Table 2 eHealth for adolescent SRH [23, 53,54,55,56,57,58]

Chen et al. (2016) [54]

Aim: Review mobile apps for pregnancy prevention used in adolescents and young adults (AYAs) to generate guidelines on best practices

Methods

• 22 free English smartphone Apps in the Apple App Store (n = 13) and Google Play (n = 9) (identified in 2015) were included

• P: AYAs

• Countries: most targeted the US/Canada (k = 9) and UK (k = 7). Some apps focused on LMICs (k = 3): Kenya, Pakistan

• Almost all (k = 21) apps provided info relevant for both males and females

• Almost half (k = 10) of the apps were downloaded less than 1000 times, 4 were downloaded 1000 to 10,000 times, and 8 apps did not have info

• App characteristics: in app store categories: Health & Fitness (k = 8), Education (k = 5), Lifestyle (k = 6), Reference (k = 1), Medical (k = 1), and Entertainment (k = 1). Most cited credible info from a reputable public health source like CDC (k = 17) and provided SRH education (k = 19). Many also provided linkage to care (k = 13) and counseling or support (k = 12)

• User Interface features: the most common features were for clinic and service locators (k = 12). < 50% (k = 9) had GPS capabilities. Less than a quarter offered entertainment, gamification, or communication features (k = 5, 5, and 4, respectively)

• E-SRH TX topics: most include unintended pregnancy prevention (20/22 condom use info, 14/22 contraception use info, 14/22 service location); STI (19/22), provide info about or refer for abortion services (12/22); < 50% apps describe or counsel on abusive relationships/IPV (10/22), alcohol/ substance abuse (5/22), refer for pregnancy testing (10/22), mentioned confidentiality/privacy (10/22), state app is not a replacement for professional medical advice (4/22)

• High quality Apps: 3 are recommended- (i) my choice by PPT (includes 5 of the 8 best practices and one promising practice. (ii) Safe Sex Tips (includes 5 best practices but no promising practices), (iii) Get S.M.A.R.T. (includes 4 best practices and 2 promising practices)

• Apps with high # SRH features: 6 Apps included 4 or more SRH features. my choice by PPT includes the highest SRH features (6/7)

• Evidence not examined

• Generate 8 best practice guidelines for developing mobile apps for AYA pregnancy prevention (Mobile Criteria for Adolescent Pregnancy Prevention; mCAPP)

• How the best pregnancy prevention practices guideline integrated in the Apps: among the 8 guideline, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22)

Gabarron et al. (2016) [55]

Aim: Scoping review of literature on the use of online social media for sexual health promotion & STIs prevention

Methods

• 51 articles published between 2020–2015 were included (4 RCT, 39 non-randomized, 8 observational studies)

• P: AYAs. 59% of studies (k = 30) focused on youth or young people (aged 11–29 years), 11 (22%) focus on adults

• Countries: Most were in developed countries (US, Canada, Europe, Australia, New Zealand), 10 in LMICs (Nigeria, Ghana, Pakistan, Peru); and in 79 countries

• Technology/Social media platforms used: Facebook, Twitter, YouTube, Instagram, and Snapchat were used. 86% publications (n = 44) used Facebook

• E-SRH TX topics: 57% of studies (k = 29) focused on the ‘general’ sexual health promotion or to increase STI testing; 29% focused on the incurable STI, HIV (k = 15), and 14% addressed curable STIs such as chlamydia, syphilis, gonorrhea, or HPV (k = 7)

• Digital-Strategies: 23 publications used social media as only strategy to promote sexual health, and 28 publications use social media as resource tools (website, games, on-air component) to support a sexual health promotion

• In 4 RCTs (all use Facebook), 2 for STI and 2 for HIV prevention

• In 39 non-RCT studies (use Twitter, YouTube, Facebook, Whatsapp, MySpace), 5 applied theory (Kelly’s opinion leader model, game-based learning with participatory, Penders’ health promotion, peer education model)

