Interactive, Artistic, Fun, and Weird: Exploring Facilitators and Challenges to Youth Engagement across In-Person, Virtual, and Hybrid Pregnancy Prevention Programs

Abstract

Although U.S. adolescent birth rates in general have declined in recent decades, they continue to be a primary public health concern due to notable disparities among adolescent birth rates. In response, pregnancy prevention program development has increasingly focused on understanding how to better serve the needs of adolescents in underserved populations. To inform future program development and implementation efforts, this qualitative study explored which attributes of programs facilitated and hindered youth engagement. We collected data from educators (N = 43) and a subset of youth program participants (N = 249) from programs implemented by 14 organizations in different community-based settings. We used three data collection methods: (1) post-session surveys completed by educators, (2) post-program implementation interviews with educators, and (3) individual and focus group interviews with youth participants. Qualitative analyses revealed that educators who skillfully facilitated interactive activities and safe and inclusive learning environments promoted engagement. Feeling uncomfortable and awkward during program activities, learning in mixed-gender settings, and COVID-19 disruptions hindered engagement. Additionally, we found that youth participants had conflicting views on learning about sexual relationships at churches. Participants and educators had conflicting views on the benefit of youth attending programs with previously acquainted friends.

Keywords:

• Teen pregnancy prevention
• youth engagement
• health educators
• sexual health education

Acknowledgments

The authors sincerely thank all the youth and parents/legal guardians for participating in the study, and partner organizations’ educators and staff for their collaboration and diligent work. We thank Dana Kampschror, Lauren R. Honess-Morreale, and Sarah Kriz for guidance with project management and Nathan Dieckmann, Tam Nguyen-Louie, and Shauna St. Clair Flemming for feedback on earlier versions of the paper. We are also grateful for the contributions of the larger research team, including Whitney Ball, Michelle Bryant, Parker Foe, Samantha Iwinski, Morgan Johnson, Shayri Kansagra, Vanessa Li, Ashley Morsell, Kat Muse, Michelle Obijekwu, David Revilla, Jaclyn Saltzman, Hailey Robbins, John Rose, and Alex Whittaker for their contributions to data collection, cleaning, and coding.

Ethical approval

The research protocol used in this research was reviewed and approved by the MITRE Institutional Review Board, approval number 2020-003-CR2021.

Notice

This (software/technical data) was produced for the U.S. Government under Contract Number 75FCMC18D0047, and is subject to Federal Acquisition Regulation Clause 52.227–14, Rights in Data-General.

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Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 This manuscript uses the term Hispanic for consistency with the US Census categories for ethnicity when citing results from the governmental surveys and data collection tools developed based on these, such as the enrollment survey for this study, which used the terms “Hispanic/Latino.” When we reference the same demographic group outside of the context of such surveys, we use the gender-inclusive term Latinx unless we are quoting a study participant’s own words.

2 Although we collected data from a total of 50 educators, the paper reports findings from 43 because we were not able to collect data from the youth who participated in programs with two organizations with which seven educators worked. The survey and interview responses of these additional seven educators were similar to those represented in this paper. Additionally, the authors’ organization required educators to meet the following criteria, which were documented prior to educators implementing the programs: (1) training and resources regarding trauma-informed approaches, (2) training and expertise to implement the proposed program in an age-appropriate and culturally and linguistically appropriate manner, (3) experience implementing a pregnancy prevention program or other health education program for adolescents in the populations, and (4) a bachelor’s degree from an accredited institution of higher education, or three or more years of experience as an educator in the field of pregnancy prevention or sexually transmitted infection prevention.

3 The remaining data from the survey are reported in two other manuscripts focusing on (1) the agreement between educator self-reports and objective observers’ reports of program fidelity and (2) predictors of patterns of changes in sexuality-related knowledge, attitudes, beliefs, and behavioral intentions of youth who participated in pregnancy prevention programs. Interested readers should contact the corresponding author for more information.

Additional information

Funding

This work was accomplished in support of Health and Human Services, Office of the Assistant Secretary for Health. This paper was first produced for the U.S. Government under contract number HHSM-500-2012-00008I. The views and conclusions contained herein are solely those of the authors and do not necessarily represent the official views of the Office of Population Affairs, the Office of the Assistant Secretary for Health, the U.S. Department of Health and Human Services, or any of the authors’ host affiliations.