ETR, along with our evaluation partner University of California San Francisco (UCSF), propose the rigorous evaluation of Yes & Know!, a fully virtual intervention that integrates group-based education with digital tools to support young people ages 14-19 by increasing their relationship and healthy life skills with the goal of reducing unintended pregnancy and sexually transmitted infections (STIs). The evaluation will test the efficacy of Yes & Know! among youth living in rural communities across the U.S. This intervention is a digital and enhanced adaptation of an in-person, adolescent sexual health education program that was co-designed with youth and evaluated in community-based organizations and schools in Fresno County, California from 2017-20201. Building on findings from the original intervention and scientific evidence, the primary aim of Yes & Know! supports skills related to adolescents’ positive health and well-being and provides necessary and timely information and resources to reduce unprotected vaginal or anal sex. The evaluation will be led by UCSF. Using a cluster randomized controlled trial, we will compare the short-term (3-month post-intervention), and long-term (12-month post-intervention) outcomes of the Yes & Know! program relative to standard of care on youth aged 14-19 years, with a focus on youth in rural areas. The study will seek to answer the primary and secondary research questions: (Primary) Twelve months following the end of the program, what is the impact of Yes & Know! on the prevalence of unprotected vaginal or anal sex in the past 3 months? (Secondary) Three months following the end of the program, what is the impact of Yes & Know! relative to standard of care on composite scores of reproductive health knowledge? (Secondary) Three months following the end of the program, what is the impact of Yes & Know! relative to standard of care on compositive scores of healthy relationships kno
wledge? (Secondary) Three months following the end of the program, what is the impact of Yes & Know! relative to standard of care on self-efficacy to refuse unwanted sex? (Secondary) Three months following the end of the program, what is the impact of Yes & Know! relative to standard of care on self-efficacy to cope with stress? (Secondary) Twelve months following the end of the program, what is the impact of Yes & Know! relative to standard of care on use of sexual and reproductive health services in the past 3 months? This study has the potential to add to the paucity of literature about the feasibility and efficacy of technology based sexual health programs, particularly self-paced, asynchronous learning supported by technology. This new modality for implementation has the potential to profoundly transform future program development and address inequities by extending the reach to youth who are missed by traditional in-person, school-based programming. The study will also add to the literature on programs for rural populations, with the potential to reduce persistent geographic disparities in unintended pregnancy and STIs. In addition, it will specifically measure changes in use of sexual health services and youth mental health and resilience, areas which are under evaluated in evidence-based program research.
