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.