Promoting teen-to-teen contraceptive communication with the SpeakOut intervention, a cluster randomized trial

Abstract Background To improve teen contraceptive use, the SpeakOut intervention combines structured counseling, online resources, and text reminders to encourage teens to share their experiences using intrauterine contraception (IUC) or an implant with peers. Methods To evaluate the effectiveness of remote delivery of the SpeakOut intervention in increasing teen contraceptive use, we conducted a cluster randomized trial involving female adolescents who were recruited online. Primary participants (n=520) were randomly assigned to receive SpeakOut or an attention control; each primary participant recruited a cluster of up to five female peers as secondary participants (n=581). We assessed contraceptive communication, knowledge, and use, at baseline, three and nine months after participants enrolled. We examined differences between study groups, controlling for clustering by primary participant and baseline characteristics. Results The trial's primary outcome, contraceptive use by secondary participants, was similar between groups at both three and nine months post-intervention. Compared to controls, primary participants receiving SpeakOut tended to be less likely to discontinue contraception within nine months (4.8% vs 7.8%, p=0.11 for IUC; 7.8% vs 9.8%, p=0.45 for implants), but this did not reach statistical significance. SpeakOut failed to increase contraceptive communication; regardless of study group, most secondary participants reported peer communication about contraception (86% vs 88%, p=0.57). Most secondary participants were aware of the hormonal IUC (91.4% vs 90.4%, p=0.72), copper IUC (92.9% vs 88.6%, p=0.13), and implant (96.5% vs 96.1%, p=0.83) three months after enrolling, regardless of the intervention their primary participant received. However, contraceptive knowledge remained incomplete in all study groups. Conclusion Remote delivery of the SpeakOut Intervention did not improve contraceptive communication, knowledge or use among participating teens or their peers. Implications Efforts to support teen-to-teen contraceptive communication and ensure that teens have accurate information about the full range of contraceptive methods, including highly effective reversible contraceptives, require refinement.