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A Technology-Based Peer Education Intervention: Results from a Sexual Health Textline Feasibility Study

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Title: A Technology-Based Peer Education Intervention: Results from a Sexual Health Textline Feasibility Study
Language: English
Authors: O'Malley, Teagen L., Horowitz, Katie Rose, Garth, José, Mair, Christina, Burke, Jessica G.
Source: American Journal of Sexuality Education. 2017 12(4):383-394.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 12
Publication Date: 2017
Document Type: Journal Articles
Reports - Research
Education Level: High Schools
Descriptors: Sex Education, Sexuality, Technology Uses in Education, Educational Technology, Handheld Devices, Telecommunications, Peer Teaching, Teaching Methods, Pregnancy, Prevention, School Community Programs, Training, High School Students, Program Effectiveness, Access to Information, Computer Software, Observation, Audio Equipment, Radio, Feasibility Studies
Geographic Terms: Pennsylvania
DOI: 10.1080/15546128.2017.1372831
ISSN: 1554-6128
Abstract: Sexuality health education is moving beyond the classroom, with technology expanding youth access to sexual health information. While text message services are increasingly being used to provide information, a peer education approach has yet to be incorporated. Results from this feasibility study support a sexual health textline (IOTAS), incorporating teens asking and answering questions. Our findings suggest IOTAS fills a gap for sexual health information, and the technology-based approach offers peer educators an opportunity to expand their knowledge of healthy sexual behaviors and educate an extended peer network. Further work to refine IOTAS will enable dissemination of the intervention model.
Abstractor: As Provided
Number of References: 18
Entry Date: 2018
Accession Number: EJ1167792
Database: ERIC
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  Value: <anid>AN0127414486;[1h2p]01oct.17;2019Jan31.11:30;v2.2.500</anid> <title id="AN0127414486-1">A Technology-Based Peer Education Intervention: Results from a Sexual Health Textline Feasibility Study </title> <p>Sexuality health education is moving beyond the classroom, with technology expanding youth access to sexual health information. While text message services are increasingly being used to provide information, a peer education approach has yet to be incorporated. Results from this feasibility study support a sexual health textline (IOTAS), incorporating teens asking and answering questions. Our findings suggest IOTAS fills a gap for sexual health information, and the technology-based approach offers peer educators an opportunity to expand their knowledge of healthy sexual behaviors and educate an extended peer network. Further work to refine IOTAS will enable dissemination of the intervention model.</p> <p>Keywords: Adolescents; peer education; sexual health; text messaging; textline</p> <p>Although public health, medical, and educational professional organizations broadly recognize the importance of comprehensive sexuality health education for prevention of sexually transmitted infections (STIs) and unintended pregnancy among youth, there has been a decline in recent years in adolescents' receipt of formal sexuality health education in the United States, especially for youth living outside of metropolitan areas (Lindberg, Maddow-Zimet, & Boonstra, [<reflink idref="bib11" id="ref1">11</reflink>]). Without school- or community-based education, youth lacking access to relevant, reliable, and confidential sources for sexual health information most often turn to the Internet for their questions (Boyar, Levine, & Zensius, [<reflink idref="bib2" id="ref2">2</reflink>]).</p> <p>While Internet searches do increase youth access to health information, a number of barriers may still prevent access to high-quality, medically-accurate information. These include youths' perceptions of stigma around being "caught" searching for sexual health information; a lack of knowledge about reliable online sources for health information; a high reliance on results found on the first page returned, regardless of the source; other difficulties sorting search results; and mistrust of information found online (Magee, Bigelow, Dehaan, & Mustanski, [<reflink idref="bib12" id="ref3">12</reflink>]; Starling, and Cheshire, [<reflink idref="bib16" id="ref4">16</reflink>]; Wartella, Rideout, Montague, Beaudoin-Ryan, & Lauricella, [<reflink idref="bib19" id="ref5">19</reflink>]). As the field of sexuality education seeks to meet youth outside the classroom, it must simultaneously improve the experience of searching for and finding reliable sexual health information online, while also employing innovative technology approaches that engage youth using methods beyond online searches.