RCT evidence: (1) positive association between participation in the Facebook group (↑network ties) and the likelihood of HIV testing, follow-up for test results, and participation in group discussion; (2) 2-month short-term, but not 6-month longer term TX effect on condom use and sex acts protection. (3) no impact on HPV vaccination rate

Non-RCT evidence: Two projects referring to the Kelly’s popular opinion leader model and Pender’s health promotion model, reported positive results regarding an increase in intention to test (43.9%/22.3%) and in intention to use condoms (34.2%/26.2%); 23% reported an increase in condom utilization, and 54% reported a reduction in positive chlamydia cases among 15–17 years olds

Observational study evidence: social media were reported to be pervasive, and the study participants reacted positively to using new technologies for sexual health promotion or education. In studies with adults, the importance of considering privacy, stigma, and social norms was emphasized, and in this sense, links to social media profiles were not considered to be appealing

L’Engle, et al. (2016) [57]

Aim: Systematic review of mobile phone TXs for adolescent SRH

Methods

• 35 articles, representing 28 programs published between 2000 & 2014 were included

• 9 RCTs test the impact on SRH (knowledge, sexual behavior, medication adherence, and contraception use, quality of health service delivery, uptake of health screening and treatment services)

• P: Target 10–24 years AYAs both genders

• Countries: 7 Countries. 21 US (including Laatino, African American), 4 Australia/New Zealand, 1 Netherlands. 1 Tanzania, 1 Democratic Republic of the Congo)

• E-SRH TX topics: 8 focused on pregnancy, 4 on contraceptive method, 2 on youth assets and broader pregnancy prevention messaging, 2 to pregnant or parenting adolescents. 8 on STIs (STI vaccination, screening, or treatment), 8 on HIV/AIDS (prevention or support for HIV-positive youth)

• Mobile phone function used: Most programs (82%) used text messages (a mobile platform for youth to text SRH questions). Some add mobile phone voice call, and a few use mobile phone videos, email, instant messaging, or multimedia applications

• Digital Strategy used in SRH TXs: (1) Health promotion campaigns (43%) were the most common purpose of the e-SRH TXs. These TXs provided a mobile platform for youth to text SRH questions to professionals, allowed adolescents to retrieve on-demand SRH content and offered “push” messaging where SRH content was texted to adolescents on a regular schedule. (2) The mHealth TXs for screening and follow-up service utilization (k = 7) included human papillomavirus (HPV) vaccination text message reminders for follow-up, notification for positive chlamydia and other STI results, and chlamydia screening promotion. Patient adherence to medications or health recommendations was addressed in 7 additional programs that provided text message reminders for taking daily oral contraceptive pills or ART for HIV patients

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• High acceptability for using technology

Impact evidence by focus of TXs

• Health promotion campaigns with curriculum (e.g., multimedia + SMS messaging) was association with more optimal sexual health knowledge and behaviors (↑protected sex & STI testing)

• STI screening/follow-up TXs: (1) combining text messages with a small financial incentive to encourage screening; (2) SMS to parents or teens yielded higher rates of receiving second and third doses of the HPV vaccine and more timely completion of the HPV vaccine series

• mHealth Provider Counseling: follow-up mobile phone calls (for reminder or support) improve adherence to HIV TX, but inconsistent or no evidence to support impact on contraceptive behavior, STI rates, or other SRH outcomes

• Text messages on oral contraceptive pill (OCP) use: individuals received education text messages or video messages were more likely to improve OCP knowledge and continue OCP use overtime; interactive text message provide a helpful tool to identify and respond to adherence challenges

Badawy et al. (2017) [53]

Aim: Systematic review of texting & mobile phone app TXs for improving adherence to preventive behaviors

Methods

• 19 experimental or pre-experimental design (11/19 RCTs, 5 user ITT), literature published between 1995–2015 were included

• 2–12 months follow up period

• P: Adolescents 12–24 years old

• Countries: Most studies were performed in the United States (47%, 9/19), included diverse younger adolescents ≥ 12 and < 18 years (63%, 12/19)

• Settings: Most were conducted in a clinical setting (9), others were in university (3), vocational schools (2), summer camp (1), participant’s home (1)

