Meaningful Use of Technology to Improve Health Care Delivery for Urban Adolescents: Focus on Teen Pregnancy Prevention (DepoText Study)

Aims:

The aim of this proof of concept pilot project is to determine the feasibility and acceptability of a text messaging reminder system for communicating with urban adolescents using Depo-Provera for long-acting contraception. We will randomize urban adolescent girls who have elected Depo-Provera for ongoing contraception to receive either standard counseling and clinic appointment reminders or a text messaging (DepoTEXT) follow-up intervention. Participants in the DepoTEXT intervention will receive reminders for clinic visits and encouraging messages each month for STI prevention. The primary outcome is the preliminary efficacy for improving appointment adherence. Secondary measures include patient responsiveness to text messages and acceptability/satisfaction with this approach.

Setting and Participants:

This research study will be conducted in the Johns Hopkins Harriet Lane Clinic located Baltimore, Maryland. As noted above, Baltimore currently has rates of teen pregnancy that are significantly higher than statewide rates.5, 6 The United States Census estimates that there are 47,710 adolescents between the ages of 15-19 years in Baltimore. 7 Using 2007 Youth Risk Behavior Survey estimates, approximately 35,829 youth in this age group are having sexual intercourse and 13,302 are not using condoms for either STI or pregnancy prevention. 20 The current rise in birth rates to teens in urban Baltimore has prompted a joint initiative involving the mayor's office, Baltimore City Health Department, Urban Health Institute, and Healthy Teen Network.21

The Harriet Lane Clinic located in East Baltimore primarily serves low-income African American families from the neighboring communities. Adolescents and young adults in East Baltimore have high rates of pregnancy and STIs. During the 1st 12-months of funding of the Johns Hopkins Harriet Lane Teen Clinic's Title X Program, the majority of clients were females aged 15 to 25 years (83%), uninsured (52%), and minors seeking confidential services (50%). The program provides sexual/reproductive health services to young persons who are uninsured, underinsured and seeking confidential services. More than 80% of patients served by the clinic participate in a Medicaid Managed Care Organization. While there are approximately 250 individuals on the Depo-Provera logs, the Harriet Lane Clinic currently has more than 100 active users, but adherence to scheduled Depo-Provera appointments remains a problem despite access to care through our clinical site.