(130) Use of Digital Flashcards for Reproductive Health Counseling among Adolescents

Background: Adolescents may view reproductive health topics as difficult to understand, and there is limited research about adolescent health literacy. Visual aids can be utilized to illustrate concepts that are difficult to comprehend. In the clinic setting, large models or posters may not be readily available, but cell phone use is ubiquitous. The purpose of this study is to determine whether digital flashcards on a provider's cell phone are helpful in educating adolescents about reproductive health.

Methods: Adolescents age 11-17 presenting to a PAG clinic participated in this IRB approved study. Informed consent was obtained from patients and guardians. Subjects were randomized 1:1 to "flashcards" or "control". For subjects in the flashcard group, the provider used multiple graphics to explain reproductive health topics during the clinic visit. The control group received counseling as usual but without any graphics. The digital flashcards were designed by a graphic designer with help from a PAG physician and uploaded to a file on their cellphone. This PAG physician conducted all clinic encounters. The flashcards included all contraceptive methods, internal and external anatomy and the menstrual cycle (Figure 1). Data was collected on subject age, prior contraceptive use, reason for clinic visit and whether they were new or return. Subjects were surveyed on topics discussed and underlying knowledge by Likert scale. Power analysis determined 96 subjects per group.

Results: There were 197 subjects (99 flashcards, 98 no flashcards) with mean age of 14.7 (SD 1.67). In the flashcard group the mean number used was 2.8 (SD 1.69) with range of 1-7. New patients used used more flashcards than return patients (3.48 vs 2.40, p=0.001). The most frequently used flashcards were 7 day placebo birth control pills, the intrauterine device, the 84 day birth control pills and internal anatomy. Among the flashcard group 96.9% reported they "agreed" or "strongly agreed" that flashcards were helpful in understanding the topics discussed, and 98% would recommend using them in the future. Among the control group only 22.5% reported they would have learned more if flashcards had been used and 61.2% had a neutral response. Both groups experienced an increase in understanding of the topics discussed during clinic, and there was no difference between the flashcard group and control (Figure 2).

Conclusions: Digital flashcards are accessible via cell phone use. While there was not a difference in subject reported reproductive health understanding compared to control, those subjects using the flashcards reported high acceptability.