JMIR Publications

ABSTRACT

Background:

Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase convenience, simplicity, and affordability of contraceptives.

Objective:

The purpose of this study was to develop, pilot test, and evaluate acceptability and feasibility of a telemedicine electronic-platform (e-platform) application (app) simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits.

Methods:

This study was conducted in two phases: 1) development and usability testing of a prototype app to simulate pharmacist prescribing contraceptives to AYA and 2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded “think aloud” interview to share feedback and technical issues while using the app prototype on smartphone and completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio recorded interview. Descriptive analyses were conducted for quantitative survey data and thematic analyses were employed for interview transcripts.

Results:

Of the 22 participants, 10 completed usability testing with a mean age of 16.9 (SD 1.97) years old, and 12 completed pilot testing with a mean age of 18.25 (SD 1.48) years old. Three issues with the prototype were identified during “think aloud” interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided frontend and backend creation of the platform. Overall participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86.4%) and make contraceptive use less stigmatizing (n=19, 86.4%). Also, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 81.8%), convenient (n=19, 86.4%), acceptable (n=18, 81.8%), and easy (n=18, 81.8%). Pharmacist and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants.

Conclusions:

AYA found contraceptive prescription by pharmacist via an app to be highly acceptable and provided critical feedback to improve design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visit were identical.