Simulation of Contraceptive Access for Adolescents using a Pharmacist-staffed e-Platform: Development and Usability Testing

ABSTRACT

Purpose: Offering contraceptives at pharmacies without a prescription is one solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA) in the US by increasing convince, simplicity, and affordability of contraceptives. The purpose of this study was to develop a Telemedicine e-platform that simulates pharmacist prescribing contraceptives to AYA, and receive feedback from the target population via usability testing of the e-platform prototype. Methods: An existing telemedicine e-platform COVID symptom check-in tool used by a large pediatric hospital system was modified into a prototype to simulate pharmacist prescribing contraceptives to AYA. Usability testing participants enrolled in April 2021 were assigned female sex at birth, 15-21 years old, seeking contraceptive initiation services at a subspecialty academic adolescent medicine clinic, had a prior history or intention to have penile-vaginal intercourse in the next 12 months, owned a mobile device, and could read and speak English. During a one-hour study visit participants first completed brief surveys on their sociodemographic and sexual history. Next, in a video-recorded “think aloud” interview participants verbalized initial thoughts, technical issues, and feedback while they engaged with the e-platform prototype on their own mobile device. Following the interview, participants completed an online survey answering questions on a 5-point Likert scale to evaluate the usefulness, ease of use, effectiveness, reliability, and satisfaction with the prototype. Descriptive analysis was utilized for the analysis of quantitative survey data and thematic analysis was employed for the interview transcripts. Results: Usability testing was conducted with N=10 patients, with a mean age of 16.9 (SD 1.97) years old. Seven participants (70%) reported using birth control to prevent pregnancy and 4 (40%) reported taking a pregnancy test in the past. Overall participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (100%) and make contraceptive use less stigmatizing (100%). Also, participants agreed that receiving birth control prescriptions from a pharmacist without a doctor’s visit would be safe (80%), convenient (80%), acceptable (80%), and easy (80%). Additionally, three main issues with the prototype were identified during interviews. First, participants described difficulty comprehending medical history questions from CDC medical eligibility criteria, suggesting the need to better account for adolescent health literacy in re-design. Next, participants identified glitches with the prototype e-platform to address before moving to production. Lastly, participants shared e-platform design suggestions to improve engagement including, adding images and visually drawing attention to links to important resources or functions (i.e. link to bedside.org, button to call pharmacist directly). Conclusions: AYA found contraceptive prescription by pharmacist via an e-platform to be highly acceptable and provided critical feedback to improve usability prior to final design and pilot testing, including edits for health literacy, and to improve function and aesthetics of the e-platform. Sources of Support CHOP Center for Pediatric Clinical Effectiveness;National Institutes of Health, K23 (NIH K23MH119976-01A, Wood).