</p> <p>Given that phone ownership is widespread among American youth and that text messaging is highly acceptable, with the typical youth sending over 30 text messages a day, mobile interventions represent an opportunity to reach a broad population (Anderson, [<reflink idref="bib1" id="ref6">1</reflink>]). In 2015, 88% of American teens ages 13–17 had access to a mobile phone of some kind, with African-American teens having higher rates of access than their White and Hispanic counterparts, at 92% versus 88% and 86%, respectively (Anderson, [<reflink idref="bib1" id="ref7">1</reflink>]). Ninety-one percent of teen cell phone users employed some form of text messaging, either through their phone's messaging functionality or a messaging app like WhatsApp (Anderson, [<reflink idref="bib1" id="ref8">1</reflink>]). In addition to acceptability and accessibility, SMS (short message service) interventions may also uniquely address health equity goals, since they utilize a technology with few barriers for people across different socioeconomic status and race.</p> <p>In [<reflink idref="bib7" id="ref9">7</reflink>] Hall, McDermott Sales, Komro, and Santelli called for the development of multipronged approaches that "reach beyond the classroom and capitalize on cutting-edge, youth-friendly technologies ... to shift cultural paradigms of sexual health, advance the state of sex education, and improve sexual and reproductive health outcomes for adolescents in the United States." (Hall, McDermott Sales, Komro, & Santelli, [<reflink idref="bib7" id="ref10">7</reflink>], p. 596). To date, interventions have included mobile applications focused on sexual health, social media interventions, and gaming experiences, with several demonstrating promise in increasing self-efficacy and/or knowledge around sexual health, delaying sexual initiation, increasing intentions to use condoms, and other positive sexual health outcomes (Chávez, Shearer, & Rosenthal, [<reflink idref="bib3" id="ref11">3</reflink>]; DeSmet, Shegog, Van Ryckeghem, Crombex, & De Bourdeaudhuij, [<reflink idref="bib4" id="ref12">4</reflink>]; Guse et al., [<reflink idref="bib6" id="ref13">6</reflink>]). Targeted text message services represent another innovative model increasingly being used to provide sexual health information to youth. Texting has been incorporated into interventions in a variety of ways. For example, information can be delivered via text on a set schedule [e.g., The Hookup; (Perry et al., [<reflink idref="bib14" id="ref14">14</reflink>])]; adolescents can text requests for information on specific topics [e.g., SEXINFO; (Levine, McCright, Dobkin, Woodruff, & Klausner, [<reflink idref="bib10" id="ref15">10</reflink>])]; and youth text questions directly to a health educator [e.g., BrdsNBz; (Phillips, [<reflink idref="bib15" id="ref16">15</reflink>]), Planned Parenthood Federation of America's Chat/Text (Giorgio, Kantor, Levine, & Arons, [<reflink idref="bib5" id="ref17">5</reflink>]), In Case You're Curious (ICYC In Case You're Curious, [<reflink idref="bib8" id="ref18">8</reflink>])]. Some models combine two or more of these approaches [e.g., TxTina, which utilizes weekly sexual health tips and quizzes in conjunction with open hours during which youth can text their questions (TxTina, [<reflink idref="bib18" id="ref19">18</reflink>])].</p> <p>Peer education interventions that train youth to promote sexuality health education have been used widely for decades (Kim & Free, [<reflink idref="bib9" id="ref20">9</reflink>]). The term "peer education" is broad, encompassing intervention models that vary widely. Due to this heterogeneity, generalizations about the overall effectiveness of peer education for improving adolescent sexual health outcomes have been difficult to make. However, recent reviews have highlighted numerous examples of peer education models that have demonstrated significant positive effects on sexual health knowledge, attitudes, and intentions among youth, as well as a number that have demonstrated improved sexual health outcomes (Kim & Free, [<reflink idref="bib9" id="ref21">9</reflink>]; Maticka-Tyndale, & Barnett, [<reflink idref="bib13" id="ref22">13</reflink>]).</p> <p>Because of the success of both peer education and text messaging interventions to promote sexual health among youth, engaging youth through a peer education model that utilizes text messaging to allow peer educators to respond to texted sexual health questions has great potential. While text message services are already being used to provide sexual health information to youth seeking information, to our knowledge, only one program [Teen Health Source (Teen Health Source, [<reflink idref="bib17" id="ref23">17</reflink>])] has employed a model that also allows youth to engage in answering sexual health questions. Teen Health Source, a program of Planned Parenthood Toronto, allows youth to communicate one-on-one with a trained youth volunteer through text, email, phone, or chat via their website. Trained youth volunteers (ages 16–19) help contactors find answers to questions and provide local clinic and community resource referrals. Teen Health Source incorporates peer education and provides services during specific hours (Mondays through Thursdays between 4 and 9 p.m. and Saturdays between 12 and 5 p.m.), with peer educators coming in person to a community site to staff the line. Teen Health Source staff report that they consistently have interested teens to volunteer as peer educators and receive an average of 156 contacts per month.