A Peer-Led Social Communication Intervention

Edith Fox, MPHProgram in Woman-Centered Contraception

Department of Family & Community MedicineUniversity of California, San Francisco

Our mission and goal

• The Program in Woman-Centered Contraception is Dr. Christine Dehlendorf’s research team

• We know that many women and adolescents want to prevent pregnancy

• We want to help them get the best birth control method for them

• WhyIUD aims to help the friends of current IUD users decide if the IUD is a good fit for them, too

What’s an IUD?• T-shaped piece of copper

or plastic that is placed in the uterus

• May be hormonal or non-hormonal

• Can stay in for years, but can easily be removed

• Highly effective – over 99%

Who uses an IUD?• In 2011 – 2013…

• 6% of women 15 – 44 reported using an IUD

• 4% of adolescents 15 – 24 reported using an IUD

Branum, A. M., & Jones, J. (2015). Trends in Long-acting Reversible Contraception Use Among US Women Aged 15–44. NCHS data brief, (188), 1-8.

What have people heard about the IUD?

• Negative and incorrect information based in history of the IUD• Ex. IUD leads to infertile; IUD can’t be removed

early

• Often shared by people who have not used the method

The WhyIUD intervention• Delivered by healthcare

providers to current IUD users during clinic appointments

• Provides info on the IUD and encouragement to share your story

• WhyIUD website

• Weekly text messages for 8 weeks

• Pamphlets

WhyIUD and adolescents• The intervention was designed for women of all

reproductive age

• 43% of participants in our pilot study were aged 15 – 19

• We observed that these participants were more likely to share WhyIUD with their friends

• Adolescents found the materials engaging

• We are planning to expand WhyIUD for 15- to 19-year-olds specifically

Formative Research• Interviews and focus groups with women about social

communication around IUDs

• What do women want to hear from their friends about the IUD?

• How the IUD feels inside

• How it feels for their partner

• Safety

• Side effects

• Casual conversation is the preferred mode of communication

WhyIUD Design• Peer-led intervention that

reflects formative research findings

• Collaborators

• National Campaign to Prevent Teen and Unplanned Pregnancy

• Dr. Tom Valente, Associate Professor of Preventive Medicine at Keck School of Medicine of USC

Pilot Study• Tested acceptability and feasibility of the intervention

• Some effectiveness data

• We enrolled 10 new IUD users from a San Francisco clinic and 32 of their female friends and family members

• Baseline and 3-month surveys on IUD knowledge, attitudes, communication, and use

• Follow-up interviews to get participants’ feedback

Some results• IUD users listed a mean of 7.1 “social contacts” with

whom they were comfortable talking about birth control

• Mean of 10.3 among adolescents aged 15 -19!

• Positive feedback on design

• Low text message and website usage, likely due to lack of provider orientation materials

Some more results• 32% of social contacts said they “strongly liked” the

IUD as a method for themselves, compared to 23% at baseline

• All IUD users still had an IUD at follow-up; 100% said they “knew a lot” or “knew everything” about the IUD at follow-up

Conclusions from pilot• More evidence that people, especially young people,

like to talk to their friends about what birth control method to use

• WhyIUD is feasible and acceptable

• In a larger trial, WhyIUD could be demonstrated as effective in increasing knowledge and changing attitudes about IUDs, ultimately leading to greater uptake of IUDs and prevention of unintended pregnancy

Next steps• Currently conducting second pilot in Sacramento,

where fewer people already use IUDs

• Have made initial plans to possibly design a version of the intervention for the subdermal contraceptive implant, and conduct a large randomized controlled trial of both versions’ effectiveness

Thank you!