Let's Talk Birth Control: Study protocol for a cluster randomized trial of a clinic-based contraceptive intervention for adolescents and young adults.

BACKGROUND: Adolescents and young adults (AYA) often lack sufficient information to make informed contraceptive choices, and many are not using their preferred method. Clinical decision aids (CDAs) improve contraceptive knowledge, self-efficacy, and decision-making, but few have been designed for or evaluated with AYA. Let's Talk Birth Control (Let's Talk) is a clinic-based intervention that combines a printed CDA and the digital Bedsider.org Method Explorer with a provider training on person-centered contraceptive counseling. This study evaluates the effectiveness of Let's Talk in improving contraceptive behaviors and related outcomes among AYA.

METHODS: We are conducting a cluster-randomized controlled trial across 30 U.S. community health centers. Eligible participants are females ages 15-24, sexually active or interested in contraception, not pregnant or intending pregnancy within one year. Health centers are randomized by block design, stratified by Title X funding and school-based status. At intervention sites, participants review the CDA prior to their appointment and discuss contraceptive priorities with their provider using the tool; controls receive standard of care. Primary outcomes, measured at 9 months, are consistent contraceptive use and preferred method use. Secondary outcomes, assessed at 1 week and 9 months, include contraceptive self-efficacy, decision-making confidence, intentions, and knowledge. Multilevel regression models will account for clustering at the health center level.

CONCLUSION: Delivering person-centered contraceptive counseling with CDA support is a promising strategy to improve sexual and reproductive health outcomes among AYA. Let's Talk has the potential to strengthen contraceptive counseling for young people and to address gaps in evidence-based sexual health programming.