Impact of peer adolescent contraceptive counseling in teens (ImPACCT)
Awarded 2013
Complex Family Planning Fellowship Research
Susan Wilson, MD
University of Pennsylvania

Background: Unintended adolescent pregnancy continues to be a significant public health challenge in the US today, with up to 80% of teen pregnancies being unintended. Most unintended pregnancies are due to incorrect or inconsistent use of contraception. Long-acting, reversible contraceptives (the intrauterine device (IUD) and subdermal implant (implant)) are a potentially ideal contraceptive to address these issues since they are user-independent and more effective than traditional forms of birth control. Currently, only 4.5% of US adolescents use a LARC method. Studies have shown that external influences, specifically peers, are a dominant factor in adolescent reproductive health decision-making. While the use of peers has been shown to influence positive healthcare change in many areas, their use in reproductive health care is very limited.
Purpose: To evaluate the impact peer counseling has on same-day desire for long-acting, reversible contraception (LARC) among adolescents attending a family planning clinic.
Methodology: A randomized, controlled trial of 110 adolescents. Participants received either peer counseling in addition to routine contraceptive counseling or routine counseling alone in an outpatient clinic from March to September 2013. Same-day desire for LARC was the primary outcome. Secondary analyses included impact of counseling on knowledge and attitudes regarding LARC, reception to contraceptive peer counselor, and the association between LARC desire and uptake that day in clinic.
Important Findings: Peer counseling was well received; 97% of adolescents enjoyed the counseling session, and 70% reported the counselor was helpful in their contraceptive decision-making. Peer counseling did not affect same-day desire for LARC after controlling for covariates; however, adolescents who received peer counseling were more likely to report an increased knowledge and positive change in attitude toward LARC compared to adolescents who received routine counseling (OR 6.4; 95% confidence interval 2.0-20.2, and OR 5.5, 95% CI 1.3-22.8, respectively). Less than 50% of adolescents who desired placement of a LARC device obtained one on the day of their visit.
Conclusion: Contraceptive peer counseling is well received, and may be an effective strategy to increase LARC use in the adolescent population.
Implications: Peer counselors used in association with other family planning strategies may be a novel approach to increasing adolescent use of highly effective forms of contraception in attempts to prevent unintended teen pregnancy.