Luciana E. Hebert

“Because if we don’t talk about it, how are we going to prevent it?”: Lucidity, a narrative-based digital game about sexual violence

Abstract This paper describes the development and evaluation of an interactive, narrative-based, multimedia game to promote learning and communication about sexual violence and health topics. High school-aged participants created the game concept in a three-week workshop, after which assets were assembled and refined by a university-based game design lab. The outcome, Lucidity, was a multimedia game with a nonlinear narrative that led to two different outcomes based on player decisions. The narrative followed the life of one character, an African American woman named Zaria who remembers and grapples with a sexual assault from her past. The player discovers parts of the story by reading comics, watching videos, navigating interactive websites and playing short videogames. The final evaluation consisted of gameplay, a post-game focus group and follow-up interviews. Twenty-four young people participated in three focus group discussions (n = 9, n = 5, n = 10); 23 participated in the follow-up interviews. Salient themes identified in the focus group discussions included: overall approval of the game, the acquisition of new knowledge and minimal past exposure to conversations or education about sexual violence. At follow-up, almost all (n = 22) had initiated a conversation about sexual violence with a parent, peer and/or teacher. Lucidity succeeded in engaging young people and facilitating communication with adults and peers regarding sexual violence and other sexual health topics. Ultimately, a game-based intervention such as this represents a feasible approach for introducing issues of sexual violence, with potential for future implementation in educational settings.

Development of a Mobile App on Contraceptive Options for Young African American and Latina Women

Young African American and Latina women aged 15 to 24 are more likely to adopt short-acting forms of contraception over long-acting reversible contraception. Mobile applications and other forms of digital media may be useful for providing adolescents with information about sexual and reproductive health both inside and outside of the health care setting. The miPlan app was designed in accordance with principles of user experience design, and its content was informed by the theory of planned behavior and the transtheoretical model of behavior change. A university-based design team engaged young African American and Latina women to inform app development and provide input on app design, conducting multiple rounds of usability testing. Researchers then evaluated the acceptability of the miPlan app in family planning clinics among African American and Latina women aged 15 to 24. Participants rated the app highly acceptable, finding it both easy to use and highly informative. We demonstrate that mobile applications designed in conjunction with user populations may be effective at providing health information due to users’ ability to identify with them and their accessibility.

Do women know whether their hospital is Catholic? Results from a national survey

OBJECTIVES Catholic healthcare limits access to common reproductive care. We assessed what percentage of US women seeking care at Catholic hospitals are aware of their hospitals religious affiliation and identified variables associated with correct identification. STUDY DESIGN We conducted a national survey of women ages 18-45 (response rate 50%). The survey asked participants what hospital they would go to for reproductive care and what the religious affiliation of that hospital was. We verified responses as correct or incorrect against a known Catholic hospital list. We used bivariate analysis and logistic regressions to evaluate factors associated with correct identification. RESULTS Sixteen percent of women reported a Catholic hospital as their primary hospital for reproductive care. Among women whose primary hospital was Catholic, 63% [95% confidence interval (CI): 54.5-70.7] correctly identified this, compared to 93% who correctly identified their hospital as non-Catholic (95% CI 91.4 - 95.0). Two thirds of respondents who misidentified their Catholic hospitals affiliation reported that their hospital was secular (66%), and 48% of those women felt sure or very sure of their incorrect response. Factors associated with correctly identifying Catholic hospitals included hospital with a religious-sounding name [adjusted odds ratio (aOR)=2.80; 95% CI: 1.07-7.34], respondent older age (aOR=3.77; 95% CI: 1.35-10.56), metropolitan residence (aOR=3.35; 95% CI: 1.01-11.10) and income over

Religious hospital policies on reproductive care: what do patients want to know?

100,000 (aOR 4.95; 95% CI 1.35 - 18.17). CONCLUSION Over one third of US women who named a Catholic hospital as their primary hospital for reproductive care are unaware it is Catholic. Women are more likely to correctly identify a hospital as Catholic when that hospital has a religious sounding name. IMPLICATIONS Patients need accurate information in order to make decisions about where to seek reproductive healthcare. Our results suggest that women are often unaware of their hospitals religious affiliation. Efforts are needed to increase hospital transparency and patient awareness of the implications that arise when healthcare is restricted by religion.