</p> <p>This paper provides an overview of the refinement and assessment of the acceptability and feasibility of a youth-friendly, confidential sexual health textline designed to engage both teens asking and answering questions, powered by a custom mobile app that allows adults and youth to collaborate in real time and from different locations.</p> <hd id="AN0127414486-2">Background</hd> <p></p> <hd id="AN0127414486-3">Peer education program model</hd> <p>Planned Parenthood of Western Pennsylvania (PPWP)'s Peer Helpers peer education program operates in seven middle and high schools in western Pennsylvania and is currently in its 27th year. Two hundred and fifty Peer Helper students participate on a long-term basis in weekly sessions of comprehensive sexuality education and peer educator skills training, utilizing evidence-based pregnancy prevention curricula and established sexuality education methodology and guidelines. The program, run by the PPWP Education Department, has dual goals of pregnancy prevention and school completion and measures changes in students' knowledge, attitudes, and behaviors around sexual health topics.</p> <p>Previously, the program's peer education component primarily involved a resource room located physically within a school and staffed by Peer Helpers where students could obtain information and service referrals for sexual health and relationship-related topics. Over time it became clear that the effectiveness of this approach was waning due to several factors, including overcrowding in participating schools resulting in diminishing available space, less freedom for students to travel throughout the building during their lunch or special subject classes, and students' increasing unwillingness to come in person to ask questions of their peers. As a result, Education Department staff sought to identify a new model by which students could engage in peer education.</p> <hd id="AN0127414486-4">Technology need and software development</hd> <p>In the summer of 2013 Education Department staff identified that a sexual health textline—a "warmline" to which any youth can send a text message and receive an answer back within 24 hours—could increase access for teens seeking sexual health information regionally, as well as expand sexuality health education beyond the classroom. Realizing that these incoming questions would represent an excellent peer education opportunity for their students, staff sought to find an interface by which students could also staff the textline. However, no existing SMS gateway software allowed for a collaborative process between adult educators and students (i.e., adult review of incoming questions and outgoing answers that would be necessary to ensure appropriate content for students and the medical accuracy of outgoing answers).</p> <p>In February 2014 the Education Department participated in a 24-hour "hackathon," the Steel City Codefest, where teams of programmers and designers develop mobile applications ("apps") in partnership with participating local nonprofits who have proposed app concepts. Education staff challenged coding teams to create an app interface ("It's OK to Ask Someone" [IOTAS]) that allowed for staff to oversee the process of peer educators answering questions, filtering and approving all incoming/outgoing SMS, and for peer educators to independently craft answers from tablets and personal cell phones. PPWP also requested that the app allow for peer educators to participate in a collaborative process of suggesting answers and commenting on other students' suggested answers. Participation in the hackathon resulted in a partially-functioning app prototype and a series of design mock-ups (Figure 1). The development team (who later incorporated as Apps N'at, LLC), and PPWP Education staff applied to and were awarded a grant for Codefest participants through a local foundation, the Forbes Funds, to complete development of the IOTAS app during 2014.</p> <p>Graph: Figure 1. IOTAS home page mock-up.</p> <hd id="AN0127414486-5">Community-academic partnership</hd> <p>Following the Codefest, the Education Department collaborated with academic researchers from the University of Pittsburgh, Graduate School of Public Health in March 2014 to refine the IOTAS application and develop associated marketing and intervention package materials. Because of the novelty of the intervention, the team determined that a proof-of-concept feasibility pilot upon completion of the Android version of the app would serve the ultimate goal of launching countywide. The pilot aimed to test the acceptability of the model among local youth, peer educators, and PPWP Education staff and also served as beta testing of the technology prior to cross-platform development.