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Health Literacy Needs and Preferences for a Technology-Based Intervention to Improve College Students' Sexual and Reproductive Health

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Title: Health Literacy Needs and Preferences for a Technology-Based Intervention to Improve College Students' Sexual and Reproductive Health
Language: English
Authors: Cheryl A. Vamos (ORCID 0000-0003-0227-514X), Joseph A. Puccio, Stacey B. Griner (ORCID 0000-0002-2774-5841), Rachel G. Logan (ORCID 0000-0001-7686-5754), Rumour Piepenbrink (ORCID 0000-0002-1931-1277), Morgan Richardson Cayama (ORCID 0000-0003-1903-1512), Sharonda M. Lovett (ORCID 0000-0002-5840-6404), Helen Mahony (ORCID 0000-0002-6874-6824), Ellen M. Daley (ORCID 0000-0003-3020-295X)
Source: Journal of American College Health. 2024 72(2):477-486.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 11
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: College Students, Sexually Transmitted Diseases, Sex Education, Health Education, Contraception, Immunization Programs, Technology Uses in Education, Intervention, Technology Integration, Information Literacy, Health Materials, Universities, Decision Making, Credibility, Handheld Devices, Computer Software, Usability, Health Services, Computer Oriented Programs, Learner Engagement, Clinics
DOI: 10.1080/07448481.2022.2040517
ISSN: 0744-8481
1940-3208
Abstract: Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1419442
Database: ERIC
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  Value: <anid>AN0176405448;acl01feb.24;2024Apr05.04:37;v2.2.500</anid> <title id="AN0176405448-1">Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health </title> <p>Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.</p> <p>Keywords: Health literacy; qualitative data; sexual and reproductive health; technology</p> <hd id="AN0176405448-2">Introduction</hd> <p>Adolescents and young adults (AYA) are disproportionately affected by adverse sexual and reproductive health (SRH) outcomes, such as sexually transmitted infections (STIs) and unintended pregnancies.[<reflink idref="bib1" id="ref1">1</reflink>],[<reflink idref="bib2" id="ref2">2</reflink>] AYA aged 15–24 years account for half of all new STIs that occur annually in the United States (US).[<reflink idref="bib3" id="ref3">3</reflink>] If left untreated, STIs can cause serious health consequences, including infertility, chronic pelvic pain, and increased risk of acquiring the human immunodeficiency virus (HIV).[<reflink idref="bib4" id="ref4">4</reflink>] Furthermore, nearly half (45%) of all pregnancies are unintended in the US, and this rate is highest among AYA women 18 to 24 years.[<reflink idref="bib5" id="ref5">5</reflink>],[<reflink idref="bib6" id="ref6">6</reflink>] Unintended pregnancies among AYA can lead to long-term health consequences including higher rates of maternal depression, lower educational attainment, and lower socioeconomic status (SES).[<reflink idref="bib7" id="ref7">7</reflink>]</p> <p>College students represent a unique subgroup within AYA that are more likely to engage in risky behaviors (e.g., multiple sexual partners, unprotected sex, binge drinking), which can lead to adverse outcomes.[<reflink idref="bib8" id="ref8">8</reflink>] In 2019, 66% of high school graduates aged 16–24 were enrolled in colleges or universities, suggesting that a large proportion of AYA attend college and may be at increased risk for adverse SRH outcomes.[<reflink idref="bib9" id="ref9">9</reflink>] Low sexual health knowledge and low perceived risk of adverse SRH outcomes may contribute to college students engaging in risky sexual behaviors.[<reflink idref="bib10" id="ref10">10</reflink>] Additionally, college students often rely on misconceptions related to sexual health due to inconsistent and inaccurate sexual health education.[<reflink idref="bib11" id="ref11">11</reflink>]</p> <p>College health clinics can play an important role in the dissemination of SRH information and in the delivery of SRH services that may ultimately improve college students' sexual health literacy.[<reflink idref="bib8" id="ref12">8</reflink>] A recent study investigated 2- and 4-year colleges and found that nearly 71% of these colleges reported having a student health center, with the majority offering sexual health services.[<reflink idref="bib8" id="ref13">8</reflink>] This study also found that about half of the colleges reported implementing STI awareness campaigns, which is associated with an increase in STI screening and education efforts.[<reflink idref="bib8" id="ref14">8</reflink>] Another study found that when colleges have student health centers that provide adequate SRH services (clinic services, contraceptive options), the rates of unprotected sex and unintended pregnancies decrease.[<reflink idref="bib12" id="ref15">12</reflink>] Given the substantial burden of STIs and unintended pregnancy on college students, additional research is needed on college health interventions which can effectively address students' SRH needs and mitigate risky sexual behaviors.</p> <p>Previous research has found that college students seek health-related information online across a variety of SRH topics (e.g., contraception, pregnancy, STIs).[[<reflink idref="bib13" id="ref16">13</reflink>], [<reflink idref="bib15" id="ref17">15</reflink>]] Technology-based health interventions often referred to as electronic health (eHealth) have become a popular mechanism to deliver SRH interventions.[<reflink idref="bib17" id="ref18">17</reflink>],[<reflink idref="bib18" id="ref19">18</reflink>] eHealth interventions can include the use of computers, social media, tablets, and a range of other technology tools to deliver intervention messages.[<reflink idref="bib19" id="ref20">19</reflink>] Compared to other interventions, eHealth can deliver interventions at lower costs, has the ability to tailor content, is easily accessible, and affords a greater level of privacy for sensitive topics.[<reflink idref="bib5" id="ref21">5</reflink>],[<reflink idref="bib19" id="ref22">19</reflink>] eHealth interventions can be particularly useful for sensitive topics (i.e., SRH health) among the AYA and college student population.[<reflink idref="bib5" id="ref23">5</reflink>] Moreover, SRH eHealth interventions have become popular among AYA, including college students, because of their engaging, interactive components and ability to enable AYA to feel comfortable in the online environment.[<reflink idref="bib5" id="ref24">5</reflink>],[<reflink idref="bib19" id="ref25">19</reflink>]</p> <p>One of the primary settings in which SRH interventions can be implemented for college students, including eHealth interventions, are college health centers. College health centers have a critical role in promoting and improving college students' SRH literacy by providing them with credible and reliable information. Specifically, college health centers can use eHealth (i.e., health monitoring through mobile applications, websites, social media, patient portals) to provide students with SRH information and resources. Moreover, eHealth interventions that utilize user-centered design (UCD) principles have the potential to be more engaging and useful among their intended target population.