Be Legendary – Using Intervention Mapping and Participatory Strategies to Develop a Multi-Component Teen Pregnancy Prevention Intervention for Older Teen Males of Color

" Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 8 : Iss. 1 Be Legendar y - Using Inter vention Mapping and Participator y Strategies to Develop a Multi- Component Teen Pregnancy Prevention Inter vention for Older Teen Males of Color Opportunities for Teen Pregnancy Prevention 0 1 2 Kimberly Johnson 0 1 2 Christine Markham 0 1 2 Rianne Smith 0 1 2 Susan R. Tortolero 0 1 2 0 University of Texas Health Science Center at Houston , USA 1 UTHealth School of Public Health 2 University of Texas Health Science Center , USA Follow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatrisk Recommended Citation Background Research on males and teen pregnancy indicates significant negative life outcomes and substantial racial/ethnic disparities. African-American and Hispanic teens are more likely to become teen parents1 than white and Asian teens. For African-American male teens in particular, teen fatherhood is associated with negative outcomes (high school dropout, unemployment, criminal activity).2To date, no effective teen pregnancy prevention intervention has been developed specifically for older teen males from disadvantaged backgrounds. Although most pregnancy prevention efforts have not directly targeted adolescent males, there is an increasing recognition that they should be engaged in such efforts.3-4 Most men believe they share equal responsibility with their female partners for decisions about contraception.5 However, young men, especially blacks, do not have an adequate knowledge of female contraception methods, such as long-acting reversible methods, and emergency contraception methods.6-7 Contraception use is higher when male partners are involved in contraceptive decision-making than when they are excluded, and male involvement in contraception decision making increases the use of dual protection.8-11 However, few interventions that have been shown to be effective in preventing teen pregnancy are designed specifically for young men. A systematic review identified 35 rigorously evaluated interventions found to have an impact on sexual risk behaviors, teen pregnancy, and/or sexually transmitted infections.12 Most of these interventions included male and female participants; however, only one of these interventions was designed specifically for males.13These interventions were typically designed as HIV/STI prevention interventions and focus primarily on condoms, with relatively little discussion of other contraception methods. Furthermore, these interventions typically lack a focus on the shared responsibility of contraceptive decision-making or on sexual and reproductive health services. Because of their scarcity, rigorous evaluations of interventions targeting male-specific risk and protective factors for teen pregnancy are missing from the peer-reviewed literature.14-17 Thus, federal agencies and professional groups are calling for more teen pregnancy prevention programs for males.18-20 Our team sought to fill this gap through the development of Be Legendary (BL). BL is an innovative, culturally appropriate multi-component school-based teen pregnancy prevention intervention for African-American older male teens living in economically disadvantaged areas. BL was developed using Intervention Mapping,21 participatory methods and design thinking strategies.22 This article outlines the methods we used in developing BL, key lessons learned and insights from working alongside African-American male teens. Intervention Development Activities Our team engaged in three major activities to develop BL. These included: completing the Intervention Mapping process, conducting participatory development strategies with the target population using design thinking tools and convening a stakeholder advisory group. We provide a description of each major activity here along with lessons learned. Activity 1. Intervention Mapping We used Intervention Mapping (IM), a systematic instructional design approach, to guide intervention development. IM is a stepped developmental process that incorporates evidence from empirical and theoretical research to inform each phase of intervention development in order to influence changes in health-related behavior21. IM involves five steps that include: ( 1 ) assessing needs and establishing community support, ( 2 ) developing planning matrices to assess necessary intervention elements, ( 3 ) selecting theory-based methods and strategies for intervention production, ( 4 ) developing program components and activities and ( 5 ) planning for program adoption, implementation and sustainability. Steps 1 – 3: Needs assessment activities involved implementing school wide health behavior surveys in target high schools to examine the problem scope. We also facilitated listening sessions with male teens to understand their needs and desires for education related to teen pregnancy, relationships and post-secondary opport (...truncated)