Using Telemedicine to Teach Reproductive Health to Rural at Risk High School Females

While teen pregnancy nationwide has declined in recent years, in many areas in West Virginia rates have remained high. In 2013 the rural county of McDowell, WV had a teen birth rate of 78.1 per 1000, a high school dropout rate of 17.8%, and 49.3% of children under 18 lived in homes below the federal poverty level.1 Telemedicine has been used in many facilities to disseminate information and medical care to underserved areas. This study evaluated the use of telemedicine to teach reproductive health to two high schools in McDowell County. A reproductive health curriculum was developed and incorporated into an existing afterschool program in two high schools in McDowell County. High school females at both schools were invited to attend hour long reproductive health sessions discussing anatomy and menses, birth control, and sexually transmitted disease prevention. Sessions discussing self-esteem, stress, relationships, nutrition, and career planning were also a part of the curriculum. Each session was taught using telehealth equipment connecting to both school classrooms simultaneously. Subjects were asked to complete a demographic survey assessing risks for teen pregnancy, pre and post-tests assessing knowledge and self-efficacy during every reproductive health session, and a six month follow up survey assessing demographics, knowledge, and self-efficacy. A small incentive was given to students for participation. University IRB approval was obtained along with permission from the McDowell School Board to conduct the program. Funding was provided by the Robert C. Byrd Center for Rural Health. Fifty-five subjects participated in the program with an average age of 16.1 (SD 1.2). Only 20.4% of subjects’ mothers and 12.2% of subjects’ fathers had achieved education beyond high school, and 20% of subject’s mothers had experienced teen pregnancies (age ≤18). Sexual activity was reported among 52.7% of subjects, 4 (7.2%) reported desire to become pregnant within the next year, and 4 (7.2%) reported already pregnant. Report of compliance with condom use increased from 20% to 40% (p=.04), and report of compliance with contraception increased from 22% to 38%, but did not reach statistical significance (p=0.12). Mean knowledge score regarding reproductive health increased from pre and post testing (3.03 vs 4.42 p=.045) and remained stable at 6 month assessment (4.04, p=.586). Mean knowledge scores also increased regarding birth control use and STD prevention, but this did not reach statistical significance. Thirty-seven subjects completed the 6 month follow up survey. Report of HPV vaccine initiation or completion increased from 38% to 71.4% (p=.03) among participants of the STD prevention session (n=28). At conclusion of the program 96.4% of subjects reported “very confident” that the material presented was accurate, 86.4% reported the use of telehealth was “very effective” as a means to teach the material, and 92.8% reported they were “very likely” to participate again. At six month follow up there were no school dropouts among subjects and one additional pregnancy reported. Telehealth is an effective means to teach reproductive health in rural areas.