[<reflink idref="bib20" id="ref26">20</reflink>] UCD seeks to focus the design of interventions based on information (e.g., needs and preferences) from the users who will ultimately use it.[<reflink idref="bib21" id="ref27">21</reflink>] A key component of UCD is including primary users of the intervention (e.g., AYA or college students) in intervention development and design to ensure acceptability and appropriateness.[<reflink idref="bib20" id="ref28">20</reflink>] UCD has been used previously with AYA to design culturally-appropriate interventions to promote SRH and prevent HIV and STIs.[<reflink idref="bib22" id="ref29">22</reflink>] Therefore, the purpose of this study was to explore: (<reflink idref="bib1" id="ref30">1</reflink>) the SRH literacy needs; and (<reflink idref="bib2" id="ref31">2</reflink>) integration, functionality, and intervention characteristic preferences for a technology-based intervention (app) that could be integrated into an on-campus, student health clinic among college students.</p> <hd id="AN0176405448-3">Methods</hd> <p></p> <hd id="AN0176405448-4">Sampling and recruitment</hd> <p>College students were recruited from a large, public university in the southeastern region of the United States. All students were 18 years or older and able to read and speak English. Participants were recruited electronically (e.g., email listservs, course learning platforms, social media platforms) and in-person (e.g., campus events) between January 2019 and June 2019. Participants completed a brief, online survey via Qualtrics, which assessed study eligibility, socio-demographics, attitudes toward using technology, and interest in participating in an in-depth interview. Those survey participants who volunteered to be later interviewed were contacted by research staff to schedule an on-campus interview at a convenient time and location. A total of 132 participants completed the online survey. A convenience sample of 20 participants (10 females, 10 males) who completed the online survey were recruited to participate in in-depth, semi-structured interviews. Quota sampling was used to intentionally recruit an equal number of female and male participants.[<reflink idref="bib23" id="ref32">23</reflink>] While females are more likely to utilize SRH services, this study aimed to assure equal participation to better understand male needs and preferences in the goal to provide more inclusive SRH services.[<reflink idref="bib24" id="ref33">24</reflink>] This study was reviewed and approved by the University of South Florida's Institutional Review Board.</p> <hd id="AN0176405448-5">Instruments</hd> <p>A 20-item survey was developed to assess participants' sociodemographic characteristics and attitudes toward using technology via the Technology Acceptance Model (TAM). The TAM is a validated, 6-item instrument that measures users' adoption and use of emerging technology.[<reflink idref="bib25" id="ref34">25</reflink>],[<reflink idref="bib26" id="ref35">26</reflink>] Response options for the TAM range from strongly disagree (<reflink idref="bib1" id="ref36">1</reflink>) to strongly agree (<reflink idref="bib5" id="ref37">5</reflink>).</p> <p>An interview guide was developed to elicit participants' preferences for an app to be used before, during, and after a visit to the campus health clinic. An interview guide was developed based on the Integrated Model of Health Literacy (IMHL), the Diffusion of Innovations theory (DOI), and the Social Cognitive Theory (SCT); however, the dominant themes that emerged aligned with IMHL and DOI. Thus, the results focus on the themes related to those theoretical frameworks. The IMHL uses an integrated, public health perspective to examine the critical skills across four domains (access, understand, apply, and appraise) needed by individuals to make health decisions.[<reflink idref="bib27" id="ref38">27</reflink>] DOI is a complex, organizational level theory with key concepts and stages of diffusion such as the following: dissemination and adoption; characteristics of the innovation (e.g. relative advantage and trialability); characteristics of the adopters; and the five stages of the innovation-decision process.[<reflink idref="bib28" id="ref39">28</reflink>] Following UCD principles, participants were asked to provide feedback on relevant information to be included in the app, different app features to facilitate engagement, and design elements that may increase usability.[<reflink idref="bib21" id="ref40">21</reflink>],[<reflink idref="bib29" id="ref41">29</reflink>] At the beginning of the interview, participants were explained that the research team was thinking about creating an app for college students to use before, during and after their visit to the campus health clinic, and that the team was interested in hearing about experiences and preferences from those who have and have not been to the campus clinic. It was explained to participants that the potential app had the following three goals: (<reflink idref="bib1" id="ref42">1</reflink>) help students access credible and patient-centered information; (<reflink idref="bib2" id="ref43">2</reflink>) understand SRH information; (<reflink idref="bib3" id="ref44">3</reflink>) know what questions to ask their provider; and (<reflink idref="bib4" id="ref45">4</reflink>) facilitate students in making decisions about their SRH that aligned with their needs and health goals.</p> <p>Both the online survey and interview guide were piloted with participants who met the inclusion criteria and were revised prior to data collection. In-depth interviews ranged from 30–45 minutes in length and were conducted by two members (SBG and RGL) of the research team trained in qualitative research.</p> <hd id="AN0176405448-6">Data analysis</hd> <p>Each interview was audio-recorded and transcribed by a professional transcriptionist. The research team developed a codebook based on the interview guide using <emph>a priori</emph> codes driven by theoretical constructs and study aims (SRH health literacy needs and decision-making; and integration, functionality, and intervention characteristic preferences) as well as emergent codes in the data. The qualitative data were analyzed using an applied thematic analysis approach[<reflink idref="bib30" id="ref46">30</reflink>] and were coded using MaxQDA version 20.[<reflink idref="bib31" id="ref47">31</reflink>] Intercoder agreement was calculated using MaxQDA (Kappa = 0.89) between two coders (SBG and RGL). The two coders also used code configurations and lexical searches in MaxQDA to examine code co-occurrences and refine identified patterns in coding. Codes were compared and the codebook was adjusted until consensus was reached. The research team agreed on themes to be included in the findings. Quantitative data from the brief demographic survey were summarized using descriptive statistics in SAS version 9.4.</p> <hd id="AN0176405448-7">Results</hd> <p>Demographics for the in-depth interview sample are reported in Table 1. The majority of participants were white (60%), non-Hispanic (90%), and heterosexual (70%). Responses to the TAM items suggest that participants found eHealth to be acceptable and useful. Agreement was highest with the statement "Overall, eHealth will be useful in managing my health care" (M = 4.10, SD = 0.64) and lowest with the statement "I will find it easy to get eHealth to do what I want it to do" (M = 3.80, SD = 0.83). In the following sections, the dominant themes and participant quotes from the qualitative interview data are presented. Additional supporting quotes are displayed in Table 2.