HELPING CLINICIANS ADDRESS DIGITAL INFORMATION ABOUT CONTRACEPTION WITH ADOLESCENTS

Adolescents frequently encounter contraceptive information online, though its quality varies, and many struggle to discern trustworthy sources given limited knowledge and prevalent misinformation. In the context of increasingly restrictive reproductive laws and threats to contraceptive access in the United States, supporting reproductive justice and informed decision-making about contraception is essential. Yet clinicians often lack strategies to address online information in clinical encounters, which exacerbates low rates of person-centered counseling for minors and contributes to dissatisfaction and use of non-preferred methods. This dissertation aimed to strengthen adolescent-centered contraceptive care by improving clinician communication. Aim 1 involved a qualitative content analysis of N=297 Reddit posts from adolescents/young adults (AYA) and caregivers. AYA (n=268) most often sought direct medical or behavioral advice (38%), contraceptive knowledge (15%), pregnancy scare guidance (11%), and communication or access advice (9%). They also shared sex/contraception education (13%) and opinions on contraceptive rights or behaviors (12%). Caregivers (n=29) most often sought method recommendations (38%), expressed moral concerns (35%), or sought knowledge (17%) and communication advice (10%). Across all posts (N=297), including 10% with randomly sampled comments, 15% contained misconceptions. Few posts expressed positive emotions (10%) or trust (10%), and many conveyed negative emotions (60%), mistrust (28%), and anti-hormonal sentiment (16%). Aim 2 analyzed interviews with 24 clinicians specializing in adolescent sexual and reproductive health. Clinicians identified ways to integrate online information into encounters, described strategies for digital and health literacy, and shared approaches for addressing disagreements with patient-identified information. They also emphasized the importance of using patient-centered language, including careful framing of the term “misinformation.” Aim 3 tested a training on incorporating discussion of online information about contraception into routine counseling, co-developed with N=20 advisors (teens, caregivers, clinicians). Pilot testing with N=35 clinicians demonstrated acceptability (mean=4.6, SD=0.5), appropriateness (4.7, 0.5), and feasibility (4.6, 0.5). Participants demonstrated immediate and sustained (4-month) improvements in knowledge, beliefs, self-efficacy, and self-reported counseling behaviors (p<0.05). This dissertation advances understanding of adolescent and caregiver contraceptive concerns and provides actionable strategies for clinical communication around online health information, addressing a critical social determinant of health in the digital age.