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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Study protocol

Trial protocol: a parallel group, individually randomized clinical trial to evaluate the effect of a mobile phone application to improve sexual health among youth in Stockholm County

Authors: Anna Nielsen, Ayesha De Costa, Aspasia Bågenholm, Kristina Gemzell Danielsson, Gaetano Marrone, Jens Boman, Mariano Salazar, Vinod Diwan

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Genital Chlamydia trachomatis infection is a major public health problem worldwide affecting mostly youth. Sweden introduced an opportunistic screening approach in 1982 accompanied by treatment, partner notification and case reporting. After an initial decline in infection rate till the mid-90s, the number of reported cases has increased over the last two decades and has now stabilized at a high level of 37,000 reported cases in Sweden per year (85% of cases in youth). Sexual risk-taking among youth is also reported to have significantly increased over the last 20 years. Mobile health (mHealth) interventions could be particularly suitable for youth and sexual health promotion as the intervention is delivered in a familiar and discrete way to a tech savvy at-risk population. This paper presents a protocol for a randomized trial to study the effect of an interactive mHealth application (app) on condom use among the youth of Stockholm.

Methods

446 youth resident in Stockholm, will be recruited in this two arm parallel group individually randomized trial. Recruitment will be from Youth Health Clinics or via the trial website. Participants will be randomized to receive either the intervention (which comprises an interactive app on safe sexual health that will be installed on their smart phones) or a control group (standard of care). Youth will be followed up for 6 months, with questionnaire responses submitted periodically via the app. Self-reported condom use over 6 months will be the primary outcome. Secondary outcomes will include presence of an infection, Chlamydia tests during the study period and proxy markers of safe sex. Analysis is by intention to treat.

Discussion

This trial exploits the high mobile phone usage among youth to provide a phone app intervention in the area of sexual health. If successful, the results will have implications for health service delivery and health promotion among the youth. From a methodological perspective, this trial is expected to provide information on the strength and challenges of implementing a partially app (internet) based trial in this context.

