An Adaptation of "Safe in the City" to Prevent STDs and Unintended Pregnancies Among Older Adolescents

Background: Older adolescent African-American and Latina females experience disproportionately high rates of unintended pregnancies and STDs. We created a new video intervention for this population by adapting the model created for “Safe in the City” (SITC), a soap-opera style video found to reduce STD infections among clinic patients by nearly 10%. SITC is one of CDC’s Effective Behavioral Interventions.

Methods: We developed “Plan A” from 2015-2016, using an iterative process similar to SITC. This included a reproductive health clinic staff survey (n=8) and feedback from several subject matter experts. The target audience of African-American and Latina women age 18-19 provided input throughout program development, beginning with 3 focus groups (n=41) and subsequently through a 9-person review panel that provided detailed feedback on multiple script drafts and program elements. We hired a professional screenwriter and production company to produce a television-quality video. 

Results: The clinic staff survey, expert input, and focus groups informed the content and format of “Plan A.” Target audience members stressed that the video must be engaging and realistic. Review panel feedback resulted in numerous script changes, and was key to ensuring that “Plan A” is entertaining as well as culturally and age appropriate. The final video includes three connected stories involving relatable characters, and two animated sequences. Topics covered include long-acting reversible contraception, condoms, emergency contraception, STD/HIV prevention and testing, and healthy relationships. Because “Plan A” will be watched by clinic patients before seeing their provider, it depicts approachable providers and effective patient-provider communication. 

Conclusions: SITC provided a model to create a new entertainment-education intervention for a different audience and to address pregnancy prevention as well as STDs. Extensive target audience involvement, input from stakeholders, and an iterative process were vital to developing the video. “Plan A” will be evaluated in a randomized controlled trial from 2016-2019.