</p> <p>Table 1. Summary of demographic variables.</p> <p> <ephtml> <table><thead><tr><td /><td>N</td><td>%</td></tr></thead><tbody valign="top"><tr><td>Age (years)</td><td /><td /></tr><tr><td> 18–22</td><td>13</td><td>65</td></tr><tr><td> ≥23</td><td>7</td><td>35</td></tr><tr><td>Gender</td><td /><td /></tr><tr><td> Female</td><td>10</td><td>50</td></tr><tr><td> Male</td><td>10</td><td>50</td></tr><tr><td>Race</td><td /><td /></tr><tr><td> Asian</td><td>3</td><td>15</td></tr><tr><td> African American</td><td>4</td><td>20</td></tr><tr><td> White</td><td>12</td><td>60</td></tr><tr><td> Other</td><td>1</td><td>5</td></tr><tr><td>Ethnicity</td><td /><td /></tr><tr><td> Hispanic</td><td>2</td><td>10</td></tr><tr><td> Non-Hispanic</td><td>18</td><td>90</td></tr><tr><td>Sexual Orientation</td><td /><td /></tr><tr><td> Straight/Heterosexual</td><td>14</td><td>70</td></tr><tr><td> Sexual Minority</td><td>6</td><td>30</td></tr><tr><td>Relationship Status</td><td /><td /></tr><tr><td> Not in a relationship</td><td>10</td><td>50</td></tr><tr><td> Dating</td><td>8</td><td>40</td></tr><tr><td> Long-term monogamous</td><td>2</td><td>10</td></tr><tr><td /><td>M</td><td>SD</td></tr><tr><td>TAM Responses</td><td /><td /></tr><tr><td> Using e-health will support critical aspects of my health care</td><td char=".">3.85</td><td char=".">0.93</td></tr><tr><td> Using e-health will enhance my effectiveness in managing my health care</td><td char=".">4.00</td><td char=".">0.92</td></tr><tr><td> Overall, e-health will be useful in managing my health care</td><td char=".">4.10</td><td char=".">0.64</td></tr><tr><td> My interaction with e-health will be clear and understandable</td><td char=".">3.95</td><td char=".">0.60</td></tr><tr><td> E-health will be easy to use</td><td char=".">4.35</td><td char=".">0.49</td></tr><tr><td> I will find it easy to get e-health to do what I want it to do</td><td char=".">3.80</td><td char=".">0.83</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note: N</emph> = 20, M = mean, SD = standard deviation.</p> <ulist> <item>2 TAM = Technology Acceptance Model.</item> <item>3 TAM Responses: Strongly disagree (<reflink idref="bib1" id="ref48">1</reflink>) to strongly agree (<reflink idref="bib5" id="ref49">5</reflink>).</item> </ulist> <p>Table 2. Additional supporting quotes.</p> <p> <ephtml> <table><thead><tr><td>Theme</td><td>Supporting Quotes</td></tr></thead><tbody valign="top"><tr><td>Health Information and Services</td><td>"If [the service] was something on campus you could have an appointment creator on the app. But if it wasn't through campus that would be a little harder to do...if there [were] both options, you could have the appointment thing for [the university] and look up what your insurance covers and then find that." (Participant 5, Female)</td></tr><tr><td>Apply: Communicate about Sexual and Reproductive Health</td><td>"Let's say you have a significant other and you both have the app, you guys just want to have a shared experience and maybe there's an invite code that you might send to someone and then they put that code in and then you guys are linked and you guys can track certain things together." (Participant 18, Male)</td></tr><tr><td>Risk and Uncertainty Level</td><td>"You never know who could get access to that data. I think people who are aware that there is a risk that the data could be compromised, that would steer them away from using it." (Participant 12, Female)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0176405448-8">Health literacy needs</hd> <p></p> <hd id="AN0176405448-9">Access: Health information and services</hd> <p>Participants were asked how the app could be used to increase students' access to health services and information. Participants felt that health information should be provided for a broad range of diseases and conditions, including information on symptoms, prevention, and treatment. Suggested methods for delivery of information included facts, statistics, infographics, pictures/images, videos, and interactive games or quizzes. Participants also wanted the app to include information on health services available to students, including those found on-campus, off-campus, and available to students irrespective of insurance status. They also felt that the built-in ability to directly schedule clinical appointments would facilitate access to services.</p> <p>Concerning access to SRH services, most participant responses were focused on access to STI testing. Participants suggested providing information on testing locations, contact information for these locations, and dates that testing services are provided. One participant recommended the app could be used to complete intake forms for testing sites, allowing for quicker visits that only require students to enter the clinic, leave their sample, and exit.</p> <p>Say there was a preloaded form where you could go in and put everything in. If it was something like, these are the symptoms of having [an STI], and all you have to do is walk into the clinic and they tell you to go into this door and leave the sample, you just leave it and go. (Participant 11, Female)</p> <hd id="AN0176405448-10">Understand, appraise, and evaluate SRH information</hd> <p>Participants were asked how they felt the app could help users make SRH decisions both broadly and in relation to specific topics such as contraception, STI testing, and the HPV vaccine. Participants suggested that by providing information on a variety of topics, the app could enable students to make a variety of positive decisions, spanning relationships, sexual activity, and prevention behaviors such as contraception and STI testing.</p> <p>Participants commonly discussed the role of the app in helping users make decisions about <emph>contraception</emph>. They recommended providing pro/con lists of the full range of contraceptive options available, with additional information and statistics on side-effects, failure rates, and costs. Participants also expressed an interest in being able to read about peers' (other users') experiences with various contraceptive methods, with several suggesting open forums or discussion boards.</p> <p>Understanding the different birth control options. I'm not very informed on birth control by any means, but I know there's different ones and more long-term options and different medicines have different side effects and all that. Maybe if they answer a general questionnaire you can recommend options ... (Participant 16, Male)</p> <p>Similarly, participants recommended the app provide detailed information on <emph>HPV and the HPV vaccine,</emph> including what HPV is and the prevalence of the infection, how the vaccine provides protection, updates on vaccination guidelines and recommendations, and vaccine cost. They also wanted information on locations providing the vaccine, both on- and off-campus, and vaccine availability through the campus clinic. It should be noted that a few participants did not know what HPV or the HPV vaccine was.