</p> <hd id="AN0127414486-6">Intervention development and refinement</hd> <p>First, PPWP Education staff developed an 8-lesson student curriculum for peer educators to train students to staff the textline. The curriculum focused on students' development of several key skills, including: cultivation of empathy during interpretation of questions texted; parsing question content to understand what underlying questions the texter is asking; utilizing reliable websites to do online research for answers; and lastly, the craft of writing a response text which employs validation, an even, positive tone, and casual but medically accurate language to normalize texters' concerns and provide information and resources. The training also included hands-on practice doing research on question content, writing answers, and interfacing with the IOTAS app. The curriculum was developed collaboratively by PPWP Education staff. Facilitators tested the lessons with individual classes and met to share feedback on lesson logistics, effectiveness, and content with the Vice President for Education, who then used the information to edit lessons and help inform development of the remaining lessons.</p> <p>The software interface developed for the pilot was an Android version of a mobile app that provided a clean, colorful, attractive means by which adult staff could maintain oversight of incoming questions and outgoing answers through a threaded, Reddit-style message board with also allowing students to interact with one another as they worked to answer questions. Both students and staff created unique logins to sign in and track data about their participation. Staff functionalities included viewing and approving all questions before sending them on to the student queue, the ability to delete and edit student comments and answers, and the ability to choose and approve answers to be sent back to texters. Student functionalities included suggesting answers to approved questions, commenting on others' suggested answers, and voting for the answers they thought were best. The app also included tabs where students could look for answers to Frequently Asked Questions and links for reliable websites that could be used to do additional research.</p> <hd id="AN0127414486-7">Feasibility and acceptability pilot</hd> <p>Development of the IOTAS Android app was completed at the end of January 2015 and PPWP Education staff finished the student training curriculum to 183 Peer Helpers simultaneously. During February and March 2015, as a proof-of-concept feasibility pilot, IOTAS was launched on a limited basis in the Peer Helpers programs of four high schools in western Pennsylvania. Two of the high schools were public, urban high schools and two were public high schools in low-income, first ring suburbs of the City of Pittsburgh. IOTAS informational palm cards (Figure 2) marketing the textline were distributed by Peer Helpers to students at their school as the primary method of service advertisement. Peer Helpers were encouraged to participate in answering questions during the feasibility pilot on classroom tablets and those with Android phones were encouraged to download the app, but none were required to do so. PPWP Education staff, including the VP, provided adult oversight in the App, ensuring that questions were appropriate for students and that outgoing answers were medically accurate and age appropriate.</p> <p>Graph: Figure 2. IOTAS informational palm cards (front and back).</p> <hd id="AN0127414486-8">Methods</hd> <p>To answer fundamental questions about acceptability of the IOTAS textline model, the following three questions were explored:</p> <p></p> <ulist> <item> 1. Will high school students utilize a textline to ask sexual health questions?</item> <p></p> <item> 2. After being trained to staff a sexual health textline using the IOTAS curriculum, will peer educators understand and engage with this model of answering their peers' questions?</item> <p></p> <item> 3. Will the software provide an acceptable, effective interface by which to answer the questions in a timely, user-friendly manner?</item> </ulist> <hd id="AN0127414486-9">Data sources</hd> <p>This feasibility study reports on data drawn from three primary sources: App data, student comments, and direct observation.</p> <hd id="AN0127414486-10">App data</hd> <p>Technical programming information was collected from the App back end. Information collected assessed both peer educators' engagement in staffing IOTAS and texters' utilization of the App. Engagement indicators of peer educators included answer response time, answers provided by peer educators, and final submitted answer type (i.e., peer educator answer vs. adult staff answer). Utilization indicators for IOTAS texters included level of utilization (e.g., unique, repeat texters) and what young people want to know regarding sexual health.