21. Simulation of Contraceptive Access for Adolescents using a Pharmacist-staffed mHealth Application: Pilot Testing

Offering contraceptives at pharmacies without a prescription may reduce the incidence of unintended pregnancies among adolescents and young adults (AYA) by increasing contraceptive access. Our team previously developed and refined a mHealth application (app) simulating pharmacist contraceptive prescribing. Our primary objective of the present research was to assess usability of the final prototype of the app and evaluate acceptability and feasibility. Additionally, we assessed concordance between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Participants were assigned female sex at birth, 15-21 years of age, who sought contraceptive services at an adolescent medicine subspecialty clinic, had a prior history of or intention to have penile-vaginal intercourse in the next 12 months, owned a mobile device, and could read and speak English. Recruitment occurred October 2021-August 2022. During a one-hour study visit, participants tested the app in a simulation exercise, requesting contraception through the app from a pharmacist. A pharmacist reviewed and approved or rejected the request for contraception in real time through the platform’s back end, with the outcome automatically sent to participants via text or email. Following the simulation, participants completed brief online surveys on their sociodemographics and sexual history, and the utility, ease of use, effectiveness, reliability, and satisfaction with the app. Finally, participants completed a brief audio-recorded interview to share their perspectives on the app. No actual contraception was prescribed through the study. All participants had a related contraception-related clinic visit with 4 weeks of the study visit, and clinic-based contraceptive outcomes were compared to the simulation-based outcomes. Descriptive analysis was utilized for the analysis of quantitative survey data and thematic qualitative analysis was employed for the interview transcripts. Pilot testing has been completed with N=12 patients with a goal of N=20, with a mean age of 18.3 (SD 1.48). Ten participants (83.3%) reported using contraception to prevent pregnancy, half (n=6, 50.0%) reported taking a pregnancy test in the past, and one (8.3%) participant reported taking emergency contraception. Overall, most participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access contraception (n=11, 91.7%) and agreed most teens their age would use an app to get birth control (n=11, 91.7%). During the interview, 10 (83.3%) participants described the app as easy to navigate. Participants agreed that receiving contraceptive prescriptions from a pharmacist without a doctor’s visit would be safe (n=10, 83.3%), convenient (n=11, 91.7%), acceptable (n=10, 83.3%), and easy (n=10, 83.3%). Out of N = 7 who chose a contraceptive method there was 100% concordance between approval of the method by the medical provider and the pharmacist. Adolescents and young adults found simulated contraceptive prescription by pharmacist via an app to be highly acceptable and usable. We found pharmacist contraceptive approvals and contraception as prescribed in routine clinic to be identical. These data support the use of mobile health applications for pharmacist-delivered contraception.