</p> <p>What it is? Why it's important? I guess it would include what age you should get said vaccine. Like where to go for it, which I'd assume you can get [on campus]. But also, maybe offer some non-[campus locations]. (Participant 20, Male)</p> <p>When asked how the app could help students make decisions about <emph>STI testing</emph>, participants recommended providing basic information on symptoms and periodic reminders to prompt users to get tested. Similar to participants' recommendations for contraceptive decision-making, a few recommended having users complete a questionnaire so that information on STIs and testing can be tailored to their needs.</p> <p>Like a questionnaire asking, "Are you sexually active? How often? Do you use protection?" That type of thing and then based on that, give another recommendation. Just recommendation on how frequently you should be getting tested and that type of thing. (Participant 18, Male)</p> <hd id="AN0176405448-11">Apply: Communicate about sexual and reproductive health</hd> <p>Participants were asked how the app could help them communicate about their SRH and were probed to consider communication with doctors and partners. Regarding communication with <emph>providers</emph>, some suggested functions within the app to directly email, message, and send updates. Participants believed that by providing information about medical conditions, symptoms, and terminology, the app could prepare students for more effective and productive conversations with their providers.</p> <p>Like having a piece that can empower you to ask your own questions, or give sample plain questions, things you can ask your doctor, so you don't feel like you walked out without really finding out what's wrong with you. (Participant 1, Female)</p> <p>When asked to think specifically about how the app could facilitate communication with their <emph>partners</emph>, participants suggested that the app provide education and resources on having SRH conversations. Some recommended being able to share information with partners directly from the app and link profiles or accounts. Participants reported that sharing this kind of information could enable users to better understand what their partners experience and some may even become more understanding in those scenarios. Other participants spoke about how the app could educate partners together, remind one another to schedule an appointment, and encourage contraceptive use or STI testing.</p> <hd id="AN0176405448-12">Intervention integration and functionality</hd> <p></p> <hd id="AN0176405448-13">App design and function</hd> <p>Each interview included open elicitation questions that asked participants to envision how an app could be designed to manage their SRH needs. Table 3 summarizes the most frequently reported preferences for integration and functionality characteristics. Regarding app design, the majority of participants reported that a user-friendly interface was favorable, as well as the app's ability to be integrated with other systems or products. For app function, participants expressed an interest in the app having the ability to send notifications and feature forums, chatrooms, or messaging options for discussion.</p> <p>Table 3. Summary of the top 10 preferred characteristics for integration and functionality.</p> <p> <ephtml> <table><thead><tr><td>Preferred Characteristics</td><td>Relative Frequencies</td></tr></thead><tbody valign="top"><tr><td>App Design</td><td /></tr><tr><td>Simple, user-friendly interface that is easy to navigate</td><td char=".">15</td></tr><tr><td>Integration with other systems, products, or applications</td><td char=".">14</td></tr><tr><td>Displays infographics, photos, diagrams, or videos</td><td char=".">12</td></tr><tr><td>Anonymity (including specific features)</td><td char=".">11</td></tr><tr><td>Divided in sections, categories, or tabs</td><td char=".">10</td></tr><tr><td>User-created profiles or accounts</td><td char=".">9</td></tr><tr><td>App function</td><td /></tr><tr><td>Sends users notifications, reminders, or alerts</td><td char=".">13</td></tr><tr><td>Features forums and discussion boards for questions</td><td char=".">13</td></tr><tr><td>Features chatrooms to send messages</td><td char=".">12</td></tr><tr><td>Features search capabilities (search field, search bar)</td><td char=".">11</td></tr></tbody></table> </ephtml> </p> <p>In addition, many participants reported visual descriptions of the app and specific components that could be built into the app design. Some participants communicated a desire for a clean and modern construction, articulating that the app could be inspired by Apple products or characteristics of current social media applications (i.e., visuals that are esthetically pleasing, rounded corners for the icon, and external links opening internally instead of navigating the user to an external browser similar to Instagram). Several participants further commented that navigating through the app should be intuitive and relatively easy to use.</p> <p>Well, when I say modern, [I mean] it doesn't have this blocky-looking design. It's like the corners are rounded out. Because on older apps that aren't updated, there's apps from five, six years ago that are still on the Android, the Play Store on Google, they are just completely boxy with some generic text. And it's quick, but it looks really outdated. If [users think] that it looks outdated, [users might think] the information's outdated, too. (Participant 17, Male)</p> <hd id="AN0176405448-14">Sustained engagement</hd> <p>When asked how users could be motivated to continue using the app, notable themes included features to document health information and incentives to keep users engaged. For example, participants stated they would be motivated to use the app if they could monitor their health by documenting their sexual activity, recording fitness activity, or setting goals to improve their health. Rewarding users with free merchandise (e.g., clothing items, feminine hygiene products, or condoms) for the amount of time that they used the app could also be a source of motivation.</p> <hd id="AN0176405448-15">Intervention utility</hd> <p>In response to questions about when and why participants would use the app, several themes overlapped with the four domains of health literacy previously reported. For example, participants discussed using the app to find information on a broad range of health topics, schedule appointments, and communicate with their health care provider. Depending on users' needs, participants felt the app could be used anywhere between 5 to 60 minutes at a time and may only be used once or periodically.</p> <hd id="AN0176405448-16">Before, during, and after clinic visits</hd> <p>Participants were also asked to consider how the app could specifically be used before, during, and after clinic visits. Participants felt the app would primarily be used <emph>before a visit</emph> when users have a "problem", such as when they are experiencing a health issue, or, if interested in learning more about a particular topic. Several suggested using the app to check symptoms, relying on the app to provide a tentative diagnosis and help users determine whether an appointment is needed. Other uses before a visit included identifying services, scheduling visits, determining visit costs, completing patient intake forms (e.g., medical history), and preparing for the visit by learning how to better communicate with providers and ask questions.