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Background
Approximately 15% of adolescents have used depot-medroxyprogesterone. Although traditionally administered in the clinical space, it is effective and well tolerated when subcutaneously self-administered; however, the technique must be taught, and office visits may be a barrier to care. There are no currently available online instructional videos specific to both this age group and medication. We hypothesize that our peer-to peer video lesson is easy to understand, effective as a stand-alone method for accurately teaching safe technique, and well received by adolescents, who will continue to self-administer the medication.
Methods
This is a prospective IRB approved clinical trial of subjects 21 years old and younger using depot-medroxyprogesterone. Patients from our pediatric gynecology and adolescent medicine clinics were enrolled, obtained the medication, then watched the 4 minute instructional video. Injections were self-administered under direct observation by a healthcare provider. The patient and healthcare provider were surveyed after the initial injection and 90 days later. Rate of successful self-injection at the first study visit was determined by collecting and correlating patient and healthcare provider survey responses. The follow-up survey enquired about medication continuation.
Results
Pilot data includes seven subjects, age range of 15-19 years. 6/7 felt that the video clearly explained all steps of self-injection. All subjects either self-injected successfully or performed all steps correctly but deferred inserting the needle into the skin. If a parent administered the shot, it was considered a successful self-injection; if the shot was administered by the healthcare provider it was considered unsuccessful. Of those who said they planned to continue self-administration, all were comfortable giving the shot unsupervised at home. Patient and provider responses correlated 100% on perception of successful injection, prediction of which subjects would likely continue the method, and which subjects did continue. All subjects who said they planned to continue self-administration gave themselves a second shot, and most repeatedly viewed the video.
Conclusions
Self-administration of subcutaneous depot-medroxyprogesterone is safe, confidential, and convenient for adolescents. This video enables teens to teach themselves, without a health care provider, how to successfully and consistently self-inject. Pilot data also suggests that teens choosing to self-inject subcutaneous depot-medroxyprogesterone will continue the method. The next step is to offer this video to a wider audience of motivated adolescents to learn and continue self-injection.
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© 2023 Published by Elsevier Inc.
