JMIR Publications

ABSTRACT

Background:

Adolescents experiencing marginalization face challenges accessing care for mental health (MH) and sexual and reproductive health (SRH). In previous work, we demonstrated acceptability of our community outreach event focused on SRH (AccessKCTeen), one element of an anticipated multi-level intervention. We now include MH content and trained peer leaders (PL) to foster support for healthy behaviors and overcome care-seeking barriers.

Objective:

To conduct feasibility testing of AccessKCTeen 2.0, our expanded, multi-level intervention to increase adolescent access to care.

Methods:

We conducted a prospective, open trial. We first recruited adolescents aged 14-18 years from structurally marginalized neighborhoods to serve as PL, who then recruited friends to participate as part of their network. PL were trained to share SRH/MH information with their networks, including information on SRH/MH community outreach events (i.e., social and educational gatherings to disseminate health facts and care connections) designed for this study. We used participant surveys and staff field notes to assess feasibility constructs: acceptability, practicality, implementation, and limited efficacy. Participants completed surveys at baseline (demographics) and at 2, 4, 6 months after enrollment (care utilization, PL intervention satisfaction, and friend trust in PL). Staff completed field notes at training sessions and outreach events.

Results:

We recruited and trained 18 PL (median age 16 years; interquartile range (IQR): 15.5, 17); they recruited 32 adolescents into their networks (median age 15 years; IQR: 15, 16). Most participants were Black (72%), female sex at birth (58%), and heterosexual (60%). We completed seven outreach events. Nearly all (91%) PL were satisfied and felt supported by the study team; community events were deemed valuable (acceptability). All PL felt prepared for their role after training, but some had challenges recruiting adolescents into their network, and some did not ultimately discuss MH or SRH content with their network (practicality). Nearly all (89%) of network friends said they trusted information from their PL (implementation). One in four participants reported SRH/MH care utilization by six months (limited efficacy).

Conclusions:

Adolescents from structurally marginalized communities evaluated a multi-level intervention to increase SRH and MH care access. Evaluation of multiple feasibility constructs was favorable. Additional refinement to enhance peer-to-peer recruitment and communication and then assessment of efficacy is warranted. Clinical Trial: NCT05444855)