</p> <hd id="AN0127414486-11">Student comments</hd> <p>Student comments were captured (a) during a conversation between peer educators recorded as a media piece for a youth radio program and (b) during a visioning session facilitated by a branding agency. Audio recordings of the youth radio program and notes collected by branding agency were shared with PPWP Education staff.</p> <hd id="AN0127414486-12">Direct observation</hd> <p>PPWP Education staff conducted direct observations throughout the IOTAS training curriculum. PPWP Education staff considered students' interest and engagement during training lessons, hands-on practice, and level of palm card distribution. Ease and acceptability of the software interface among users was also assessed.</p> <hd id="AN0127414486-13">Findings and lessons learned</hd> <p></p> <hd id="AN0127414486-14">Acceptability for youth asking questions</hd> <p>From mid-February through June 1, 2015, the IOTAS textline received 34 questions. Seventeen texters sent one question and seven texters sent multiple questions. The app interface allowed for tagging of questions by categories and questions could be tagged for more than one category. Categories of the questions received during the pilot, descending from most to least frequent occurrence, included: Planned Parenthood Services (<emph>n</emph> = 11), Contraception (<emph>n</emph> = 8), Relationships (<emph>n</emph> = 6), Pregnancy (<emph>n</emph> = 3), Sex (<emph>n</emph> = 8), STDs (<emph>n</emph> = 6), Bodies (<emph>n</emph> = 3), Values-Based (<emph>n</emph> = 2), and LGBTQ (<emph>n</emph> = 2). Examples of types of questions included in the categories can be seen in Table 1.</p> <p>Table 1. Sample questions and answers received during pilot study.</p> <p> <ephtml> <table><thead><tr><td>Texted question</td><td>Peer educator answer</td><td>Categories</td><td>Response time</td></tr></thead><tbody><tr><td>Hello! If both people are 100% STD free, is there still a chance that someone could get an STD while performing oral sex?</td><td>There is no chance of either of you getting any STDs if both people are STD free. But remember some STDs are hard to detect and go unnoticed so you and/or your partner could just but unaware of the STD. It is always best to get tested or just wear a condom to be on the safe side of things.</td><td>STDs, sex</td><td>14 hours, 52 minutes</td></tr><tr><td>How do I tell someone they gave me an STD?</td><td>I'd say the best thing to do is be honest. I would do it in person and very calmly––don't be angry or accusatory because they may not have known themselves. If you're comfortable with it, offer to go with them to get tested and be supportive. Make sure you both are educated on the infection so you can both get the proper treatments. Both of you should also notify all other sex partners. I commend you for being so responsible about it!</td><td>STDs</td><td>16 hours, 01 minute</td></tr><tr><td>I'm not ready to have sex, I need help.</td><td>This is such a normal way to feel. If there's someone pressuring you remember that you're in charge of your life. No one should EVER pressure you to have sex. And if they are, they're probably not someone you can trust. It's a huge decision and there's plenty of time in the future to decide that you're ready. Use a clear no. Make sure you say the word no and that they know you're serious. You might really like the person. If so, let them know that! But also let them know that just because you like them doesn't mean you're ready to have sex. There can be major consequences like pregnancy and STDs and it's not worth risking if you don't feel 100% comfortable.</td><td>Sex, values-based</td><td>22 hours, 09 minutes</td></tr></tbody></table> </ephtml> </p> <p>Submitted questions were answered by peer educators, with adult oversight, using the Android app on classroom tablets and personal phones (for those students with Android phones). Twenty-five questions were answered by students within the 24-hour window, with an average response time of 14 hours. Four educators agreed to monitor the textline during evenings and weekends, with the understanding that future operations would include a set schedule and the potential for help from trained adult volunteers. On the day following the launch, a bug in the IOTAS software prevented questions from being answered within the 24-hour response window. The bug was fixed and the 24-hour response window resumed.