Original Study| Volume 30, ISSUE 1, P116-122, February 2017

“Just Take a Moment and Breathe and Think”: Young Women with Depression Talk about the Development of an Ecological Momentary Intervention to Reduce Their Sexual Risk

  • Lydia A. Shrier
    Address correspondence to: Lydia A. Shrier, MD, MPH, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Phone: (617) 355-8306
    Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Allegra Spalding
    Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
    Search for articles by this author
Published:August 27, 2016DOI:


      Study Objective

      Depressed young women are at increased risk for adverse outcomes related to sexual behavior, including unintended pregnancy, HIV, and other sexually transmitted infections. Brief sexual risk reduction interventions have not targeted depressed young women's specific needs for affect management and impulse control.

      Design, Setting, Participants, Interventions, and Main Outcome Measures

      We interviewed depressed young women ages 15-23 years engaging in sexual risk behavior about a proposed intervention approach. The approach was described as in-person counseling and cognitive-behavioral skills training, followed by an ecological momentary intervention (EMI) delivered via smartphone application for 4 weeks. The EMI would include reporting multiple times a day on affective states, self-efficacy for safer sex behavior, and sexual behavior, and receiving responsive messages to provide support and prompt use of cognitive-behavioral skills. Participants provided their perspectives on comfort, usability, burden, confidentiality, and potential efficacy of the EMI and recommended message content. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.


      Thematic saturation was reached with 16 interviews. Participants expressed positive opinions about the EMI. They believed that reporting at random times would help them to recognize their feelings, receiving the messages would be reassuring, and overall the smartphone application would be experienced as therapeutic. They desired a high degree of personalization of the message quality, style, and voice, and provided a wide variety of message content.


      Depressed young women believed that a flexible, personalized approach to mobile momentary intervention for addressing the link between their symptoms and behavior would be acceptable, supportive, and effective in reducing sexual risk.

      Key Words

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