There are a number of good planning models that help understand the contextual and background factors behindefficiently implementing interventions aimed at behavior change, making them comprehensive and applicable on a community level. 6 The Transtheoretical Model or Social Cognitive Theory (SCT) can be applied to identify and mobilize individuals in focus groups, subgroups and communities to develop and maintain desired health outcomes.6 For instance, we can use the Transtheoretical Model to destigmatize condom use and increase accessibility to condoms throughout all East Harlem’s Public High Schools. The Transtheoretical Model uses premeditated stages of change to lead to desired health outcomes (condom use among the students targeted).6
In the Transtheoretical model, we focus on the decision-making processing before the attainment of the desired health objective. This decision-making processing is broken down into 6 phases: pre-contemplation, contemplation, decision (Preparation), action, maintenance, relapse/termination. Each phase reflects a concept of the decision-making process before acting or taking on the behavior change. 6 The first phase ‘pre-contemplation’6 would consist of creating ads, advocating condom use that target students and that are visible in their community (for example: ads in school newsletters/student bulletins, letters sent home from principal/teachers, hubs of ‘Student Life’ accessible to students and their peers), engage in sexual health workshops/classes where condom use is taught and condoms are distributed to the public for free (within the limits of the geographic area for example: afterschool programs, community centers, community health street fairs community schools) alongside social media campaigns and online community support groups.
The second phase, of the Transtheoretical Model, is ‘the contemplation phase’ 6. During the ‘contemplation phase’, we provide discreet accessibility to free condoms and promote condom use targeting students (ex: a jar of condoms inside school bathrooms, locker rooms, school libraries and the nurse’s office) and provide an explanation the benefits of condom use targeting students. Offering small and inexpensive incentives for picking up condoms such as 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.
‘The Decision Preparation’ is the third phase 6, where we would educate student on properly equipping with condoms by properly 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). The next phase, ‘the action phase’6 has to do with being properly equipping with condoms (by actually having the condoms at hand, having been properly maintained, stored, and ready for use) and preparing for a situation where the preventative measure to be taken (condom use), arises, and is then properly taken (used). The following phase, ‘the maintenance phase’6 requires 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.
Unfortunately, in the final phase, ‘the relapse phase’6 we would no longer be in the preventative level of disease but in the secondary level where we would prepare for periodic HIV/STI/STD diagnostic testing especially since condoms are not 100% effective at preventing pregnancy, HIV, STI’s and STD’s.
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). 2 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.
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.5 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.5
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.1 Understanding the needs of the community we are planning to work with, helps to understand the different levels and kinds of access and/or resources are available to its members (such as health insurance). In East Harlem, 24% of adults have no health insurance (compared to 15% of adults in Manhattan).1 The poverty level is 31% in East Harlem where, 31.7% of teens between the ages of 15 years through 19 years, gave birth.
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. 2 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. 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 and/or Health Literacy. 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.2
Resources:
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.