My Take: Using Digital Tools to Support Sexual Health

By Leslie Kantor, MPH / June 25, 2014

If you work in sexual and reproductive health, you know that the world today is different from the world of only a few years ago. Changes in social media and the digital environment affect norms, risks and behaviors among young people. I’m Vice President of Education for Planned Parenthood, and our organization has some promising new tools that combine what’s known about effective sex education with what young people like to do online. They provide a model that can be helpful across a range of health issues.

Our new series of digital tools are designed to support greater sexual and reproductive health in adolescents and young adults. But before I tell you about these tools, I want to reiterate our belief in the continued value of in-person programs.

Planned Parenthood reaches 1.1 million individuals every year with in-person sexuality education programs. We are deeply involved in replicating a number of evidence-based programs. Many of our local affiliates are developing and testing new programs. We have offerings for parents and teachers. We are doing outreach to the LGBT youth community. About half of these in-person contacts are made in school settings, and about half in the community.

There is a lot of strong pedagogy that can only take place in person and simply can’t be replicated via the technology currently available. In addition, the only sex education programs with demonstrated behavioral outcomes thus far are conducted in person.

Reaching Youth Where They Are

School was once the place where young people spent the greatest portion of their time. Creating school-based programs for sexual health education made sense. Today, adolescents and young adults actually spend more time in the digital realm—on average, more than 7½ hours a day with media such as TV, music, video games and social networking sites. Today, it definitely makes sense to offer educational content in this youth-oriented digital space.

Planned Parenthood has a vibrant, active website that receives more than 6 million visits a month. We also have a strong social media presence. We are on Facebook (one site for young adults, one site for teens), Twitter (general, for teens), Tumblr and Instagram.

We offer a chat-text program designed to reach young people in what we call “moments of urgent need”—when they want to interact with an actual person who can give advice and help them plan next steps. These are the “I think I’m pregnant,” or “the condom broke,” or “I need information about abortion” moments. We’ve had over 345,000 conversations through this program since it began in 2010, with an average of 10,000-12,000 contacts per month, which will expand to 15,000 per month by the end of this year.

All of the digital tools we offer are optimized for mobile use—an approach well suited to a teen/young adult audience. While a digital divide exists for computers and tablets, we find that young people from the lowest income households are just as likely to have smartphones as those from the highest income households.

Raising the Bar: Using the Characteristics of Effective Programs

We’ve had great success with these approaches. We believe that’s because our basic belief in the scientific evidence of what makes sexual and reproductive health education programs effective has been incorporated into this digital work. We wondered what we could do in the digital world that would give people more substantive educational support than a tweet might offer (although we try to bring some science to the tweets we develop as well!). Could we take the 17 characteristics of effective programs, apply them to digital approaches, and end up with something that actually changes behavior?

We’re well on our way to finding out. Over a 2-year period, Planned Parenthood has developed an initial set of nine digital tools designed to provide sex education on mobile phones tailored for both younger and older teens.

We wanted to make sure the content of the tools came from young people themselves, so we worked with focus groups to develop our initial ideas. We were particularly committed to including the input of African-American and Latino teens. Many interventions are created for general youth audiences and later adapted to work with youth of color, but disparities in sexual and reproductive health—STD rates, unplanned pregnancy—continue to be highest among African-American and Latino teens. We chose to bring emphasis to these teens’ perspectives right from the start.

We pulled together an interdisciplinary advisory group, including experts in adolescent development, sexual and reproductive health, and digital content. The group used a common framework of established determinants (the Unified Theory of Behavior) to help us understand the ideas and actions that build positive intentions and support follow-through regarding healthy behaviors.

Once we came up with our initial ideas, we went back to youth focus groups for feedback on everything—word choice, look and feel, effectiveness, interest. The youth had a lot to say, and we made a lot of changes.

Here’s an example. We had a tool designed for younger teens addressing “love personality”—a self-quiz that looks at the values, attitudes and beliefs a young person has about sex. We wanted to create a single tool for males and females. The young people in our focus groups wanted separate quizzes for guys and girls. This was something they communicated strongly and repeatedly to us. So, we developed separate quizzes. We listened, we calibrated, and we listened some more. We made sure that the messages resonated with youth.

Testing, Then Rolling Them Out

We introduced the tools in two phases. In our initial beta phase, close to 50,000 young people used the tools. We monitored what they used, for how long, and at what points they dropped off. We also did in-person testing, both in small groups and individually.

Once again, we made many adjustments to make the tools as appealing and effective as we could. Then we did our big roll out in October, 2013.

Since that time, 133,000 young people have used the apps. The average time spent on the tools is 4.5 minutes. In web app terms, that’s a really long visit. The average time people spend on health apps is 2.5 minutes, and on apps in general it’s about 1 minute.

That’s impressive—even more so when you realize that we are pushing the tools out to young people on Facebook and other websites where they’re not looking for information about sexual and reproductive health.

We’ve also found that the apps are effectively reaching and engaging our target audience. During beta testing, 36% of all users and 47% of those who completed the tools were African-American or Latino.

So—Are They Working?

We know the apps are holding young people’s attention. But, we don’t know yet what effect they’re having on behavioral intentions or behaviors. Raising funding for an efficacy trial is high on our list of priorities.

We’re also interested in getting these sorts of tools out to as many young people as possible and expanding the range of topics. Planned Parenthood’s initial nine apps don’t even begin to cover the areas of need. I believe that lots of youth-serving organizations should be creating tools in the digital arena. To that end, we invite those of you working with young people to join us in these efforts. Please link to Planned Parenthood’s apps from your sites, and begin to develop your own based on the needs and interests of those you serve.

We all must do more to learn how to use these powerful media to support young people in the best ways possible. We need to create more, use more, push them out more, and incorporate them into the work we do. This will move us all in these new directions.

Planned Parenthood is continuing to work on new tools. We’re developing tools specifically geared to LGBT youth. We have plans to do more content on healthy and unhealthy relationships. And we will continue to stay in touch with young people to stay informed about the issues important to them.

We’re a long way from offering true comprehensive sexuality education in the digital space, but these steps are putting the pillars in place. We will continue to learn, to improve, to adapt and to build the structures that make it possible for us to offer the best interventions possible, in a place, time and manner that truly work for teens.

Leslie Kantor, MPH, is Vice President of Education at Planned Parenthood Federation of America, and author of numerous scholarly articles and book chapters on sexual health. She can be reached at Leslie.kantor@ppfa.org, and you can also follow her on Twitter.