Supporting Women at the Time of Abortion: A Mixed-Methods Study of Male Partner Experiences and Perspectives: Support from male partners at the time of abortion

Background Religious hospitals are a large and growing part of the American healthcare system. Patients who receive obstetric and other reproductive care in religious hospitals may face religiously‐based restrictions on the treatment their doctor can provide. Little is known about patients’ knowledge or preferences regarding religiously restricted reproductive healthcare. Objective(s) We aimed to assess women’s preferences for knowing a hospital’s religion and religiously based restrictions before deciding where to seek care and the acceptability of a hospital denying miscarriage treatment options for religious reasons, with and without informing the patient that other options may be available. Study Design We conducted a national survey of women aged 18–45 years. The sample was recruited from AmeriSpeak, a probability‐based research panel of civilian noninstitutionalized adults. Of 2857 women invited to participate, 1430 completed surveys online or over the phone, for a survey response rate of 50.1%. All analyses adjusted for the complex sampling design and were weighted to generate estimates representative of the population of US adult reproductive‐age women. We used χ2 tests and multivariable logistic regression to evaluate associations. Results One third of women aged 18–45 years (34.5%) believe it is somewhat or very important to know a hospital’s religion when deciding where to get care, but 80.7% feel it is somewhat or very important to know about a hospital’s religious restrictions on care. Being Catholic or attending religious services more frequently does not make one more or less likely to want this information. Compared with Protestant women who do not identify as born‐again, women of other religious backgrounds are more likely to consider it important to know a hospital’s religious affiliation. These include religious minority women (adjusted odds ratio, 2.17; 95% confidence interval, 1.11–4.27), those who reported no religion/atheist/agnostic (adjusted odds ratio, 2.27; 95% confidence interval, 1.19–4.34), and born‐again Protestants (adjusted odds ratio, 2.38; 95% confidence interval, 1.32–4.28). Religious minority women (adjusted odds ratio, 2.36; 95% confidence interval, 1.01–5.51) and those who reported no religion/atheist/agnostic (adjusted odds ratio, 3.16; 95% confidence interval, 1.42–7.04) were more likely to want to know a hospital’s restrictions on care. More than two thirds of women find it unacceptable for the hospital to restrict information and treatment options during miscarriage based on religion. Women who attended weekly religious services were significantly more likely to accept such restrictions (adjusted odds ratio, 3.13; 95% confidence interval, 1.70–5.76) and to consider transfer to another site an acceptable solution (adjusted odds ratio, 3.22; 95% confidence interval, 1.69–6.12). The question, “When should a religious hospital be allowed to restrict care based on religion?” was asked, and 52.3% responded never; 16.6%, always; and 31.1%,“under some conditions. Conclusion The vast majority of adult American women of reproductive age want information about a hospital’s religious restrictions on care when deciding where to go for obstetrics/gynecology care. Growth in the US Catholic health care sector suggests an increasing need for transparency about these restrictions so that women can make informed decisions and, when needed, seek alternative providers.

MOBILE‐izing Adolescent Sexual and Reproductive Health Care: A Pilot Study Using a Mobile Health Unit in Chicago

CONTEXT Although men are commonly viewed as unaware, uninvolved and even obstructive regarding their partners abortion access, those who accompany women to an abortion appointment may be more supportive. A better understanding of mens motivations could inform clinic policies regarding their involvement. METHODS In 2015-2016, data were collected from male partners of women seeking an abortion at two clinics in a large Midwestern city. Twenty-nine interviews were conducted to explore how men wanted to be involved in the abortion and why they accompanied their partners. Thematic content analysis was used to examine these data, and emergent themes informed a survey, completed by 210 men, that focused on perceptions about and reasons for accompaniment. Descriptive statistics were calculated for the survey data. RESULTS Four in 10 interviewees were aged 25-34, as were half of survey respondents. Overall, most had at least some college education and were in long-term or committed relationships. Interviewees described providing primarily instrumental (e.g., transportation and financial) and emotional (e.g., companionship and reassurance) support during the abortion process. While 57% of survey respondents would not have chosen to terminate the pregnancy if the decision had been their own, all wanted to support their partners. Notably, 70% viewed the appointment as an opportunity to receive contraceptive counseling. CONCLUSIONS Positive narratives regarding mens support for the abortion decisions of their partners provide a counterpoint to commonly held negative narratives. Future research should explore how supportive men who accompany partners at the time of an abortion may improve womens abortion experiences.