</p> <p>I think it could be helpful for them to know if they need to see a health care provider at all, and if so, what type, because obviously, if it's an immediate problem they should go to urgent care, [but] if it's like something that could wait a week, but it's not the end of the world, they can just wait to go to their normal doctor, or do they have to go to a different doctor, do they have to go to that doctor first to go to the other doctor. (Participant 19, Female)</p> <p>Suggested app uses <emph>during the visit</emph> were primarily dependent upon the app being integrated with the on-campus student health clinic. Participants recommended that health care providers be able to use the app during visits to refer to users' health information entered into the app (e.g., health behaviors) and to take notes for users to refer to later. Some felt the app could be used as a guide for patients during visits, with reminders on health topics to discuss.</p> <p>Maybe bringing up the app during a doctor's visit and maybe telling the doctor, "Listen, I read this and this and this. What do you think about this? Do you think this is a good idea?" Going back and forth between using the information within that app and still checking with the doctor to see if this is a good idea. (Participant 9, Female)</p> <p> <emph>After the visit</emph>, participants reported the app could be used to seek additional information on diagnoses, medical terms and advice, and prescribed treatments. The app could also be used to set reminders for prescriptions, take medication, and schedule follow-up visits. The theme of communicating with providers also continued. Participants suggested providers could use the app to follow-up with users, develop an individualized care plan, and provide additional health information. A few participants suggested using the app to track health progress based on their care plan or goals discussed with providers.</p> <p>The provider could send the aftercare instructions instead of a huge printout, because that could get lost really easily. And then follow up care. Like come back in a week, maybe set up an appointment, maybe an appointment setter through that. (Participant 11, Female)</p> <hd id="AN0176405448-17">Intervention characteristics</hd> <p></p> <hd id="AN0176405448-18">Risk and uncertainty level</hd> <p>Most participants reported privacy as a salient risk. Participants wanted assurance that data collected, or health information entered into the app, would be safe and secure. Other concerns reported by participants include data leaks, hacking, and how the app could be integrated with other systems and applications. To address these concerns, participants discussed the benefits of additional safeguards for security such as the utilization of a username or display name, a password, personal identification numbers, and encryption. Beyond these concerns, participants reported data authorization to be another risk. Several participants noted that users should have the authority to control who has access to their identifiable information and for how long, including developers of the app, significant others, university personnel, and health care providers.</p> <hd id="AN0176405448-19">Modifiability</hd> <p>Another dominant theme within intervention characteristics was the option for the app to be modified to meet the diverse SRH needs of college students. Some participants expressed that different features and functions could be modified based on the user's characteristics or preferences. An innovative way these functionalities could be prioritized is through an introductory questionnaire that users complete when they launch or use the app for the first time. Based on the preferences selected, the app could then prompt additional pathways. For example, college students with disabilities may benefit from more accessibility features built into the app design such as screen reader compatibility, haptic feedback (vibrations), and the ability to type messages to communicate with others. Concerning gender and sexual minorities, participants reported the app could address misconceptions about sexual preventive measures and provide additional resources that support individuals in the LGBTQ + community. Alternatively, some participants reported the app could have different interfaces catered to individual-level characteristics identified by the user. For example, different interfaces for female and male users that display similar information. With multiple interfaces, the user would have the freedom to utilize multiple sides of the app or see information that might be displayed on their partner's interface. Other examples of how the app could be modified to meet the diverse needs of college students can be seen in Table 4.</p> <p>Table 4. Supporting quotes for app modifiability.</p> <p> <ephtml> <table><thead><tr><td>Demographic Characteristics</td><td>Select Quotes</td></tr></thead><tbody valign="top"><tr><td>College students who identify as male</td><td>"I think in the opening survey, one of the very first questions that needs to be asked is, are you male or female and then based on that, the app can not necessarily exclude information of the other gender, but it can put the information about your gender at the forefront." (Participant 18, Male) "Something that's tailor-made toward guys, because I know tampons to pads, that stuff is tailored more toward girls as opposed to guys. I feel the guys may feel that there's not that much for them to read about. They might think, "Oh those, not necessary, I don't have to worry about a lot of that stuff." There's things that guys need to know, but they don't know." (Participant 18, Male)</td></tr><tr><td>College students who identify as LGBTQ+</td><td>"Especially with the LGBT community, there's a lot of misconceptions about what's safe and what's not. So having that information there could be really helpful to them, cause they might not even know that they're doing something that they shouldn't be doing, or aren't doing something that they should be doing." (Participant 19, Female) "I think the LGBTQ community definitely has their own unique needs because theirs is not only [physical], but it's also psychological too. So they're having different experiences with their sexual health than the norm, and most resources are geared toward the norm. So I think having a special place for them I think would be really, really benefit." (Participant 11, Female)</td></tr><tr><td>College students with an international background or language barrier</td><td>"Since there's more international [students] we could change the language. We have different versions [because] not everybody's the same and go through the same things." (Participant 2, Female)</td></tr><tr><td>College students in their first year of study</td><td>"I think for girls in college, especially like first years, the transition could be rough. I have friends who they're only learning now how to be on top of taking care of themselves. So I think with all the hustle and bustle going on, these little notifications and everything being in one simple app that could help them be more mindful of their body." (Participant 12, Female) "But freshmen, learning how to have that conversation, what types of things they'll be asked, cutting down on the awkwardness so they don't lie, because that's the worst thing that you can do to a provider, because then if you're not giving them accurate information they can't care for you accurately." (Participant 11, Female)</td></tr><tr><td>College students with or without health insurance</td><td>"I think it would be nice to have on campus resources, so they could [select in the app] "I'm on campus", and also maybe if they could [select in the app], "I have health insurance" or "I don't have health insurance", I think that that's gonna change the way the information [will] be relayed to them, because not everyone has health insurance." (Participant 19, Female).