Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors

Lauren S Chernick; Alexis Konja; Ariana Gonzalez; Melissa S Stockwell; Anke Ehrhardt; Susanne Bakken; Carolyn L Westhoff; Peter S Dayan; John Santelli

doi:10.1177/20552076221104660

Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors

Digit Health. 2022 Jun 9:8:20552076221104660. doi: 10.1177/20552076221104660. eCollection 2022 Jan-Dec.

Authors

Lauren S Chernick¹, Alexis Konja², Ariana Gonzalez¹, Melissa S Stockwell^{2

3}, Anke Ehrhardt⁴, Susanne Bakken⁵, Carolyn L Westhoff^{2

6}, Peter S Dayan¹, John Santelli^{2

3}

Affiliations

¹ Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA.
² Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
³ Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA.
⁴ Department of Psychology, Columbia University Medical Center, New York, NY, USA.
⁵ Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, NY, USA.
⁶ Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, NY, USA.

Abstract

Objective: Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support.

Methods: We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients.

Results: Females (n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n = 39) found the images "relatable," "super-realistic," and "educational."

Conclusion: Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.

Keywords: Teenage pregnancy; adolescent behavior; adolescent health; contraception behavior; emergency medicine; health planning; population health; pregnancy in adolescence; pregnancy prevention; sexual behavior; sexual health; social media; social support.

Grants and funding

K23 HD096060/HD/NICHD NIH HHS/United States