Feasibility study of a health coaching intervention to improve contraceptive continuation in adolescent and young adult women in Philadelphia, Pennsylvania

• Published in: Perspectives on sexual and reproductive health 2021-09, Vol.53 (3-4), p.27-43
• Main Authors: Akers, Aletha Y., Skolnik, Ava, DiFiore, Gabrielle, Harding, Jennifer, Timko, C. Alix
• Format: Article
• Language: English
• Subjects: Accountability; Adolescent; Adult; Avoidance behavior; Behavior change; Child; Coaching; Content analysis; Contraceptive Agents; Contraceptives; Decision making; Discontinued; Efficacy; Electronic medical records; Exit interviews; Feasibility; Feasibility Studies; Female; Health promotion; Humans; Intervention; Interviews; Mentoring; Needs assessment; Objectives; Patient-centered care; Patients; Pediatrics; Pharmacy; Philadelphia; Pregnancy; Psychological distress; Quality of Life; Questionnaires; Recruitment; Reproductive health; Secondary schools; Sexual health; Statistical analysis; Unwanted pregnancy; Womens health; Young Adult; Young adults
• ISSN: 1538-6341; 1931-2393; 1931-2393
• DOI: 10.1363/psrh.12188

Introduction Few interventions to improve contraceptive continuation are tailored to meet the developmental needs of young women under age 25 years. The Health Coaching for Contraceptive Continuation (HC3) intervention was designed to address this gap. In this special report, we describe the rationale for using health coaching, conceptual framework, intervention processes, and findings from a single‐arm feasibility study of the intervention protocol. Methodology Health coaching is a person‐centered behavioral change approach organized around five main strategies: providing education relevant to health goals, building health self‐management skills, offering patient‐centered counseling, identifying barriers to adherence, and fostering personal accountability for achieving health goals. We used these strategies to affect theory‐driven mediators delineated in the Integrative Model of Behavioral Prediction (intentions, knowledge, attitudes, perceived social norms, and self‐efficacy) and clinical mediators posited to change through program participation (shared contraceptive decision‐making, method satisfaction, quality of life, distress tolerance, experiential avoidance, patient‐coach alliance, and expectations of treatment effect). Experienced sexual health educators completed a manualized, 4‐week health training program adapted from the National Society of Health Coaches. Between March and December 2017, we recruited a convenience sample of sexually‐active women ages 14–21 years who initiated a new contraceptive in the prior 14 days from three urban pediatric clinics in Philadelphia, Pennsylvania. At baseline, participants completed a socio‐demographic questionnaire, contraceptive needs assessment interview, and prioritized reproductive topics to learn more about. We synthesized these data into a coaching plan that guided the monthly coaching sessions which occurred for 6 months following contraceptive initiation. We assessed method adherence and continuation with monthly follow‐up questionnaires and corroborated the findings through electronic medical record and pharmacy refill data review. Exit interviews assessed program acceptability. Feasibility outcomes measured throughout the protocol administration included recruitment and retention success. We used descriptive statistics to assess baseline and follow up questionnaire measures and audio‐recorded and transcribed exit interviews verbatim. Two independent coders used deductive and inductive content analy