• SRH & Behavioral TX topics: The 11 RCTs examined whether texting/mobile phone improve adherence to sexual health behaviors (k = 3), smoking & alcohol use (k = 2), and other behaviors (k = 6; weight management, oral hygiene)

• Digital Strategy used: TXs based on texting or Apps

(i)Texting TX (15 studies): 10 included texting only, 5 included additional components (2 added in-person training sessions, 2 added WB program, 1 added internet-based curriculum). Text reminders were sent once daily in 7 studies, once or twice weekly in 5 studies. Text reminder directionality was 1-way in 7 studies, 2-way in 8 studies, with emotion icon response in 1 study, and sophisticated tailored algorithm in 3 studies. Appointment reminders were sent at a differing frequency (1 reminder/day in 7 studies; daily for 3 days before in 1 study; customized to patient preference in 5 studies). Text messages were also used as a tool for Education (k = 7), positive reinforcement or personalized feedback (k = 5), goal setting (k = 3), addressing barriers (k = 1), or for incentive/as a reward system for promoting patient engagement (k = 9)

(ii)Mobile App TXs (5 studies): It has not been used for SRH. 2/5 use Apps to improve fitness adherence behaviors (WhatsApp, Zombies, Run! 5 K Training app)

• Only 32% of studies (k = 6) incorporated a behavioral theoretical framework in design (e.g., Transtheoretical Model, Geser’s Sociological Framework, Health Belief Model and Information Motivation Behavior Model, Health Action Process Approach, Stages Motivational Readiness for Change Model, Addiction Treatment Model)

• In 3 studies related to SRH, texting did not improve condom use, drug or alcohol use before last sex (ns), or improve SRH knowledge (e.g., HIV), attitude toward condoms, or reduction in risk behaviors (during intercourse, illegal drugs use). Testing does improve HPV vaccine does 2 and 3 completion

• Most studies reported good feasibility with high acceptability and satisfaction. About half of the included studies (42%, 8/19) demonstrated significant improvement in preventive behavior with moderate standardized mean differences

• Most studies were low to moderate in quality

Ippoliti, et al. (2017) [56]

Aim: Review phone programs for adolescent SRH in LMICs

Methods

• 17 SRH projects were review (include GBV, contraception methods/ knowledge, sexual health, STI info, HIV, family planning; improve provision of medical abortion and post abortion family planning use)

• P: Youth ages 10–24 (in or out of school adolescents)

• Countries: 67% Africa (e.g., Nigeria, Senegal, Morocco, Egypt, Cambodia), 26% Eurasia (European & Asia), and 13% Latin American countries

• SRH TX topics: The majority of mHealth projects (82%) were for SRH health promotion (to facilitate knowledge sharing and behavior change). Other projects (18%) used mHealth as a way to link users to essential SRH services (e.g., family planning counseling services, medical abortion and post-abortion care, and HIV care and treatment)

• Phone use Strategies: Little variation in delivery methods for TX content, as 70% of the projects relied on text messaging to facilitate knowledge sharing and behavior change (e.g., transmit health message on post-abortion care, psychosocial support for cases live in HIV, theory-based role model story narratives, counseling). The remaining TXs (5 projects) employed a mix of informational hotlines, social media/Facebook, and email applications to reach & support their users

• SMS functionalities for knowledge sharing: (i) SMS provide a platform for youth to text SRH question to a health professional, allow the adolescent to retrieve “on-demand” SRH content through a question and answer platform, (ii) “push” SRH messaging (through an information message system) to adolescent on a regular schedule; share role model stories that show common barriers to contraceptive use faced by youth; (iii) use social media website online forum and mobile apps to disseminate HIV prevention, treatment, and care info

• Mobile functionalities for providing psychosocial support: using SMS or Voice-based info hotline to support HIV positive adolescents

• Implement by trained counselors: train counselors to provide rapid, accurate, and non-judgmental answers, or use a database of answers to frequently asked questions or customized replies

TX Examples:

• m-ASSIST and Project Khuluma use SMS to transmit a message on post-abortion care and psychosocial support for HIV youth, respectively;