</td></tr><tr><td>College students with different religious views and morals</td><td>"It's more of just, not just religious, but just more people who value abstinence. You don't have to educate them and push their values onto them. Maybe when you're creating up an account, you can say I identify as this, this, this, this. I believe in abstinence, I don't believe in abstinence, stuff like that." (Participant 12, Female) "That's where I believe that any app, whatever it is, needs to address the population as a whole in terms of race, in terms of ethnicity, in terms of religion, whatever it may be. Now, birth control is something that's hush-hush in the Catholic community. A lot of them don't practice birth control and they get very conservative in their needs or even, lets just say [any] religion [they are] very hush-hush about things like this or anything sexual in particular." (Participant 9, Female)</td></tr><tr><td>College students with disabilities or impairments </td><td>"As well as not just language, but also just accessibility with visually impaired, or hearing impaired. So making sure that the app is capable of TDD [Telecommunication Device for the Deaf] or something like that, because I know that's a population that really gets overlooked." (Participant 11, Female) "People who are disabled might have different issues with health insurance or might have different issues being able to access going to the doctor and stuff like that." (Participant 19, Female) "Just having a setting for people [with disabilities]. If they want little vibrations, or even for pictures to convert it to text. That way, if it has something like audio reader it can read to them what the picture is, for example." (Participant 13, Female)</td></tr><tr><td>College students with little knowledge in SRH and interested to learn more about their SRH needs</td><td>"We don't talk about sex. It's not something that you bring up in your conversation ever. Same thing with mental health. Let's talk about that. I think the app needs to be very specific but at the same time, not as direct. For example, maybe it could work people up to the point where they're comfortable enough to read something they're not accustom to reading." (Participant 9, Female) "Also, when you say [someone who has] less knowledge about sexual assault, I think that's important. Because some people come from schools where they don't even have sex ed. I came from a private school, high school that did not have sex ed. I think that's important that we at least fill out those gaps for them." (Participant 13, Female)</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note</emph>: LGBTQ+ = lesbian, gay, bisexual, transgender, queer and questioning; SRH = sexual and reproductive health.</p> <p>It can be specifically catered towards the individual. There could be a series of questions on orientation, how often they do things, or anything under the sun. That could be geared towards them, like, here's some helpful little articles you can read, pertaining to you specifically. (Participant 3, Male)</p> <hd id="AN0176405448-20">Emergent theme</hd> <p>While not asked about it directly, credibility of information was a theme that emerged across interviews. Participants noted that it is important to provide citations and references for sources of health information provided on the app. Participants wanted to know that the information they are being given is accurate, up-to-date, and from trustworthy sources. They felt that this information would help set the app apart from questionable Internet sources or help combat misinformation impacting SRH health decision-making. In general, participants considered credible sources to be medical professionals, health organizations, and peer-reviewed studies or literature.</p> <p>I think articles are good and then if more information's needed, being able to talk to a professional in some form, video chat or maybe even just a web thing, a chat room or something, things that are from credible sources as opposed, from the internet is not gonna be so much of a credible place. (Participant 16, Male)</p> <hd id="AN0176405448-21">Discussion</hd> <p>Guided by a UCD approach, this qualitative study conducted semi-structured, in-depth interviews with 20 college students to elicit health literacy needs and preferences for a technology-based intervention (app). Dominant themes were related to accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility.</p> <p>Our findings are consistent with other studies that found technology could help fill unmet needs among college students and provide an additional, credible source of health information, which includes accessing information for SRH purposes.[<reflink idref="bib13" id="ref50">13</reflink>],[[<reflink idref="bib32" id="ref51">32</reflink>], [<reflink idref="bib34" id="ref52">34</reflink>]] Specifically, participants in this study discussed using an app to help them access information on a broad range of topics and conditions (e.g., prevention, symptoms, treatment) to inform their decisions about whether healthcare appointments are needed, as well as to learn more about these topics prior to their clinical visits.</p> <p>Participants felt that an app could increase access to SRH services by allowing users to conveniently and discreetly locate services, both on- and off-campus, and schedule appointments directly through the app. Lack of knowledge about what and where SRH services are available has been identified as a barrier to college students' SRH service utilization.[<reflink idref="bib24" id="ref53">24</reflink>],[[<reflink idref="bib35" id="ref54">35</reflink>], [<reflink idref="bib37" id="ref55">37</reflink>]] Students have described being inundated with information when they arrive on campus and that that they do not retain information about their campus' services; thus, delivering prompts and reminders about available SRH services via apps and text messages is recommended.[<reflink idref="bib24" id="ref56">24</reflink>],[<reflink idref="bib35" id="ref57">35</reflink>]</p> <p>During clinical visits, participants felt that an app could facilitate patient-provider communication by preparing and guiding students through discussions with their provider and offering a direct line of communication for questions and follow-up. Previous research has credited technology with improving patient-provider communication, such as speaking with providers outside of standard clinic hours, communicating questions in writing, and feeling more comfortable asking sensitive questions.