The Focus4Teens Initiative: Developing Theory-Driven YR1 Needs Assessment Tools for Teen Pregnancy Prevention in Mississippi's Delta

Theoretical Background and research questions/hypothesis:  Focus4Teens is a multi-year CDC-funded project spear-headed by Mississippi First to reduce teen pregnancy in the Mississippi (MS) Delta. MS is regularly ranked among the top three states in births to teens, with the MS Delta disproportionately affected. Team members at Mississippi State University used the Ecological Model (EM) to guide development of the Focus4Teens YR1 needs assessments. Using EM to approach teen pregnancy prevention across individual, interpersonal, community, organizational, and policy factors allowed us to consider this issue’s multiple factors under a single framework. Our needs assessments are informed by two research questions: 1) what are the multi-level barriers and facilitators to reducing teen births in the MS Delta; 2) what are the multilevel barriers and facilitators to increasing access to birth control—including long-acting reversible contraceptives (LARC)—among MS Delta teens. 

Methods and Results (informing the conceptual analysis):  In an iterative and collaborative process with MS First, the CDC, and a national training and technical assistance (T&TA) provider, we produced a suite of EM-informed needs assessments targeting four distinct groups of Focus4Teen participants in the MS Delta—youth ages 13-19, parents/caregivers of youth ages 12-19, healthcare providers (HCP) and clinic staff who serve youth (including school-based clinic staff), and staff of schools/other youth-serving organizations (YSO). Assessments for youth ages 13-19 include focus group guides and demographic surveys to explore, for example, teens’ experiences seeking sexual and reproductive health (SRH) services, knowledge of where they can receive free/low-cost confidential SRH services, SRH communication with parents/caregivers, and preferred attributes of youth-friendly SRH providers. Assessments for parents/caregivers of youth ages 12-19 include in-depth interview guides and surveys to explore, for example, their perspectives on teen pregnancy at the family- and community-levels, SRH communication with their teens, abstinence only versus abstinence-plus sex education in local schools, and knowledge of where teens can receive free/low-cost SRH services. HCP/clinic staff assessments include in-depth interview guides to explore, for example, organizational- and policy-level barriers to providing birth control/LARC for teens, such as confidentiality issues and SRH billing, and how they currently address these barriers. YSO staff assessments include in-depth interview guides to explore, for example, community- and organizational-level barriers to referring local teens for SRH services.

Conclusions:  Using EM to guide our instrument development ensures that multilevel factors are systematically considered for each of Focus4Teen’s diverse groups of participants—youth ages 13-19, parents/caregivers of youth ages 12-19, HCP/clinic staff, and YSO staff. 

Implications for research and/or practice:  Needs assessment benefits from a theoretical model that is consistently applied across the initiative, beginning with the earliest stage of development. EM is particularly well-suited for needs assessments that addresses a complex, community-wide public health issue such as teen pregnancy prevention. We anticipate that grounding the Focus4Teen’s YR1 needs assessment instruments in EM theory will not only increase the utility of the data for MS First, the CDC, and the national T&TA provider, but will increase the assessment’s relevance for teens, parents, HCP/clinic staff, and YSO staff in the MS Delta, as well as SRH policy-makers/advocates.