STRESS LESS ABOUT SEX: A PEER-LED SMS MODEL TO INCREASE ACCESS TO SEXUAL HEALTH AND FAMILY PLANNING SERVICES

Erika DugayJohn GuigayomaAsian & Pacific Islander Wellness Center

Affiliated Agencies

Mission: We transform lives by advancing health, wellness, and equality.

Mission: To provide technology adoption and field-building services to clients and also design technology-rich initiatives that hold promise for

national impact.

Mission: To empower healthcare organizations with mobile technologies to improve health literacy and self-health

management while fostering more efficient care delivery.

About Teen Mobile: Stress Less About Sex

• 1-year $100k grant funded by Google Impact

• Sexual health program via text message for 150 Tenderloin youth ages 13-18

• Four cohorts of 40 participants each at 3-month intervals

Program Timeline

SEPT OCT NOV DEC JAN FEB MAR APRIL

MAY

FORMATIVE

OUTREACH

COHORT 1 EVALUATIONS

COHORT 2

OUTREACH COHORT 3

OUTREACH COHORT 4

Program Goals & Objectives

1. Increase access to sexual and reproductive health information among youth in the Tenderloin neighborhood of San Francisco

1.1 By the end of the project period, 150 youth will have enrolled in the Teen Mobile: Stress Less About Sex Program.1.2 By the end of the project period, participants in the Teen Mobile: Stress Less About Sex Program will have received at least four sexual and reproductive health messages1.3 By the end of the project period, 75% of participants will report increased knowledge of sexual and reproductive health issues as measured by responses inbaseline and exit questionnaires.

2. Increase access to sexual and reproductive health services among youth in the Tenderloin neighborhood of San Francisco

2.1 By the end of the project period, 75% of participants will report increased knowledge of sexual and reproductive health resources and services in the Tenderloin

that are youth-friendly and culturally competent2.2 By the end of the project period, 75% of participants will be offered sexual and reproductive health resources and services in the Tenderloin that are youth-friendly and culturally competent.

SF Tenderloin Neighborhood Demographics

Figure 1. Map of Tenderloin Neighborhood, Google Maps

(2015)

Needs of the Tenderloin

• Limited youth programs• Increased services needed for low income, recent immigrants,

and LGBT youth• Health and wellness programs• Comprehensive health services

Figure 2. Needs of SF Youth by Department of Children, Youth, and Families

(2012)

Topic 1: User Input

Formative Planning Community Mapping Focus Groups

Tenderloin Clubhouse – Boys & Girls Club of San Francisco

Larkin Street Youth Services Provider Interviews

Tenderloin Clubhouse – High School Services Director

Larkin Street Youth Services – HIV Test Counselor

Vietnamese Youth Development Center – Program Manager

Formative research

Mobile tech a primary mode of communication Cellphone messaging; Snapchat, Facebook,

Instagram Youth would Google sexual health

information but were unsure of credibility

Barriers Socioeconomic challenge to teens

accessing services LGBT Homeless / foster children No access to personal smartphones

First Draft of Text Messages

• Text message topics based on gaps found in literature and insights from focus groups

• LGBTQ track created to target specific sexual health needs

Cohort 1 + 2 Outcomes

Knowlege of Sex and Sexual

Health

Knowledge of Birth Control

Methods

Knowledge of STDs

0%

40%

80%

11%23% 20%

67% 64% 64%

20% 13% 16%

Cohort 1 & 2 Baseline Survey Results

A lot of Questions Pretty GoodShare info with Friends

Baseline Question

Perc

enta

ge

Knowlege of Sex and Sexual

Health

Knowledge of Birth Control

Methods

Knowledge of STDs

0%

20%

40%

60%

5% 5% 5%

55% 55% 58%

30% 31%23%

Cohort 1 & 2 Exit Survey Results

A lot of Questions Pretty Good

Exit Question

Perc

enta

ge

N = 64

N = 64

Cohort 1 + 2 Participant Feedback Less didactic messaging

General topics lowered interest More engagement opportunities

True/false questions Multiple choice questions Links to more resources and information In-person meetings

More harm-reduction content “We’re going to end up doing it anyway… We

know the risks, but what else do you suggest?”

Second Draft of Text Messages

• Added links to multiple choice responses

• Made each multiple choice conditional response more specific

• Generated new content based off user demographics and survey data

• Added more info on relationships and family planning services

• Made the tone more youth friendly/less judgmental

Cohort 3 Outcomes

Knowlege of Sex and Sexual

Health

Knowledge of Birth Control

Methods

Knowledge of STDs

0%

40%

80%

3%18% 15%

72%56% 62%

7% 8% 5%

Cohort 3 Baseline Survey Results

A lot of Questions Pretty GoodShare info with Friends

Baseline Question

Perc

enta

ge

Knowlege of Sex and Sexual

Health

Knowledge of Birth Control

Methods

Knowledge of STDs

0%

20%

40%

60%

80%

5%13% 13%

68% 71% 68%

24%16% 13%

Cohort 3 Exit Survey Results

A lot of Questions Pretty Good

Exit Question

Perc

enta

ge

N = 39

N = 38

Overall Learnings

Topic 2: Peer-Led Education

Team meetings originally for retention and engagement

Peer leaders across all cohorts requested bigger projects

Creating awareness through social media Friendly, accessible sexual

health information for high school teens

Text Message

Disseminate

d

• A topic is introduced to a peer leader

Team

Meeting

• Discuss text messages and topics among peer leaders based on sexual health interest• Did you learn anything new?• How does this apply to you or

your peers?• What else would you like to

see?

Publicize via Social

Media

• Blogging • Instagram• Twitter• Facebook

Cohort 1 + 2 Peer Education Cohort 1- Galileo High School Associated

Student Body members Created a Blogger Incentivized project Addressed experiences in their life and how

sexual health plays a role Cohort 2 - Galileo High School Wellness

Clinic: Youth Outreach Workers (YOWs) Created a Twitter Lack of content development - loss of

motivation

Cohort 1: Blogger

URL: http://www.friendswithbenefitz.blogger.com

Cohort 3 and 4 Peer Education Cohort 3 – Boys and Girls Club /

Tenderloin YMCA Cohort 4 – Referrals from Cohorts 1 and 2 Difficult to maintain motivation for a social

media project Cohort collaboration to design an

outreach flyer Teens designed content and provide

feedback Outreach flyer to be passed out to program

participants and local organizations

Cohort 3 + 4 Outreach Flyer

FAMILY

PLANNINGBirth Control | IUDs | STD/STIs | Pap Smear

Tests

ASIAN & PACIFIC ISLANDER WELLNESS CENTER

730 Polk St. San Francisco, CA, 94109Tel 415.292.3400 | Fax 415.292.3404

Email: theclinic@apiwellness.orghttp://www.apiwellness.org/wellnessclinic.html

Clinic Schedule: Wednesdays 1pm-4pm & Fridays 1pm-6pm (By

appointment)

Directions to the Asian & Pacific Islander Wellness Center

The Asian & Pacific Islander Wellness Center (corner of Eddy & Polk St.) is accessible through MUNI Lines 19, 47, 49, 38 and is within minutes

from Civic Center Bart Station

Overall Learnings

Identifying strong peer leaders Strong client engagement

Community building A program for teens by teens

Face-to-face contact to maintain engagement Leading to sexual health referrals

Overall Learnings

Erika Dugay

erika@apiwellness.org

John Guigayoma

johng@apiwellness.org