</p> <hd id="AN0127414486-15">Engagement with IOTAS by peer educators</hd> <p>PPWP Education staff reported that peer educators were highly engaged in the training lessons, especially during the hands-on practice, and responded with excitement to staffing the textline during February and March. In the recorded conversation for the youth radio program, peer educators commented on their engagement with the textline and articulated that it would fill a gap for people their age. One peer educator talked about the importance of the textline's confidentiality:</p> <p>Like you get health classes that have like 30 people in the class, you might not be comfortable with asking certain questions that you might feel embarrassed to ask in front of everybody or even like after class, you might not feel comfortable asking the teacher cause you're looking at them, so you feel like you might even be judged, but with IOTAS, you just text them, you're not seeing anybody, they can't hear your voice, so they don't know who you are at all, it's just anonymous, so you can go ahead and ask those questions and you're not being judged at all, you're just getting the facts and it's a good thing for teenagers who are just embarrassed, kinda maybe scared to ask those questions.</p> <p>Another student expanded on the stigma youth can experience around accessing sexual health information:</p> <p>We need to like break the barrier, or break this bubble of people thinking that what they're thinking is wrong, what they want to ask is wrong, or it's dirty or taboo, like it's awful! Because people need help and they're scared to get help because of what people will think and this whole like cloud of awful judgment needs to clear away because very few people are getting help because they actually have the guts ... what happens sometimes in classes is that someone asks a question because they're brave enough and then literally 5 other people or 10 other people say 'I was wondering the same exact thing too, I'm so happy you asked that!'</p> <p>The answers peer educators provided to questions that came in on the textline either were medically accurate when first suggested, were sent back for edits which were completed by students to make them medically accurate, or were edited in minor ways by adult staff before being sent out. Table 1 includes three sample questions that demonstrate answers provided by peer educators and sent out on the textline.</p> <p>Peer educators were responsible for publicizing the textline with palm cards and did so effectively and with enthusiasm, distributing over 450 palm cards. In staffing the textline, students replied to texts even during times when they were outside of the program sessions, demonstrating their interest in the incoming questions and a sense of responsibility around providing answers. While the peer educators were willing to distribute palm cards to their peers and the palm cards were effective in promoting the service, reflected in questions texted, intermittent palm card distribution led to intermittent frequency of questions texted. Use of social media and other marketing will be utilized in the future to encourage consistent volume of textline questions instead of an influx following palm card distribution.</p> <hd id="AN0127414486-16">IOTAS Software interface</hd> <p>The basic software interface was effective, but in order for students to engage fully, a cross-platform version of the app accessible to students with any smart phone (e.g., Android and iPhone) needs to be developed. A handful of feature updates and changes to the workflow were also identified and documented for use in later phases of software development. For example, all previous questions and answers exchanged with a given texter should be threaded chronologically and viewable by users to help inform answers to new questions texted in by that texter.</p> <p>The feasibility pilot highlighted that the development and refinement of technology-based interventions such as IOTAS are time-intensive and require knowledge and expertise that falls outside the typical purview of a reproductive health nonprofit such as PPWP. For this first phase of the project, the level of funding available only provided the software developers a fraction of their usual rate. Fortunately, thanks to the commitment of that team to the goals of the project, the Android version of the app was completed. However, this dissonance between the real costs of software development and maintenance and the limited budgets typical of projects in the nonprofit sector is something that could present a major barrier to the development and sustainability of tech-based health intervention models. Donated time and discounted software development services, where possible and agreeable to all parties, may present one way to bridge such a gap in funds, but clear communication and agreement to the scope of the project between software developers and program staff is essential. A technologist who can act as a consultant for the life of the project to help nonprofit staff and developers to come to a common understanding about the issues mentioned, develop a strategic work plan, and set project timelines may greatly facilitate this process.</p> <p>The app interface allowing for adult oversight and approving all incoming/outgoing SMS is a unique and innovative approach to technology-based peer education interventions. However, given the small size of the PPWP Education Department, intervention sustainability may benefit from incorporation of other adult volunteers to staff overseeing student participation in IOTAS. While such an addition to the intervention would require training and further oversight, curriculum and resource documents could potentially be incorporated into the administration portion of the App.