[<reflink idref="bib38" id="ref58">38</reflink>] However, few studies have explored college students' perceptions of the ways in which technology can facilitate patient-provider communication, specifically in terms of SRH, and this presents a future area of research. Additional research should employ quantitative and qualitative methods to better understand the extent to which the technology-based intervention can impact SRH literacy, including changing knowledge or attitudes toward SRH topics, increasing clinic visits or interactions with providers, and expanding the uptake of preventive health services such as HPV vaccination and reproductive health screening.</p> <p>Concerning intervention integration and functionality, participants reported wanting an app with the ability to message others either through discussion boards, forums, or chatrooms. This finding is consistent with other studies of AYA who participated in technology-based interventions to improve SRH.[<reflink idref="bib39" id="ref59">39</reflink>],[<reflink idref="bib40" id="ref60">40</reflink>] Similar to the college students of the present study, these participants wanted messaging capabilities to ask and answer additional questions they had about their SRH (e.g., contraception methods, STI screening), read about peers' experiences, and engage in conversations about various contraceptive methods. Messaging capabilities may also be a convenient way for college students to communicate about sensitive topics, such as preventive sexual health, and connect them more easily to SRH information and services. Patient-tailored communications could also benefit from incorporating existing SRH decision-making tools, such as those found on Bedsider, a popular nonprofit SRH online resource with medical content oversight by scientific/public health experts.[<reflink idref="bib41" id="ref61">41</reflink>] Other features such as periodic reminders, a tracking system, and password protection have also been documented and implemented in technology-based interventions aimed to improve SRH health.[<reflink idref="bib39" id="ref62">39</reflink>],[<reflink idref="bib40" id="ref63">40</reflink>]</p> <p>One of the unique intervention characteristics was modifiability, which included suggestions on how the intervention could be tailored to meet college students' unique needs. These findings are important contributions to peer-reviewed literature, as a systematic review of applications on pregnancy prevention for adolescents found that none of the 22 apps evaluated allowed users to customize the application or schedule appointments.[<reflink idref="bib42" id="ref64">42</reflink>] Other reviews have noted that technology-based interventions can and should be tailored to an audience, including marginalized groups.[<reflink idref="bib43" id="ref65">43</reflink>],[<reflink idref="bib44" id="ref66">44</reflink>] Some of these interventions were tailored based on racial or ethnic identity, risk profile, and gender, which is consistent with the suggestions of the participants in the present study. Future research should explore what app features and characteristics are most effective when modified to meet the needs of diverse college students (e.g., students with disabilities or those who identify as a gender or sexual minority).</p> <p>The theme of credibility of information emerged across the interview data. Participants emphasized the need for information to be accurate, up-to-date, and from reputable sources. In a review of studies examining trust and credibility of Web-based health information, Sbaffi and Rowley[<reflink idref="bib33" id="ref67">33</reflink>] found that users are more likely to trust online health information when the author of a website is a credible source. In another study among college students, authors found that participants were more likely to directly visit a website they considered credible (e.g., Planned Parenthood) to find answers to SRH questions.[<reflink idref="bib45" id="ref68">45</reflink>] Additionally, a study that employed focus groups among adolescents aged 14–19 years reported that credibility of the source was a dominant theme regarding online SRH resources.[<reflink idref="bib34" id="ref69">34</reflink>] Similar to the participants in this study, the adolescents described credible sources as being medical professionals or health organizations. Future research should examine the importance of digital (eHealth) literacy as an extension of health literacy to access SRH content and how participants determine whether a source is credible, including judgements made about specific websites and social media platforms.</p> <hd id="AN0176405448-22">Strengths and limitations</hd> <p>Findings must be considered in light of study limitations. First, this study may not be generalizable to the larger population due to the small sample size. This study also included a convenience sample of students at one university and may not be generalizable to the entire university or college students across the US. Although the study benefited from including both males and females at the undergraduate and graduate levels, additional research may be necessary to address diverse student needs (e.g., racial/ethnic, sexual or gender minorities). Furthermore, recruitment bias may be present as subjects may have agreed to participate only if they were interested in the topic or comfortable discussing SRH information. Despite following a semi-structured interview guide, interviewer bias may have been present given the study employed two interviewers that may have varied in their wording and probing.</p> <p>This study should also be recognized for its strengths. This study was theoretically driven utilizing multiple theoretical frameworks to guide the design and dissemination of the study. In addition, this study was guided by a UCD approach focusing on technology-based interventions for college students and included graduate students on the research team who informed the design, development, and dissemination phases of the study.[<reflink idref="bib20" id="ref70">20</reflink>],[<reflink idref="bib21" id="ref71">21</reflink>] Furthermore, employing individual interviews permitted a diverse and patient-centered approach to eliciting needs and preferences with regards to SRH. Lastly, limited research has studied the potential for app use among college students for sexual health promotion; whereas more research has examined app use among college students to self-monitor health behaviors, such as dietary intake, risk for eating disorders, and mental health needs in collaboration with counseling centers in general, or specifically in response to the COVID-19 pandemic.[[<reflink idref="bib46" id="ref72">46</reflink>], [<reflink idref="bib48" id="ref73">48</reflink>], [<reflink idref="bib50" id="ref74">50</reflink>]] This study contributes to the knowledge base by focusing on how a technology intervention could be utilized in collaboration with college health clinical centers to facilitate SRH literacy, which extends beyond only increasing access to information, and expands to including other key skills such as appraising, communicating, and more importantly facilitating SRH decision-making and care within the context of a clinical visit.