Discussion
sexual behaviors, ’ contraceptive
Causal estimates produced from this RCT provide evidence that Plan A is a promising, low-burden, brief SRH EE video intervention for black and Hispanic female adolescents who are about to receive SRH care, which may have favorable effects on protective sexual health behaviors and theoretically important antecedents in these at-risk and underserved populations. The strengths of this study are its methodological rigor—a randomized design, with a high follow-up rate (96%), low differential attrition (< 1%), and benchmark inferences that are stable across a battery of sensitivity tests and racial/ethnic subgroups. Baseline equivalence analysis further attests that randomization appears to be well implemented.Results demonstrate that watching Plan A prior to a SRH health visit leads to increased STI testing for black and Hispanic female adolescents. Convention suggests that with a test statistic of 1.91 (Findings also indicate that Plan A appears to be imparting important SRH information, leading to a significant increase in viewers’ contraceptive knowledge 3 months after watching the video. Although no significant effects were observed in LARC use and condom use consistency within the full sample, a subgroup analysis indicates that Plan A was effective in motivating LARC uptake among black and Hispanic females receiving SRH care for the first time (Analysis of feedback collected immediately after the SRH visit provides evidence that Plan A may also be motivating the sort of interactions hypothesized by the intervention’s theory of change, though with some predictable but perhaps unanticipated consequences. Participants assigned to Plan A report that they discuss important sexual health topics with their providers at higher rates than participants in the control group. At the same time, these participants are also reporting greater (though modest) discomfort with these discussions (Hedge’s g for comfort talking with a provider about sexual health =  −0.109; Hedge’s g for comfort talking with a provider about sexual behaviors =  −0.136). One interpretation of these findings is that participants assigned to the Plan A video are having relatively more SRH discussions with their healthcare providers and, because these discussions may be uncomfortable for some, these respondents are reporting relatively more (but small in magnitude) discomfort on average. The video, in other words, maybe motivating patients to have discussions with their providers, but it does little to help them feel more comfortable about these discussions. This is, of course, merely conjecture at this point, as the data we have collected do not permit an empirical answer to why Plan A participants report greater discomfort than those who did not see the video. Mixed methods may be best suited to explore participant and healthcare provider perspectives on the interactions that follow (viewing of) the video.This study is limited in its scope. We have examined the efficacy of Plan A for specific populations (black and Hispanic female adolescents) within a limited geographic location (mid-California) for a particular period of time (3 months post-baseline). This sort of specification is necessary when one aims to rigorously study program impacts with finite resources. Future research could broaden this scope where it makes sense; in particular, we recommend that the long-term efficacy of the intervention be evaluated, with a specific investigation of participants’ continued engagement in SRH care after watching the video. Generalizability may also be limited by the setting of the intervention. Both Plan A and control participants received the same high standard of care (SOC) at Planned Parenthood. During the study period, participants attended one or more provider visits where the SOC included discussing their sexual health and covered a range of effective contraceptive methods. Future studies could investigate whether Plan A has a stronger impact in environments where young women do not receive the same intensity and/or quality of sexual health information, such as general health clinics, community organizations, or schools. Another limitation of the study is its reliance on self-reported data, which may not necessarily reflect actual behaviors and can lack precision and accuracy.