</p> <hd id="AN0127414486-17">Conclusions</hd> <p>Findings from this study support the acceptability and feasibility of the IOTAS textline by answering key proof-of-concept questions and led to the conclusions that student peer educators understand and engage with answering questions and the software provides an effective way to answer questions in a timely, user-friendly manner. Our findings illustrate that IOTAS programming fills an existing gap for confidential and timely sexual health information desired by young people and expands PPWP's reach beyond classroom interaction. This technology-based approach to sexual health programming successfully incorporated youth asking and answering questions. It offers student peer educators a unique opportunity to expand their knowledge of healthy sexual behaviors and to engage in communicating with and educating an extended network of peers. The customized technology, with some updates, will provide adults and peer educators with an acceptable, effective interface by which to collaborate in working to answer youth sexual health questions in a timely, user-friendly manner. Because of the time- and cost-intensive nature of the development of such technology, resource sharing by way of dissemination of the software and intervention package could maximize the resources already invested.</p> <p>Results from this feasibility study informed the development and implementation of an evaluation taking place throughout the 2016–17 school year. The evaluation will focus on the effectiveness and utilization of the IOTAS intervention among high school teenagers (ages 14–18) in Allegheny County, PA, who staff IOTAS in partnership with PPWP and texters. Evaluation results will further support the refinement of IOTAS and will enable future dissemination of the intervention model and lessons learned to interested organizations.</p> <ref id="AN0127414486-18"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref6" type="bt">1</bibl> <bibtext> Color versions of one or more of the figures in the article can be found online at <ulink href="http://www.tandfonline.com/WAJS">www.tandfonline.com/WAJS</ulink>.</bibtext> </blist> </ref> <ref id="AN0127414486-19"> <title> References </title> <blist> <bibtext> Anderson, M. (2016). Parents, teens, and digital monitoring. Retrieved from <ulink href="http://www.pewinternet.org/2016/01/07/parents-teens-and-digital-monitoring/">http://www.pewinternet.org/2016/01/07/parents-teens-and-digital-monitoring/</ulink></bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Boyar, R., Levine, D., & Zensius, N. (2011). TECHsex USA: Youth sexuality and reproductive health in the digital age. Retrieved from Oakland, CA: <ulink href="http://www.yth.org/wp-content/uploads/YTH-youth-health-digital-age.pdf">http://www.yth.org/wp-content/uploads/YTH-youth-health-digital-age.pdf</ulink></bibtext> </blist> <blist> <bibl id="bib3" idref="ref11" type="bt">3</bibl> <bibtext> Chávez, N., Shearer, L. S., & Rosenthal, S. L. (2014). Use of digital media technology for primary prevention of STIs/HIV in youth. Journal of Pediatric and Adolescent Gynecology, 27(5), 244–257.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref12" type="bt">4</bibl> <bibtext> DeSmet, A., Shegog, R., Van Ryckeghem, D., Crombex, G., & De Bourdeaudhuij, I. (2015). A systematic review and meta-analysis of interventions for sexual health promotion involving serious digital games. Games for Health, 4(2), 78–90.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref17" type="bt">5</bibl> <bibtext> Giorgio, M. M., Kantor, L. M., Levine, D. S., & Arons, W. (2013). Using chat and text technologies to answer sexual and reproductive health questions: Planned Parenthood pilot study. Journal of Medical Internet Research, 15(9), e203.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref13" type="bt">6</bibl> <bibtext> Guse, K., Levine, D., Martins, S., Lira, A., Gaarde, J., Westmorland, W., & Gilliam, M. (2012). Interventions using new digital media to improve adolescent sexual health: A systematic review. Journal of Adolescent Health, 51(6), 535–543. doi:10.1016/j.jadohealth.2012.03.014</bibtext> </blist> <blist> <bibl id="bib7" idref="ref9" type="bt">7</bibl> <bibtext> Hall, K. S., McDermott Sales, J., Komro, K. A., & Santelli, J. (2016). The state of sex education in the United States. Journal of Adolescent Health, 58(6), 595–597. doi:10.1016/j.jadohealth.2016.03.032</bibtext> </blist> <blist> <bibl id="bib8" idref="ref18" type="bt">8</bibl> <bibtext> ICYC In Case You're Curious (2017). Retrieved from https://<ulink href="http://www.plannedparenthood.org/planned-parenthood-rocky-mountains/information-teens/icyc-case-youre-curious">www.plannedparenthood.org/planned-parenthood-rocky-mountains/information-teens/icyc-case-youre-curious</ulink></bibtext> </blist> <blist> <bibl id="bib9" idref="ref20" type="bt">9</bibl> <bibtext> Kim, C. R., & Free, C. (2008). Recent evaluations of the peer-led approach in adolescent sexual health education: A systematic review. Perspectives on Sexual and Reproductive Health, 40(3), 144–151. doi:10.1363/4014408</bibtext> </blist> <blist> <bibtext> Levine, D., McCright, J., Dobkin, L., Woodruff, A. J., & Klausner, J. D. (2008). SEXINFO: A sexual health text messaging service for San Francisco youth. American Journal of Public Health, 98(3), 393–395. doi:10.2105/ajph.2007.110767</bibtext> </blist> <blist> <bibtext> Lindberg, L. D., Maddow-Zimet, I., & Boonstra, H. (2016). Changes in adolescents' receipt of sex education, 2006–2013. 