on the topic of misinformation and other internet information due to lack of time and

training. As young people are increasingly exposed to health information on social media, research is needed to understand how clinicians can support adolescent patients’ emerging autonomy and contraceptive adherence, particularly as they integrate components of their digital health infosphere into the contraceptive decision-making

process. Discussion of a patient’s infosphere can be incorporated into adolescent-tailored patient-centered contraceptive counseling (PCCC), an approach that centers autonomy and limits contraceptive coercion. To help pediatricians provide PCCC that incorporates adolescents’ digital infospheres, our objectives are: 1)

collect and review content and communication strategies related to the adolescent digital contraception infosphere, including conducting a relevant qualitative content analysis of Reddit; 2) develop a Counseling about Contraception Digital Information (CCDI) framework and training module to help clinicians incorporate

adolescents’ online information-seeking into PCCC; and 3) use mixed methods to evaluate pediatrician-reported acceptability, appropriateness, and self-efficacy related to the CCDI module within the context of a larger training pilot called Adolescent-Centered Counseling and Empowerment Skills for Success (ACCESS).

This project fills a crucial gap by conducting, to our knowledge, the first content analysis of adolescent- focused contraception information online. Furthermore, the study will develop a modern, adolescent-adapted, and stakeholder-informed PCCC training for clinicians that addresses a high-priority population’s digital

contraception infosphere. This study has potential future adaptations in many other areas of health that are also impacted by complex digital infospheres.