Sexual Health

Youth-Centered Mobile Intervention (Next4You) to Promote Healthy Relationships and Sexual Wellness Among Adolescents in or Transitioning From Foster Care: Protocol for a Randomized Controlled Trial.

TL;DR

Next4You presents an innovative approach to sexual health education by addressing critical gaps in sexual health education for foster youth through mobile technology, evaluated via a randomized controlled trial targeting 500 adolescents aged 16-19 with foster care experience in California.

Key Findings

Youth in foster care experience higher risks of unintended pregnancies and sexually transmitted infections compared to the general adolescent population.

  • National birth rates among adolescents have consistently decreased since 1991, yet substantial disparities remain.
  • Foster youth are specifically identified as a high-risk population with unmet sexual health education needs.
  • Few sexual health programs address the specific needs of foster youth or incorporate youth perspectives into their design, development, and implementation.

Next4You is a fully mobile, self-paced, 4-week sexual health intervention tailored specifically for adolescents in or transitioning from foster care.

  • The platform is designed to promote healthy relationships, sexual wellness, contraception use, communication skills, self-respect, and wellness education.
  • The intervention is intended to reduce sexual risk behaviors and related psychosocial outcomes.
  • The program is delivered through a mobile platform accessible at participants' own pace over 4 weeks.
  • Intervention development lasted approximately 7 months and engaged foster youth in a co-design process to ensure relevance and cultural competence.

The study uses an individual-level randomized controlled trial design with a target sample of 500 youth aged 16-19 with current or previous foster care experience in California.

  • Participants are randomly assigned to either the intervention group (Next4You modules) or a comparison group (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 receive access to the platform they were not initially assigned.
  • Study recruitment began in September 2023 and continued until May 2025, with final data collection anticipated by March 2026.

Primary outcome measures include contraceptive behaviors, sexual communication, consent self-efficacy, and knowledge related to health rights and financial literacy.

  • Data collection assesses contraceptive behaviors, sexual communication, and consent self-efficacy.
  • Knowledge related to health rights and financial literacy is also assessed.
  • Intervention engagement is tracked through platform analytics.
  • Qualitative interviews supplement quantitative data collection.

Data analysis will adhere to intent-to-treat principles using multilevel regression models to assess intervention impacts.

  • Multilevel regression models are specified as the primary analytic approach.
  • Intent-to-treat principles will guide the analysis.
  • Funding was awarded in 2021 with institutional review board approval in October 2022.
  • Final data analysis is planned to follow data collection completion anticipated in March 2026.

Next4You was developed using a co-design process involving foster youth to ensure cultural competence and relevance.

  • Intervention development lasted approximately 7 months.
  • Foster youth were engaged in the co-design process.
  • The program is described as trauma-informed and youth-centered.
  • The co-design approach was intended to address the gap that few existing programs incorporate youth perspectives into design, development, and implementation.

If effective, Next4You could provide an evidence-based option for promoting sexual health among foster youth and guide policymakers and practitioners in adopting similar interventions.

  • The authors describe the intervention as a potential 'evidence-based option for promoting sexual health among foster youth.'
  • The program is positioned to guide policymakers and practitioners in adopting similar trauma-informed and youth-centered interventions.
  • Mobile technology delivery is highlighted as a key innovation for reaching this population.
  • The study addresses critical gaps in sexual health education specifically for foster youth.

What This Means

This research describes the design and protocol for a study testing a mobile phone-based sexual health education program called Next4You, created specifically for teenagers who are in or have recently left the foster care system. Foster youth face significantly higher rates of unintended pregnancies and sexually transmitted infections compared to other teens, yet very few sexual health programs have been designed with their specific needs and life experiences in mind. The Next4You program was built over about seven months with direct input from foster youth themselves, covers topics like healthy relationships, contraception, communication, and consent, and can be completed at the user's own pace over four weeks entirely on a mobile device. The study is a randomized controlled trial enrolling 500 young people aged 16-19 in California who have current or past foster care experience. Half are randomly assigned to use Next4You, while the other half access general health information through a similar-looking website. All participants answer surveys at the start of the study and again at 3 and 9 months later, measuring things like contraceptive use, ability to communicate about sex, and confidence in giving and receiving consent. After the 9-month survey, everyone gets access to the program they didn't originally receive. Recruitment ran from September 2023 through May 2025, with final data expected by early 2026. This research suggests that a mobile, youth-designed, trauma-informed approach may be a promising way to reach foster youth with sexual health education that other programs have largely failed to provide. If the program is shown to be effective, it could offer a new, evidence-based tool that policymakers, child welfare agencies, and health practitioners could use to better support the sexual health and wellbeing of one of the most underserved groups of young people.

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Citation

Anderson P, Ong S, Elgin D, Laird J, Starr D, Daniels S, et al.. (2026). Youth-Centered Mobile Intervention (Next4You) to Promote Healthy Relationships and Sexual Wellness Among Adolescents in or Transitioning From Foster Care: Protocol for a Randomized Controlled Trial.. JMIR research protocols. https://doi.org/10.2196/77185