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Media and Communication, 4(3), 13–23. doi:10.17645/mac.v4i3.515</bibtext> </blist> </ref> <aug> <p>By Teagen L. O'Malley; Katie Rose Horowitz; José Garth; Christina Mair and Jessica G. Burke</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib11" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib16" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib14" firstref="ref14"></nolink> <nolink nlid="nl6" bibid="bib10" firstref="ref15"></nolink> <nolink nlid="nl7" bibid="bib15" firstref="ref16"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref19"></nolink> <nolink nlid="nl9" bibid="bib13" firstref="ref22"></nolink> <nolink nlid="nl10" bibid="bib17" firstref="ref23"></nolink>
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  Data: A Technology-Based Peer Education Intervention: Results from a Sexual Health Textline Feasibility Study
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  Data: <searchLink fieldCode="AR" term="%22O'Malley%2C+Teagen+L%2E%22">O'Malley, Teagen L.</searchLink><br /><searchLink fieldCode="AR" term="%22Horowitz%2C+Katie+Rose%22">Horowitz, Katie Rose</searchLink><br /><searchLink fieldCode="AR" term="%22Garth%2C+José%22">Garth, José</searchLink><br /><searchLink fieldCode="AR" term="%22Mair%2C+Christina%22">Mair, Christina</searchLink><br /><searchLink fieldCode="AR" term="%22Burke%2C+Jessica+G%2E%22">Burke, Jessica G.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22American+Journal+of+Sexuality+Education%22"><i>American Journal of Sexuality Education</i></searchLink>. 2017 12(4):383-394.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 12
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  Data: 2017
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Sexuality%22">Sexuality</searchLink><br /><searchLink fieldCode="DE" term="%22Technology+Uses+in+Education%22">Technology Uses in Education</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Technology%22">Educational Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Handheld+Devices%22">Handheld Devices</searchLink><br /><searchLink fieldCode="DE" term="%22Telecommunications%22">Telecommunications</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Teaching%22">Peer Teaching</searchLink><br /><searchLink fieldCode="DE" term="%22Teaching+Methods%22">Teaching Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22School+Community+Programs%22">School Community Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22High+School+Students%22">High School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Information%22">Access to Information</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Software%22">Computer Software</searchLink><br /><searchLink fieldCode="DE" term="%22Observation%22">Observation</searchLink><br /><searchLink fieldCode="DE" term="%22Audio+Equipment%22">Audio Equipment</searchLink><br /><searchLink fieldCode="DE" term="%22Radio%22">Radio</searchLink><br /><searchLink fieldCode="DE" term="%22Feasibility+Studies%22">Feasibility Studies</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Pennsylvania%22">Pennsylvania</searchLink>
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  Data: 10.1080/15546128.2017.1372831
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  Data: 1554-6128
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Sexuality health education is moving beyond the classroom, with technology expanding youth access to sexual health information. While text message services are increasingly being used to provide information, a peer education approach has yet to be incorporated. Results from this feasibility study support a sexual health textline (IOTAS), incorporating teens asking and answering questions. Our findings suggest IOTAS fills a gap for sexual health information, and the technology-based approach offers peer educators an opportunity to expand their knowledge of healthy sexual behaviors and educate an extended peer network. Further work to refine IOTAS will enable dissemination of the intervention model.
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  Data: 2018
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  Label: Accession Number
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  Data: EJ1167792
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