Updated: Dec 26, 2020
All teenagers deserve equal accessibility to and education about condom use, as a preventative measure of teen pregnancy, but that is not always the case, especially in East Harlem where the rate of the teen birth rate is double the Manhattan average.
Understanding the needs of the community we are planning to implement an intervention on, helps us to understand what the different levels to the problem are such as SES, education, health literacy and the scope of accessibility to available resources. I would to compare my chosen focus group (teenage African American and Hispanic girls between ages of 15 and 19 years old who go to Public High Schools located in East Harlem), as a sub group of African American and Hispanic teenage girls between ages of 15 and 19 years old who attend Public High Schools in the borough of Manhattan as a whole.
There are a number of good planning models aimed at behavior change, that help understand the contextual and background factors behind efficiently implementing interventions aimed at behavior change, making them comprehensive and applicable on a community level.
The Health Belief model can be applied to identify and mobilize individuals in focus groups, subgroups and communities to develop and maintain desired health outcomes. This model has an emphasis on the individual’s autonomous decision-making processes, especially when they’re exposed to relatable/understandable information, accessibility to resources, accessibility to diagnosis testing/medical treatment and learning about the short-term vs long-term gains of the desired behavior change.
In the first phase of the Health Belief model, ‘Perceived Susceptibility’, we would expose alarming statistics behind the HIV and STD epidemic to adolescents (via videos, online school websites, as assigned readings/articles, reproductive health and sexual education workshops held at school) who don’t use condoms. I would also incorporate relatable information such as creating ads to prevent unintended teen pregnancy in these ‘areas’ of the high school where students would linger around and socialize. This means making ads visible in the student’s school community (for example: ads in school newsletters/student bulletins, nurse’s office, main offices, hallways, student life buildings. after school programs/clubs, letters sent home from principal/teachers, hubs of ‘Student Life’ accessible to students and their peers).
The second phase of the Health Belief model is ‘Perceive Severity” where, we go over the challenges faced when dealing with the consequences of unintended pregnancy due to lack of proper condom use and maintenance, with high school students. We should also provide an explanation the benefits of condom use targeting students engage in sexual health workshops/classes where condom use is taught and condoms are distributed to the public for free (afterschool programs, community centers, community health street fairs community schools) alongside social media campaigns and online community support groups.
During the third phase of the Health Belief model, “Perceived Benefits of Action”, we provide an explanation the benefits of condom use, targeting students. Providing discreet accessibility to free condoms (ex: a jar of condoms inside school bathrooms, locker rooms, school libraries and the nurse’s office) and offering small and inexpensive incentives for picking up condoms such as distribution of hot food, discrete pouches made for condoms, small keychains, stickers, and/or small journals can work to increase the number of people who turn out to these areas; where condom use is taught and condoms are distributed to the public for free.
‘Perceived Barriers to Action’ is the fourth phase of the Health Belief model, where students would be educated on properly equipping, maintaining and storing condoms in an easily accessible yet discrete manner to that they remain ready for use (ex: storing condoms in purses, work bags, gym bags, school bags and discrete pouches made for condoms). We would go over and demonstrate what proper maintenance and equipping of condoms (having the condoms at hand, having been properly maintained, stored, and ready for use). The maintenance of the condoms including checking for condom expiration date, little holes or punctures in the condom, making sure that the condom size is correct, learning about the condom options available in lieu of an allergic reaction and replenishing ‘stash’ of condoms in a timely manner so you never run out. Role playing during sexual health workshops and classes, can prove to be beneficial when preparing students for situations where the preventative measure to be taken (condom use), arises, and is then properly taken (used). Challenges that may arise includes considering the fact that conservative groups and some political organizations in parts of the United States have spent considerable energy blocking comprehensive health education in schools and advocating for abstinence-only sex education.5 Many states also experienced a rise in teenage pregnancy after putting in place abstinence-only curricula and later began to reconsider the approach. School education programs that make condoms available report fewer students having intercourse and a higher level of safer sex practices among students who are having sex.
In an effort to ensure that our interventions are not perceived as imposing or forced on our participants, we would also harness grassroots surveys and conduct semi-structured interviews with the parents/legal guardians of the students and provide them with the option of allowing the student participants to be exposed to this intervention or not. It is important to garner and sustain a consistent, safe and transparent communication environment between our participants, their legal guardians, and the faculty members who work at Public High Schools in East Harlem (classroom teachers, nurses, counselors, peers). Respect for patients’ rights and more participatory, patient-centered communications can lead to improved health outcomes (Arora, 2003; Epstein & Street, 2007). Then we would conduct semi-structured interviews with students who attend Public High Schools in East Harlem, to gather information on who identifies themselves as African American or Hispanic teenage females (between ages of 15 and 19 years old) and who live in East Harlem to gather as a primary resource, to guide the intervention on unintended teen pregnancy and condom usage amongst African American and Hispanic teenage girls between ages of 15 and 19, who go to Public High Schools located in East Harlem.
The next phase of the Health Belief model, “Cues to Action”, would involve students creating peer campaigns advocating the benefits of using condoms when it comes to preventing unintended pregnancy and post them up on school websites, school newsletters, school bulletins, online support groups and on school grounds (social areas, library, nurse’s office, general office, school yard and bathrooms). The last phase of the Health Belief model, ‘Self-Efficacy’, mainly advocates for the autonomy students to stay engaged in condom use when engaging in sexual encounters by knowing where and how to replenish their condom supply, by knowing where and how to check for the expiration date on condoms, knowing where and how to storing condoms in an easily accessible yet discrete manner like in purses, work bags, gym bags, school bags and checking for any punctures or tears on the condom.
Ethnic minorities and those in poverty still experience a disproportionate burden of preventable disease and disability, and the gap persists between disadvantaged and affluent groups in the use of preventative services. School education programs that make condoms available report fewer students having intercourse and a higher level of safer sex practices among students who are having sex. The behavioral intervention mentioned in this paper, would be considered cost effective and can lead to universally availability and equally accessibility (across racial and socioeconomic groups in East Harlem and in Manhattan) of condoms and condom use advocacy as a preventative measure of preventing unintended teen pregnancy.
1. Manhattan Community District 11: EAST HARLEM. (n.d.). Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-mn11.pdf
2. Glanz, K., Rimer, B. K., & Viswanath, K. Health Behavior and Health Education: Theory, Research, and Practice. 5th Edition. Wiley/Jossey-Bass, San Francisco, CA.
3. Number and percent of unintended pregnancies among live ... (n.d.). Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/ms/PRAMSunintended-2010.pdf
4. Markt, S. C., Nuttall, E., Turman, C., Sinnott, J., Rimm, E. B., Ecsedy, E., … Mucci, L. A. (2016). Sniffing out significant “Pee values”: genome wide association study of asparagus anosmia. Bmj, i6071. doi: 10.1136/bmj.i6071
5. Simon & Schuster. (2011). Our bodies, ourselves. New York.
6. Glanz K, Rimer BK, Viswanath K, eds. Health Behavior: Theory, Research, and Practice. Fifth edition. San Francisco, CA: Jossey-Bass & Pfeiffer Imprints, Wiley; 2015.