JMIR Publications

ABSTRACT

Background:

Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, in New York City adolescents who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections.

Objective:

This qualitative, human-centered design study aimed to guide Black and Hispanic adolescent mothers to identify problem areas in SRH care and co-create health services recommendations with input from healthcare stakeholders to address those problems and improve SRH experiences.

Methods:

Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from pre-pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended two virtual co-creation workshops. In the first, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, healthcare providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second co-creation workshop and named the resulting toolkit.

Results:

Sixteen adolescent mothers participated in 47 interviews, and 10 participants attended at least one co-creation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of healthcare providers and parents, rather than schools, in improving it. Adolescent participants designed messaging to support quality conversations between adolescents, parents, and providers and created a pre-appointment checklist to help young patients initiate conversations with providers. Young participants stressed that the toolkits address topics beyond STIs and pregnancy, like emotional health and relationships. They created guidelines for healthcare providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to respectfully support young parents. Healthcare stakeholders recommended adding information on confidential care and supporting LGBTQ youth and suggested dissemination techniques. In the second workshop, adolescent participants revised the prototypes based on healthcare stakeholder feedback and named the toolkit “First Steps.”

Conclusions:

This study highlighted the important roles that parents and healthcare workers play in adolescent sexual health education. Co-created toolkits offer a practical approach for providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote adolescent health, safety, and well-being.