• m4RH and mCENAS use SMS to transmit role model stories about family planning, contraceptive use and decision-making in reproductive age

• Learning about Living uses Q&A service operates (on SMS & internet- platforms) to provide knowledge and support for sexual health

• ChatSalud in Nicaragua uses a SMS interactive platform for health promotion (allows users to customize which info to read)

High acceptability: SMSs delivered through the mobile platform were reported high acceptability

Limited effectiveness evidence: RCT studies found (i) m4RH improved family planning knowledge, but not family planning use;(ii) m-ASSIST reduce anxiety and stress for those who receive SMS message and standard care;

Widman, et al. (2019) [58]

Aim: Meta-analysis of the literature on technology-based sexual health TX

Methods

• 16 experimental studies (RCT or quasi-experiment), published in English & before May 2017, & included condom use and abstinence as outcomes

• P: Youth ages 13–24. Most study focused on boys and girls (k = 9), but a few studies included only boys (k = 3) or girls (k = 4)

• Countries: Most from the US (k = 11)

• Technology used in the e-SRH TXs: e-Sexual Health interventions were reviewed (5 programs delivered via computer programs, 2 were through internet websites, 1 through texting, 1 through social media), and nearly half were with more than one method (e.g., internet + email follow up, or texting + email delivery)

• Digital strategies: TXs tended to use interactive (accept input from the user, k = 12) and tailored (k = 10) e-strategies. The dose of TX varied, range from 1–2 sessions (k = 5) to 7 or more sessions (k = 8)

Subgroup Comparisons: Effects did not differ by age, gender, country, intervention dose, interactivity, or program tailoring. However, effects were stronger when assessed with short-term (1–5 months) compared to longer-term (greater than 6 months) follow-ups

Condom use & abstinence: There was a small but significant protective effect of technology-based interventions on condom use (d = .23, 95% CI [0.12, 0.34]) and abstinence (d = .21, 95% CI [0.02, 0.40], p = .027)

Other SRH outcomes: Compared to control programs, technology-based interventions were also more effective in increasing sexual health knowledge (d = .40, p < .001) and safer sex norms (d = .15, p = .022) and safe sex attitudes (d = .12, p = .016). No impact on safer sex intentions or perceived self-efficacy to engage in safer sexual behavior

Teadt et al. (2020) [23]

Aim: Scoping review for the use of New media platform for sexual health

Methods

• 16 studies were included (5 systematic review articles for social media, internet, web/based, social media TXs that included > 130 articles with African American youth)

• P: African American AYAs

• Types of SRH TXs: utilizing new media for improving contraception or condom use, communicating credible information regarding HIV and STIs, reducing the transmission of HIV and STIs, improving attitudes around sexual health, and promoting STI testing–related behaviors

• New media platforms are defined as social networking sites, collaborative websites, blogs (for opinion sharing/discussion), content communities (for entertainment, info sharing), virtual reality/online gaming, communication/messengers. The most common forms utilized within the included studies were social media (e.g., Facebook, Twitter) (k = 10), internet-based interventions (e.g., It’s Your Game-Tech, Keep It Up!) (k = 5), mobile applications (k = 4), and interactive video games (k = 2)

Feasibility of using new media for Reaching Youth & at-risk youth: use media (Facebook) to reach a larger number of youth for sharing STI/HIV related info was highly feasible (85% viewing Facebook after invite; youth are highly motivated to access SRH info through new media given accessibility; marginalized groups were easy to engage in HIV care given user anonymity and less concern stigma/discrimination). ~ half of the studies (7/16, 44%) reported utilizing new media as an effective SRH promotion tool due to ease of use and wide accessibility in AYAs

Change in sexual health-related attitudes and behaviors: several studies found the effects on sexual health knowledge, attitude/belief in delaying sex, self-efficacy in condom use, and having protective sex (e.g., one scoping review found an increase in the utilization of services/ # referrals/ testing; other study found 54% participants view STI info on Facebook as the most critical factor in their decision to change high-risk sexual behaviors)