Youth-centered mobile intervention (next4you) to promote healthy relationships and sexual wellness among adolescents in or transitioning from foster care

Abstract

BACKGROUND: National birth rates among adolescents have consistently decreased since 1991, yet substantial disparities remain, particularly among youth in foster care, who experience higher risks of unintended pregnancies and sexually transmitted infections. Few sexual health programs rarely address the specific needs of foster youth or incorporate youth perspectives into their design, development, and implementation.

OBJECTIVE: This study aims to refine, pilot-test, and evaluate Next4You, a fully mobile, youth-centered sexual health education platform tailored specifically for adolescents in or transitioning from foster care. The program intends to reduce sexual risk behaviors and related psychosocial outcomes by promoting healthy relationships, sexual wellness, contraception use, communication skills, self-respect, and wellness education.

METHODS: Next4You is a fully mobile, self-paced, 4-week intervention evaluated using an individual-level randomized controlled trial involving a target sample of 500 youths aged 16-19 years with current or previous foster care experience in California. Participants are randomly assigned to either the intervention group, which receives access to Next4You modules, or the comparison group, which accesses general health materials through a similar web platform. Both groups complete baseline, 3-month, and 9-month follow-up surveys. Immediately following the 9-month follow-up survey, participants in each group receive access to the platform they were not initially assigned. Data collection assesses contraceptive behaviors, sexual communication, consent self-efficacy, and knowledge related to health rights and financial literacy. Intervention engagement is tracked through platform analytics, and qualitative interviews supplement data collection. Data analysis will adhere to intent-to-treat principles, using multilevel regression models to assess impacts.

RESULTS: Funding was awarded in 2021, with institutional review board approval in October 2022. Intervention development lasted approximately 7 months, engaging foster youth in a co-design process to ensure relevance and cultural competence. Study recruitment began in September 2023, continuing until May 2025. Final data collection is anticipated by March 2026, followed by data analysis.

CONCLUSIONS: Next4You presents an innovative approach to sexual health education by addressing critical gaps in sexual health education for foster youth through mobile technology. If effective, Next4You could provide another evidence-based option for promoting sexual health among foster youth, guiding policymakers and practitioners in adopting similar trauma-informed and youth-centered interventions.