</p> <p>Additional areas of future research include adhering to UCD principles and developing a technology intervention in collaboration with college students, clinic staff, health IT personnel, and college administrators – key stakeholders who will provide leadership, buy-in, and institutional support, and/or who will be end-users of the intervention.[<reflink idref="bib21" id="ref75">21</reflink>] Thus, implementation science theories and methodologies should be utilized in future to research to guide intervention design and to maximize implementation outcomes (e.g., acceptability; feasibility; adoption; costs; sustainability) and service outcomes (e.g., efficiency; effectiveness; patient-centeredness).[<reflink idref="bib51" id="ref76">51</reflink>],[<reflink idref="bib52" id="ref77">52</reflink>] Employing an implementation science approach will also support this beyond a quality improvement project at one institution and will contribute to generalizable knowledge that can be extended to other college settings and clinical infrastructures. Including diverse interdisciplinary partners in future research – such as colleagues from medical engineering, health services research, and information technology, as well as potentially exploring academic-business partnerships – could also identify potential technological solutions to leverage existing electronic health records and patient portal systems, and innovatively integrate other applications into the current clinical workflow given potential institutional barriers and constraints. This will be important particularly for institutions that are smaller or who have limited staff, funding, or other resources and supports.</p> <hd id="AN0176405448-23">Conclusions</hd> <p>This study examined college students' SRH needs and preferences for a technology-based app, which could be integrated into an on-campus student health clinic. Students discussed their ideas for how the app could improve health information and services and patient-provider communication. Furthermore, insights were gained into preferred design and functions of the app and at which point in the clinic flow (before, during, after) it would be most useful. Meeting the SRH literacy needs of college students and providing opportunities through on-campus student health clinics to improve SRH literacy is imperative for improving SRH outcomes among this at-risk population.</p> <hd id="AN0176405448-24">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to disclose. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United State of America and received approval from the University of South Florida's Institutional Review Board.</p> <ref id="AN0176405448-25"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Finer LB, Zolna MR. Unintended pregnancy in the United States: Incidence and disparities, 2006. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Health Literacy Needs and Preferences for a Technology-Based Intervention to Improve College Students' Sexual and Reproductive Health
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Cheryl+A%2E+Vamos%22">Cheryl A. Vamos</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0227-514X">0000-0003-0227-514X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Joseph+A%2E+Puccio%22">Joseph A. Puccio</searchLink><br /><searchLink fieldCode="AR" term="%22Stacey+B%2E+Griner%22">Stacey B. Griner</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2774-5841">0000-0002-2774-5841</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rachel+G%2E+Logan%22">Rachel G. Logan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7686-5754">0000-0001-7686-5754</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rumour+Piepenbrink%22">Rumour Piepenbrink</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1931-1277">0000-0002-1931-1277</externalLink>)<br /><searchLink fieldCode="AR" term="%22Morgan+Richardson+Cayama%22">Morgan Richardson Cayama</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1903-1512">0000-0003-1903-1512</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sharonda+M%2E+Lovett%22">Sharonda M. Lovett</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5840-6404">0000-0002-5840-6404</externalLink>)<br /><searchLink fieldCode="AR" term="%22Helen+Mahony%22">Helen Mahony</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6874-6824">0000-0002-6874-6824</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ellen+M%2E+Daley%22">Ellen M. Daley</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3020-295X">0000-0003-3020-295X</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(2):477-486.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Sexually+Transmitted+Diseases%22">Sexually Transmitted Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Education%22">Health Education</searchLink><br /><searchLink fieldCode="DE" term="%22Contraception%22">Contraception</searchLink><br /><searchLink fieldCode="DE" term="%22Immunization+Programs%22">Immunization Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Technology+Uses+in+Education%22">Technology Uses in Education</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Technology+Integration%22">Technology Integration</searchLink><br /><searchLink fieldCode="DE" term="%22Information+Literacy%22">Information Literacy</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Materials%22">Health Materials</searchLink><br /><searchLink fieldCode="DE" term="%22Universities%22">Universities</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+Making%22">Decision Making</searchLink><br /><searchLink fieldCode="DE" term="%22Credibility%22">Credibility</searchLink><br /><searchLink fieldCode="DE" term="%22Handheld+Devices%22">Handheld Devices</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Software%22">Computer Software</searchLink><br /><searchLink fieldCode="DE" term="%22Usability%22">Usability</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Oriented+Programs%22">Computer Oriented Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Learner+Engagement%22">Learner Engagement</searchLink><br /><searchLink fieldCode="DE" term="%22Clinics%22">Clinics</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2022.2040517
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1419442
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1419442
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        Value: 10.1080/07448481.2022.2040517
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 477
    Subjects:
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Sexually Transmitted Diseases
        Type: general
      – SubjectFull: Sex Education
        Type: general
      – SubjectFull: Health Education
        Type: general
      – SubjectFull: Contraception
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      – SubjectFull: Immunization Programs
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      – SubjectFull: Information Literacy
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      – SubjectFull: Universities
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      – SubjectFull: Decision Making
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      – SubjectFull: Credibility
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      – SubjectFull: Handheld Devices
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      – SubjectFull: Computer Software
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