Trial registration

ISRCTN 13212899, date of registration June 22, 2017.
Literature
2.
go back to reference Nigro G, Mazzocco M, Mattia E, Di Renzo GC, Carta G, Anceschi MM. Role of the infections in recurrent spontaneous abortion. J Matern Fetal Neonatal Med. 2011;24(8):983–9. Nigro G, Mazzocco M, Mattia E, Di Renzo GC, Carta G, Anceschi MM. Role of the infections in recurrent spontaneous abortion. J Matern Fetal Neonatal Med. 2011;24(8):983–9.
3.
go back to reference Thurman AR, Doncel GF. Innate immunity and inflammatory response to Trichomonas vaginalis and bacterial vaginosis: relationship to HIV acquisition. Am J Reprod Immunol. 2011;65(2):89–98.CrossRefPubMed Thurman AR, Doncel GF. Innate immunity and inflammatory response to Trichomonas vaginalis and bacterial vaginosis: relationship to HIV acquisition. Am J Reprod Immunol. 2011;65(2):89–98.CrossRefPubMed
5.
go back to reference DS LM, Fenton KA, Randall S, Anderson S, Carter P. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex Transm Infect. 2004;80(5):335–41.CrossRef DS LM, Fenton KA, Randall S, Anderson S, Carter P. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex Transm Infect. 2004;80(5):335–41.CrossRef
6.
go back to reference Ripa T. Epidemiologic control of genital Chlamydia trachomatis infections. Scand J Infect Dis Suppl. 1990;69:157–67.PubMed Ripa T. Epidemiologic control of genital Chlamydia trachomatis infections. Scand J Infect Dis Suppl. 1990;69:157–67.PubMed
7.
go back to reference Herrmann B, Egger M. Genital Chlamydia trachomatis infections in Uppsala County, Sweden, 1985-1993: declining rates for how much longer? Sex Transm Dis. 1995;22(4):253–60.CrossRefPubMed Herrmann B, Egger M. Genital Chlamydia trachomatis infections in Uppsala County, Sweden, 1985-1993: declining rates for how much longer? Sex Transm Dis. 1995;22(4):253–60.CrossRefPubMed
9.
go back to reference Egger M, Low N, Smith GD, Lindblom B, Herrmann B. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. BMJ. 1998;316(7147):1776–80.CrossRefPubMedPubMedCentral Egger M, Low N, Smith GD, Lindblom B, Herrmann B. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. BMJ. 1998;316(7147):1776–80.CrossRefPubMedPubMedCentral
14.
go back to reference Leval A, Sundstrom K, Ploner A, Dahlstrom LA, Widmark C, Sparen P. Assessing perceived risk and STI prevention behavior: a national population-based study with special reference to HPV. PLoS One. 2011;6(6):e20624.CrossRefPubMedPubMedCentral Leval A, Sundstrom K, Ploner A, Dahlstrom LA, Widmark C, Sparen P. Assessing perceived risk and STI prevention behavior: a national population-based study with special reference to HPV. PLoS One. 2011;6(6):e20624.CrossRefPubMedPubMedCentral
16.
go back to reference Herlitz CA, Forsberg M. Sexual behaviour and risk assessment in different age cohorts in the general population of Sweden (1989-2007). Scand J Public Health. 2010;38(1):32–9.CrossRefPubMed Herlitz CA, Forsberg M. Sexual behaviour and risk assessment in different age cohorts in the general population of Sweden (1989-2007). Scand J Public Health. 2010;38(1):32–9.CrossRefPubMed
17.
go back to reference Herlitz C. Allmänheten och hiv/aids: kunskaper, attityder och beteenden 1987–2003, vol. 07. Stockholm: Statens Folkhälsoinstitut; Rapport; 2004. p. 2004. Herlitz C. Allmänheten och hiv/aids: kunskaper, attityder och beteenden 1987–2003, vol. 07. Stockholm: Statens Folkhälsoinstitut; Rapport; 2004. p. 2004.
18.
go back to reference Clark LR, Brasseux C, Richmond D, Getson P, D'Angelo LJ. Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population. Arch Pediatr Adolesc Med. 1998;152(3):269–73.CrossRefPubMed Clark LR, Brasseux C, Richmond D, Getson P, D'Angelo LJ. Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population. Arch Pediatr Adolesc Med. 1998;152(3):269–73.CrossRefPubMed
19.
go back to reference Kamb ML, Fishbein M, Douglas JM Jr, Rhodes F, Rogers J, Bolan G, Zenilman J, Hoxworth T, Malotte CK, Iatesta M, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT study group. JAMA. 1998;280(13):1161–7.CrossRefPubMed Kamb ML, Fishbein M, Douglas JM Jr, Rhodes F, Rogers J, Bolan G, Zenilman J, Hoxworth T, Malotte CK, Iatesta M, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT study group. JAMA. 1998;280(13):1161–7.CrossRefPubMed
20.
go back to reference Wight D, Raab GM, Henderson M, Abraham C, Buston K, Hart G, Scott S. Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial. BMJ. 2002;324(7351):1430.CrossRefPubMedPubMedCentral Wight D, Raab GM, Henderson M, Abraham C, Buston K, Hart G, Scott S. Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial. BMJ. 2002;324(7351):1430.CrossRefPubMedPubMedCentral
21.
go back to reference Larsson M, Eurenius K, Westerling R, Tyden T. Evaluation of a sexual education intervention among Swedish high school students. Scand J Public Health. 2006;34(2):124–31.CrossRefPubMed Larsson M, Eurenius K, Westerling R, Tyden T. Evaluation of a sexual education intervention among Swedish high school students. Scand J Public Health. 2006;34(2):124–31.CrossRefPubMed
22.
go back to reference Malbon K, Romo D. Is it ok 2 txt? Reaching out to adolescents about sexual and reproductive health. Postgrad Med J. 2013;89(1055):534–9.CrossRefPubMed Malbon K, Romo D. Is it ok 2 txt? Reaching out to adolescents about sexual and reproductive health. Postgrad Med J. 2013;89(1055):534–9.CrossRefPubMed
23.