Mobile contraceptive application use in a clinical setting in addition to standard contraceptive counseling: A randomized controlled trial

BACKGROUND Adolescents experience numerous barriers to obtaining sexual and reproductive health care (SRHC). Mobile Health Units (MHUs) can remove some barriers by traveling to the community. This pilot study developed Mobile SRHC through an iterative process on an existing MHU and evaluated it among adolescents and providers. METHODS Mobile SRHC was developed through a mixed-method, multiphase study. Three key informant interviews with MHU providers, an adolescent needs assessment survey, and a Youth Model Development Session informed model development. Emergency contraception (EC), oral contraceptive pills (OCPs), and depot-medroxyprogesterone acetate (DMPA) were sequentially incorporated into MHU services. Administrative data assessed method distribution and surveys assessed patient satisfaction. RESULTS Key informants held positive attitudes toward implementing Mobile SRHC into their practice. Needs assessment surveys (N = 103) indicated a majority was interested in learning about sexual health (66.0%) and obtaining birth control (54.4%) on an MHU. Over 3 months, 123 adolescents participated in Mobile SRHC. Seven packs and 9 prescriptions of EC, 8 3-month packs and 10 prescriptions of OCPs, and 5 injections and 5 prescriptions of DMPA were distributed. Ninety-two percent of adolescent participants reported they would recommend Mobile SRHC to friends. CONCLUSIONS Mobile SRHC is a feasible approach for reproductive health care among adolescents.

A game-based intervention to improve youth sexual and reproductive health in New Delhi, India

OBJECTIVE To evaluate the effect of miPlan, a waiting-room contraceptive counseling mobile application (app), on interest in discussing long-acting reversible contraception (LARC) during the clinical encounter and LARC uptake. STUDY DESIGN This randomized controlled trial evaluated the miPlan contraceptive counseling app. African American and Latina young women ages 15-29 years attending four family planning clinics in a large Midwestern city were randomized to either: (1) use miPlan (intervention) prior to the contraceptive clinic visit or (2) contraceptive clinic visit alone (control). Groups were compared on knowledge of contraceptive effectiveness, interest in discussing LARC, behavioral intentions to use LARC, and LARC uptake. RESULTS From February 2015 to January 2016, 207 young women were randomized to intervention (n=104) or control (n=103) group. Immediately following app use, the intervention group had an increase in knowledge and interest in learning about the implant. Immediate post visit, there was no significant difference in uptake of LARC between the two groups (p>.05). At three months post intervention, app users reported more knowledge of IUD effectiveness (52.3% vs 30.8%, p=.001) compared to controls. There was no significant difference in LARC use. CONCLUSION App use was not associated with an increase in using LARC methods. It was associated with increased knowledge of contraceptive effectiveness, an interest in learning about the implant, and behavioral intentions to use LARC methods. IMPLICATIONS The miPlan app is a feasible clinic adjunct for increasing contraceptive knowledge and intentions, however, it is not associated with increased LARC use. Mobile applications can offer an accessible complement to the contraceptive counseling visit.

The role of gender-based discrimination in shaping young men’s and women’s experience with adolescence in Uttar Pradesh, India

Clinic Quest (game only, no curriculum) significantly improved scores on an HIV knowledge index and a short (2-item) bacterial vaginosis knowledge index. After Holm-Bonferroni correction, Clinic Quest also significantly improved knowledge on three individual true/false questions on individual STIs. Clinic Quest had no significant impact on any behavioral intentions or on a general STI knowledge index. More specific results can be seen in Fig. 3 and in Table 2.

Variation in Pregnancy Options Counseling and Referrals, And Reported Proximity to Abortion Services, Among Publicly Funded Family Planning Facilities.

2009 – present Research Associate Professor, Harris School of Public Policy Studies, University of Chicago Principal Research Scientist, International Projects Department, NORC at the University of Chicago 2009 – 2014 Research Associate (Associate Professor), Department of Economics University of Chicago 2003 – 2009 Research Associate (Assistant Professor), Harris School of Public Policy Studies, University of Chicago Lecturer in Economics, Department of Economics, University of Chicago 2001 – 2003 Researcher in Economics, Research staff member, Princeton University 1997 – 2003 Lecturer in International and Public Affairs, Princeton University 1997 – 2003 Research Network Administrator, MacArthur Network in Inequality and Poverty in Broader Perspectives, Research Program in Development Studies, Princeton University