Clinical Trials Logo

Clinical Trial Summary

Unintended pregnancy (UP), defined as a mistimed or unwanted pregnancy, is a significant and prevalent public health problem, particularly among low-income women. Over half of all pregnancies are reportedly unintended and UP has been linked to adverse health outcomes in mothers and their children. Correct and consistent use of effective contraception is the primary method to prevent UP. Research has shown that low self-esteem and elevated depressive symptoms increase women's risk for ineffective contraception use and, by extension, for UP. This project examines the feasibility and possible efficacy of reducing ineffective contraception using an intervention that addresses depressive symptoms and self concept among young, low-income, predominantly minority women at risk for UP. Traditional cognitive behavioral therapy (CBT) is effective in reducing depressive symptoms and improving self concept; but limited utilization, poor response, and low adherence to CBT is common among low-income and minority women. A more acceptable method for delivering CBT is needed for the target population. This project will use peer-specialists to deliver a CBT-based intervention to women at risk for UP. Because peer specialists are drawn from the same community as the target population and share some similar life experiences, the intervention may be more acceptable and effective than one offered by trained professionals.

This project will examine the effectiveness of a 9 week (8-session) peer-specialist led CBT-based intervention compared to an observational control condition to reduce depressive symptoms, improve self-esteem, and improve consistent contraceptive use to prevent UP. The weekly intervention sessions are delivered by telephone by a trained peer specialist. The study will evaluate the effectiveness of the intervention to improve consistent contraceptive use (primary outcome) and decrease depressive symptoms and increase self-esteem (secondary outcomes).


Clinical Trial Description

This is a randomized controlled trial with one intervention group (peer-specialist led telephone-based CBT) and an observation only control group. There will be 3 measurement periods: baseline (pre-intervention), 10-week follow-up (post-intervention) and 14-week follow up. The 14-week follow up assesses the primary outcome (consistency of contraception use) and secondary outcomes (psychological symptoms and self-esteem), whereas the 10-week follow up assesses mediating variables (sexual self-efficacy, contraceptive self-efficacy, social support and coping). There is also a 4-week, mid-intervention assessment of outcomes designed to assess if there is a worsening of symptoms that needs to be addressed (e.g. referral for spike in depression or emergence of suicidal intent). This midterm evaluation also allows us to monitor the well-being of the control group, which has significantly less contact with project staff than the intervention group.

We will recruit 132 sexually active women from health care clinics (e.g., family planning, OB/GYN), with the aim of retaining at least 92 (46 per condition). Interested women will be consented and screened for eligibility in a private area of the clinics. They will be contacted by phone after consent to complete a structured, baseline questionnaire. After the baseline questionnaire, women will be randomly allocated to study conditions. Women will be randomized based on the randomization schedule established by the project biostatistician. Women allocated to the CBT intervention group will be mailed an intervention workbook and have their first telephone-based intervention session scheduled. The CBT intervention group will receive 8 telephone-based CBT intervention sessions (over 9 weeks) delivered by peer specialists. Each session will last up to 30 minutes. The control group will be an observation only control group (CTL group). They will not receive any intervention. The post-intervention and 1-month follow up questionnaires will also be collected via structured telephone interviews. Research staff who are collecting data will be blinded to study condition.

In addition to monitoring for worsening of psychological symptoms, procedures are in place for referring participants with worrisome increases in depression (i.e., >14 on the PHQ9) or suicidal intent to relevant mental health resources, including hospital emergency rooms and suicide hotlines for persons expressing suicidal intent. Further, the DSMB will be alerted so that they can monitor whether one condition appears to have an unusually high increase in symptoms, which might warrant stopping the trial for safety reasons. In addition, the researchers collecting data and the peer-specialists implementing the intervention will be engaged in weekly supervision with a clinical psychologist and have access to the study PI at all times. The project biostatistician will conduct all intention-to-treat (ITT) analyses using appropriate modern statistical approaches. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03500978
Study type Interventional
Source Temple University
Contact
Status Completed
Phase N/A
Start date March 19, 2018
Completion date May 31, 2019

See also
  Status Clinical Trial Phase
Recruiting NCT05889689 - Evaluation of an Adolescent Pregnancy Prevention Program; Relationship Smarts+ With Lessons From Mind Matters N/A
Withdrawn NCT03725358 - A Cluster-RCT to Increase the Uptake of LARCs Among Adolescent Females and Young Women in Cameroon. N/A
Completed NCT02234271 - Plan A Birth Control: Randomized Controlled Trial of a Mobile Health Application for Contraception Information N/A
Enrolling by invitation NCT05216003 - Pregnancy at a Time That Is Happy and Healthy for You N/A
Not yet recruiting NCT03612518 - An mHealth Trial to Promote the Use of Postpartum Contraception N/A
Completed NCT04136613 - Utility of Immediate Post Placental Insertion of Intrauterine Device During Cesarean Delivery N/A
Completed NCT03366636 - Project Legacy Impact Evaluation Study N/A
Recruiting NCT06100679 - Responsible Engaged and Loving (REAL) Fathers Intervention Evaluation N/A
Completed NCT03775642 - Debunking Myths About Contraceptive Safety Among Women in Kingston, Jamaica N/A
Completed NCT03571932 - Assessment of Family Planning and Immunization Service Integration in Liberia
Completed NCT03165838 - Effectiveness of Shortened Time Interval to Postpartum Visit in Improving Postpartum Attendance N/A
Completed NCT04120376 - Reducing Adolescent Pregnancy N/A
Completed NCT03400410 - Hormonal Contraceptive Health Education for Adolescent Males N/A
Not yet recruiting NCT05988983 - The Over The Counter Pill National Study
Not yet recruiting NCT05362019 - Effects of One-to-one Service on the Continuation and Satisfaction of Contraceptive Use. N/A
Completed NCT01360216 - Cluster, Randomized Trial on Long Acting Reversible Contraception (LARC) Education and Training N/A
Completed NCT03559634 - Contraception Initiation Feasibility in the Pediatric ED N/A
Enrolling by invitation NCT05022134 - Evaluating the Impact of CHOICE-AYA on Contraceptive Use, Continuation and Satisfaction N/A
Active, not recruiting NCT03733678 - A Randomized-Controlled Trial to Increase the Uptake of LARCs in Cameroon N/A
Recruiting NCT06307002 - Evaluating What's My Method? in Barbados N/A