You’ve got a friend: Does peer testimonial increase LARC uptake in adolescents more than provider counseling?
Awarded 2013
Complex Family Planning Fellowship Research
Juliana Melo, MD, MSc
University of Colorado

Background:  Adolescents and young adults have the highest rates of unintended pregnancy in the US.  Long-acting reversible contraceptive (LARC) methods are highly effective and are recommended as first line birth control methods for all women.  Less than 5% of adolescents who use birth control use LARC methods.  In our clinical setting, having a high pre-visit acceptability for LARC as measured by the question “On a scale from 0 to 10, how much do you like the idea of using (*contraceptive method) for yourself?” was highly predictive of LARC initiation.  Having a friend who used a LARC method and liked it was the biggest predictor of high pre-visit LARC acceptability.  Young women with mid-range acceptability or no prior knowledge of LARC have an approximately 45% LARC uptake, suggesting some provider influence at the clinical encounter.  
Objective:  The objective of this study was to compare same day LARC initiation among young women without high pre-visit LARC acceptability who view an informational video featuring peer models to similar women who view a similar video featuring a physician.
Methods:  This study was a randomized controlled trial of the two video interventions with same day LARC uptake as the primary outcome.  Women ages 14-24 presenting to our adolescent-focused Title X clinic for contraceptive initiation were screened for LARC pre-visit acceptability.  Those who had never heard of IUDs or subdermal implants, and/or did not have high pre-visit acceptability for either method were randomized to view one of two 2.5 minute videos.   The informational content in each video was similar, and was based on a qualitative study of contraceptive initiators from this clinic.  In one video, the information was delivered by two adolescents and in the other by a physician.  Clinicians were blinded to study allocation.  Participants completed pre-visit surveys which determined study eligibility and collected demographic, reproductive, and knowledge/attitudes/beliefs data, and post visit surveys which measured the methods initiated and the confidence in that choice. 
Results:  981 women were screened for the study and 193 (19.7%) met eligibility criteria.  181 participants were randomized (95 to MD video and 86 to teen video) and 12 declined further participation.  There were no significant differences between either intervention group with respect to age, race/ethnicity, gravidity, and parity.  Same-day LARC initiation was not significantly different between the two groups (MD video: 43.2% vs. teen video: 40.7%, p=0.74) or when compared to the historical control group of 2012 (control: 45%, p=0.76). 
Conclusions:  LARC uptake is associated with high pre-visit acceptability, which is highly predicted by having a friend who uses and likes LARC.  Among women presenting to this title X family planning clinic who did not already have a strong preference for LARC, a pre-visit video intervention did not result in higher LARC uptake.