Stress Less About Sex: A Peer-Led SMS Model to Increase Access to Sexual Health and Family Planning Services
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Stress Less About Sex, a peer-led text messaging program to increase access to sexual health and family planning services for youth in the Tenderloin neighborhood of San Francisco, has reached 150 youth in its year of implementation in a neighborhood with some of the highest youth pregnancy and STI rates in the city. Through a focus on ongoing participant empowerment and feedback, the project has evolved beyond its original scope to include a youth-generated social media component as well as supplementary funding to convene a group of young men to discuss how to better engage young men in managing their sexual health needs. This presentation will include best practices garnered from a year of implementation and will focus on how agencies can integrate a peer leader model into their text message outreach and recruitment strategies.
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Stress Less About Sex: A Peer-Led SMS Model to Increase Access to Sexual Health and Family Planning Services
- 1. STRESS LESS ABOUT SEX: A PEER-LED SMS MODEL TO INCREASE ACCESS TO SEXUAL HEALTH AND FAMILY PLANNING SERVICES Erika Dugay John Guigayoma Asian & Pacific Islander Wellness Center
- 2. 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.
- 3. 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
- 4. Program Timeline SEPT OCT NOV DEC JAN FEB MAR APRI L MAY FORMATIVE OUTREAC H COHORT 1 EVALUATIONS COHORT 2 OUTREACH COHORT 3 OUTREACH COHORT 4
- 5. 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 messages 1.3 By the end of the project period, 75% of participants will report increased knowledge of sexual and reproductive health issues as measured by responses in baseline 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 competent 2.2 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.
- 6. SF Tenderloin Neighborhood Demographics Figure 1. Map of Tenderloin Neighborhood, Google Maps (2015)
- 7. 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)
- 8. 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
- 9. 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
- 10. 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
- 11. Cohort 1 + 2 Outcomes 11% 23% 20% 67% 64% 64% 20% 13% 16% 0% 10% 20% 30% 40% 50% 60% 70% 80% Knowlege of Sex and Sexual Health Knowledge of Birth Control Methods Knowledge of STDs Percentage Baseline Question Cohort 1 & 2 Baseline Survey Results A lot of Questions Pretty Good Share info with Friends 5% 5% 5% 55% 55% 58% 30% 31% 23% 0% 10% 20% 30% 40% 50% 60% 70% Knowlege of Sex and Sexual Health Knowledge of Birth Control Methods Knowledge of STDs Percentage Exit Question Cohort 1 & 2 Exit Survey Results A lot of Questions Pretty Good Share info with Friends N = 64 N = 64
- 12. 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?”
- 13. 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
- 14. Cohort 3 Outcomes 3% 18% 15% 72% 56% 62% 7% 8% 5% 0% 10% 20% 30% 40% 50% 60% 70% 80% Knowlege of Sex and Sexual Health Knowledge of Birth Control Methods Knowledge of STDs Percentage Baseline Question Cohort 3 Baseline Survey Results A lot of Questions Pretty Good Share info with Friends 5% 13% 13% 68% 71% 68% 24% 16% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% Knowlege of Sex and Sexual Health Knowledge of Birth Control Methods Knowledge of STDs Percentage Exit Question Cohort 3 Exit Survey Results A lot of Questions Pretty Good Share info with Friends N = 39 N = 38
- 16. 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 Disseminated • 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
- 17. 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
- 18. Cohort 1: Blogger URL: http://www.friendswithbenefitz.blogger.com
- 19. 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
- 20. Cohort 3 + 4 Outreach Flyer FAMILY PLANNING Birth Control | IUDs | STD/STIs | Pap Smear Tests ASIAN & PACIFIC ISLANDER WELLNESS CENTER 730 Polk St. San Francisco, CA, 94109 Tel 415.292.3400 | Fax 415.292.3404 Email: theclinic@apiwellness.org http://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
- 21. 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
Notas del editor
- The Tenderloin District is located in the eastern section of San Francisco. The zip code for this neighborhood is 94102. The boundaries for this district lie between, Van Ness Ave, Geary St., Powell St., and Market St. Major geographic landmarks of the Tenderloin include Civic Center/City Hall, “Little Saigon”, and theaters of performing arts such as the Warfeild Theater. According to the United States Census Bureau (2012), the population of the Tenderloin is estimated at 31,176 with an average age of forty-one years old. The three predominant races of this neighborhood are White/Caucasian, Black/African American, followed by Asian/Pacific Islander. The population of adolescents ages 10-19 in this neighborhood is estimated at 1,617. In regards to school enrollment, 94% of adolescents ages 10-14 are enrolled, 100% of adolescents ages 15-17 years are enrolled, and 85% of adolescents ages 18 and 19 are enrolled in school. Citation: U.S. Census Bureau. “Tenderloin (94104), San Francisco County, California”. United States Census Bureau. Retrieved on June, 2014 http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml
- The DCYF’s 2011 Community Needs Assessment and the CDC address the following needs for the Tenderloin District: Limited youth programs. Participants agreed that the existing afterschool programs in the neighborhood are accessible and offer high quality services. However, participants are interested in additional resources such as youth sports programs which are currently not available in the Tenderloin. Limited program hours and lack of Spanish language capacity for programs in the Tenderloin. Participants find it difficult to access programs with limited hours and would like services to be offered during accessible times such as weekends. Participants noted that most programs with Spanish language capacity are located in the Mission District, and that they would like to see more programs with Spanish language capacity offered in the Tenderloin. Mentoring programs for youth. Participants highlighted the need for mentoring programs for youth, including opportunities for mentoring at low performing schools and recreational centers. Additionally, youth would like to see more opportunities for older peer mentoring. Increased services needed for low income, recent immigrant, and LGBT youth. Youth mentioned that low income youth, recent immigrant youth, and LGBT youth currently lack sufficient services. Health & Wellness Programs to promote mental and physical health. Lack of funding primarily towards sexual health prevention services Need for comprehensive health services Need for supportive policies Need for family involvement Citation: San Francisco Department of Children, Youth & Their Families [DYCF]. (2013). Issue Brief: DCYF Overview. Retrieved from Department of Children, Youth & Their Families: http://www.dcyf.org/modules/showdocument.aspx?documentid=1853 San Francisco Department of Children, Youth & Their Families. (2011, May). 2011 Community Needs Assessment. Retrieved from San Francisco Department of Children, Youth, & Their Families: http://www.dcyf.org/modules/showdocument.aspx?documentid=11
- FOCUS GROUPS Boys & Girls Club: Tenderloin Club House Teens ages 14-18 Asian Latino Larkin St. Youth Homeless Foster Teens ages 15-17 African American Latino LGBTQ Identified participants PROVIDER INTERVIEWS Service Provider’s perspective on the community and how environment plays a role on the youths’ development
- Insight into teens lives through Social Media
- Feedback (Pluses and Deltas) were collected on the last day of the program (Graduation). Program participants engaged in an open discussion addressing what they liked and didn’t like about the program, and what would they like to see differently in the future. Didactic Content General topics inhibited program interest (‘Did you know’ Text Messages)
- Participants in Cohorts 3 + 4 generally enjoy text messages where their mind is stimulated through Multiple Choice/ True or False questions Text message ‘tone’ matters (friendly vs. unfriendly, opinionated vs. informative) Implementing links to more information and resources ensured a trusted resource to participants Having Multiple Choice/True or False Text Messages makes it easier to track engagement between participant and text messaging platform
- Team Meetings were originally for Program Check-Ins Check-Ins only lased 5 Minutes Peer Leaders across all Cohorts were interested in doing a bigger project (to fill in extra time) Creating awareness through Social Media Friendly, accessible sexual health information for High School teens
- Cohort 1- Associated Student Body members ages 17-18 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) ages 17-18 Created a Twitter Lack of content development - Loss of motivation Both Cohorts met in an indoor site – Intimate setting with no distractions enabled more brainstorming and private discussions Program Participants were also regular to the meetings (occasionally if they had no place left to go/nothing left to do)
- Cohort 3 + 4 attended different schools Difficult to maintain motivation for a Social Media Project Cohort collaboration to design an outreach flyer Teens designed content and provided feedback Presented drafts between cohorts and Team Leaders for suggestions Weekly Due Dates were established for collaboration Both Cohorts met in an outdoor setting at a local park. Inhibited private conversations regarding sexual health
- (Sample of flyer: Front & Back)
- Teens & leadership: Team Leaders took ownership of their role by recruiting teens via social media (ie. Snapchat) Plan and design their group projects Review and edit proposed text message content for the Program Establishing trust among teen participants and Agency Teens were able to connect with each other and facilitator to address teen concerns such as enrolling into FamilyPACT, finding Plan B, figuring out the differences of Birth Control Location and environment sets the tone of comfort level, peer to peer engagement Group Project: Blog Teens were able to express themselves – Share their stories on what it’s like to be a teen Enabled program designers to understand their language/slang Gives insight to teens’ attitudes and beliefs