Defining Adolescent Reproductive Body Literacy: An Arkansas Evaluation of the Knowledge Domains that Influence Pregnancy Prevention and Reproductive Health Decision-Making - Reproductive Health Mission, Inc. (RHMI) proposes a 36-month project to define, measure, and validate adolescent reproductive body literacy and determine how its component domains relate to reproductive health decision-making and protective factors associated with teen pregnancy prevention. Although body literacy education is now a required objective of the Teen Pregnancy Prevention program, no validated instrument currently exists to measure this construct in adolescents. RHMI will address this gap by developing the Adolescent Reproductive Body Literacy Index (ARBLI), a public-domain, developmentally appropriate instrument designed for use across educational and clinical settings. The project has four aims: (1) define adolescent reproductive body literacy as a measurable, multidimensional construct and develop and psychometrically validate the ARBLI; (2) identify which body literacy domains are most strongly associated with eligible behavioral outcomes, including sexual activity, voluntary delay or abstinence, number of sexual partners, parental engagement, emotional closeness, sexting, and substance use; (3) estimate associations between prior exposure to distinct educational domains and ARBLI scores using observed variation in educational exposure; and (4) translate findings into a national research and implementation framework for programs, clinicians, researchers, and policymakers. The study will proceed in three phases. Phase 1 will include systematic reviews, a measure inventory, construct specification, expert Delphi consensus, and development of an initial item bank. Phase 2 will establish content validity and developmental appropriateness through expert review, cognitive interviews with approximately 54 to 66 adolescents, and pilot testing with approximately 150 adolescents. Phase 3 will enroll approximately 1,200 Arkansas adolescents ages 14 to 19 for full psychometric validation, including exploratory and confirmatory factor analysis, item response theory calibration, differential item functioning, measurement invariance, internal consistency, test-retest reliability, and convergent, discriminant, criterion, and predictive validity testing. Analyses will account for site clustering, demographic and community characteristics, educational exposure, and relevant confounders. Arkansas provides a unique policy environment because the RESTORE Act requires fertility awareness information and related provider education within public health and Title X systems, yet no method currently exists to measure whether adolescents acquire the intended body literacy. The project is an observational measurement and evaluation study, not a curriculum impact trial, and RHMI will report null or negative findings as well as positive results. Major deliverables will include validated long and short ARBLI forms, scoring algorithms, item parameters, administration protocols, consent and assent workflows, a technical manual, a parental notice and opt-out package, analytic code, and implementation guidance. All products will be released free of charge in the public domain for use by the Office of Population Affairs, Teen Pregnancy Prevention grantees, clinicians, researchers, and community organizations.
