Lessons on Telehealth Usability and Acceptability from the Choices-Teen Randomized Controlled Trial: Comparing Girls Referred from Juvenile Probation to a Social Media Sample

Background and Purpose:

As the juvenile justice system diverts youth from detention to community-based services, reducing barriers to service access is critical (i.e., time, resources and transportation). Telehealth presents an opportunity to overcome these barriers. Adoption hesitancy by providers persists due to concerns about these youths’ technology access, and research is lacking concerning the acceptability and usability of this technology with this population. CHOICES-TEEN (CT), a randomized controlled trial, used telehealth for intervention delivery with a mixed sample of girls who were involved with community probation and those who were not. This offers a unique opportunity to better understand the uptake and acceptability of this technology. CT was conducted with adolescent girls aged 14-19 at risk of pregnancy to test the efficacy of the CT intervention compared to attention control (AC), both of which were delivered using telehealth. The four-session CT intervention was designed to reduce the risks of substance-exposed pregnancy and STI/HIV. Analyses of post-intervention telehealth usability data will: 1) describe the acceptability of telehealth for participants receiving four CT counseling intervention or four psychoeducational attention control sessions (AC); 2) examine differences in acceptability by justice-involvement status, age, and treatment condition; and 3) explore the prevalence of expressed need for a study phone to participate in sessions.

Methods:

The sample (N = 106) includes participants referred from two large urban juvenile probation departments in Texas and a community social media sample who were then randomized 2:1 to CT or AC. An 8-item version of the Telehealth Usability Questionnaire (TUQ) (Parmanto et al., 2016) followed by a 5-point Likert-scale was collected as part of the 3-month assessment. Higher scores indicate greater agreement with telehealth usefulness, ease of use, quality, reliability, and satisfaction. SPSS was used to conduct descriptive analyses and independent t-tests to examine differences in acceptability by age, justice-involvement status, and treatment group on a total TUQ score and examination of individual items.

Results:

Thirty-five percent of the girls were justice involved. The sample was racially and ethnically diverse. Most participants across treatment and psychoeducational conditions and justice-involvement status agreed or strongly agreed telehealth was useful, reliable, and of good quality. There were not significant differences on overall TUQ score by treatment group or justice-involvement status, but younger participants (14-17) had significantly lower scores compared with those 18-19 years old (p = .021, d = .54). There was not a significant difference on any of the 8 individual telehealth items by age, justice-involvement status or treatment group. Sixteen (15%) study participants needed phones to participate and 81% of those who needed a phone were justice-involved.

Conclusions & Implications:

Telehealth appears feasible and acceptable for counseling and psychoeducation sessions with both justice-involved and non-involved adolescent girls. While justice-involved youth more frequently needed a study phone to participate, findings suggest this issue was very rare. Future research is necessary to understand telehealth satisfaction differences between younger and older adolescents.