go back to reference Chacko MR, Wiemann CM, Kozinetz CA, von Sternberg K, Velasquez MM, Smith PB, Di Clemente R. Efficacy of a motivational behavioral intervention to promote chlamydia and gonorrhea screening in young women: a randomized controlled trial. J Adolesc Health. 2010;46(2):152–61.CrossRefPubMed Chacko MR, Wiemann CM, Kozinetz CA, von Sternberg K, Velasquez MM, Smith PB, Di Clemente R. Efficacy of a motivational behavioral intervention to promote chlamydia and gonorrhea screening in young women: a randomized controlled trial. J Adolesc Health. 2010;46(2):152–61.CrossRefPubMed
24.
go back to reference Boman J, Lindqvist H, Forsberg L, Janlert U, Granasen G, Nylander E. Brief manual-based single-session motivational interviewing for reducing high-risk sexual behaviour in women - an evaluation. Int J STD AIDS. 2017:956462417729308. Boman J, Lindqvist H, Forsberg L, Janlert U, Granasen G, Nylander E. Brief manual-based single-session motivational interviewing for reducing high-risk sexual behaviour in women - an evaluation. Int J STD AIDS. 2017:956462417729308.
25.
go back to reference Boman J. Prevention of Chlamydia trachomatis infections. Doctoral thesis. Umeå; 2013. Boman J. Prevention of Chlamydia trachomatis infections. Doctoral thesis. Umeå; 2013.
26.
go back to reference Wise J, Operario D. Use of electronic reminder devices to improve adherence to antiretroviral therapy: a systematic review. AIDS Patient Care STDs. 2008;22(6):495–504.CrossRefPubMed Wise J, Operario D. Use of electronic reminder devices to improve adherence to antiretroviral therapy: a systematic review. AIDS Patient Care STDs. 2008;22(6):495–504.CrossRefPubMed
27.
go back to reference Burns K, Keating P, Free C. A systematic review of randomised control trials of sexual health interventions delivered by mobile technologies. BMC Public Health. 2016;16(1):778.CrossRefPubMedPubMedCentral Burns K, Keating P, Free C. A systematic review of randomised control trials of sexual health interventions delivered by mobile technologies. BMC Public Health. 2016;16(1):778.CrossRefPubMedPubMedCentral
29.
go back to reference Krupp K, Madhivanan P. Antibiotic resistance in prevalent bacterial and protozoan sexually transmitted infections. Indian J Sex Transm Dis. 2015;36(1):3–8.CrossRefPubMedPubMedCentral Krupp K, Madhivanan P. Antibiotic resistance in prevalent bacterial and protozoan sexually transmitted infections. Indian J Sex Transm Dis. 2015;36(1):3–8.CrossRefPubMedPubMedCentral
31.
go back to reference Lau JT, Li J, Choi KC, Gu J. A randomized controlled trial evaluating the efficacy of a theory-based intervention promoting condom use among Chinese monogamous female sexually transmitted infection patients. Int J Behav Med. 2014;21(4):719–29.CrossRefPubMed Lau JT, Li J, Choi KC, Gu J. A randomized controlled trial evaluating the efficacy of a theory-based intervention promoting condom use among Chinese monogamous female sexually transmitted infection patients. Int J Behav Med. 2014;21(4):719–29.CrossRefPubMed
32.
go back to reference Bailey JV, Pavlou M, Copas A, McCarthy O, Carswell K, Rait G, Hart G, Nazareth I, Free C, French R, et al. The Sexunzipped trial: optimizing the design of online randomized controlled trials. J Med Internet Res. 2013;15(12):e278.CrossRefPubMedPubMedCentral Bailey JV, Pavlou M, Copas A, McCarthy O, Carswell K, Rait G, Hart G, Nazareth I, Free C, French R, et al. The Sexunzipped trial: optimizing the design of online randomized controlled trials. J Med Internet Res. 2013;15(12):e278.CrossRefPubMedPubMedCentral
33.
go back to reference Gibbs J, Gkatzidou V, Tickle L, Manning SR, Tilakkumar T, Hone K, Ashcroft RE, Sonnenberg P, Sadiq ST, Estcourt CS. Can you recommend any good STI apps?’ a review of content, accuracy and comprehensiveness of current mobile medical applications for STIs and related genital infections. Sex Transm Infect. 2017;93(4):234–5.CrossRefPubMed Gibbs J, Gkatzidou V, Tickle L, Manning SR, Tilakkumar T, Hone K, Ashcroft RE, Sonnenberg P, Sadiq ST, Estcourt CS. Can you recommend any good STI apps?’ a review of content, accuracy and comprehensiveness of current mobile medical applications for STIs and related genital infections. Sex Transm Infect. 2017;93(4):234–5.CrossRefPubMed
35.
go back to reference Mathieu E, Mc Geechan K, Barratt A, Herbert R. Internet-based randomized controlled trials: a systematic review. J Am Med Inform Assoc. 2013;20(3):568–76.CrossRefPubMed Mathieu E, Mc Geechan K, Barratt A, Herbert R. Internet-based randomized controlled trials: a systematic review. J Am Med Inform Assoc. 2013;20(3):568–76.CrossRefPubMed
36.
go back to reference Murray E, Khadjesari Z, White IR, Kalaitzaki E, Godfrey C, McCambridge J, Thompson SG, Wallace P. Methodological challenges in online trials. J Med Internet Res. 2009;11(2):e9. Murray E, Khadjesari Z, White IR, Kalaitzaki E, Godfrey C, McCambridge J, Thompson SG, Wallace P. Methodological challenges in online trials. J Med Internet Res. 2009;11(2):e9.
Metadata
Title
Trial protocol: a parallel group, individually randomized clinical trial to evaluate the effect of a mobile phone application to improve sexual health among youth in Stockholm County
Authors
Anna Nielsen
Ayesha De Costa
Aspasia Bågenholm
Kristina Gemzell Danielsson
Gaetano Marrone
Jens Boman
Mariano Salazar
Vinod Diwan
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5110-9

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