Fostering Well-Being: Results from a Pilot RCT Sexual Health and Body Image Mobile Application Intervention for Foster Parents

Background: Adolescent youth in foster care experience extreme disparate rates of teen pregnancy and sexually transmitted infections and are at risk for significantly higher body dissatisfaction when compared to their non-foster youth counterparts. Foster parents lack the knowledge, skills, and training to address these sensitive topics. Historically, training for foster parents has been provided in person by experienced trainers using evidence-based curricula. This is very time-consuming and inconvenient for foster parents. Utilization of a mobile training program, such as Fostering Well-Being, addresses foster parents’ current dissatisfaction with existing training by providing a convenient and time-limited training. A mobile training was developed and tested for its effectiveness to support foster parents by providing a training platform and access to sexual health and body image information and resources.

Methods: The current study provides results from a pilot RCT intervention trial with the Fostering Well-Being intervention. The aims of the intervention were to improve sexual health (SH) and body image (BI) knowledge, attitudes, and communication among foster parents of adolescent foster youth. We utilized a mobile app to deliver the intervention in the following six modules delivered over six weeks (one/week): 1) BI and SH among foster youth, 2) pregnancy & contraception, 3) body positivity, 4) sexually transmitted infections, 5) communication related to positive body image, and 6) communication related to SH. The modules utilized videos, quizzes, reflections, and resources in their communities. Each module took no more than 15 minutes to complete.

We recruited foster parents from Missouri and Kansas to participate and randomly assigned them to the treatment group (n=49) and control group (treatment as usual; n=49). We collected data at baseline (T1), immediately following the intervention (T2), one month after intervention completion (T3), and three months after intervention completion (T4). Both groups participated in all four time points. Measures included SH attitudes, SH knowledge, comfort communicating about sex, how often they discuss sex with their foster youth, BI environment, and frequency of discussions with their foster youth.

Results: We ran chi-square/fisher exact tests to test for differences between the intervention and control groups based on gender ethnicity, race, and religion. We ran independent sample t tests to test for differences between the intervention and control groups based on age. There were no significant differences between groups at T1. We ran repeated linear mixed models to test the difference between treatment groups and time factor. There was a significant overall group effect for comfort communicating about sex and how often they discuss sex with their foster youth, with the treatment group scoring higher on each variable over all time measurements.

Conclusions/Implications: The results of the current pilot study provide evidence that a mobile application training platform can improve SH knowledge, comfort communicating about sex, and increase the number of conversations about sex between foster parents and foster children. These findings are particularly promising as effective parent/guardian communication is associated with increased protective factors and decreased risk regarding sexual decision-making in adolescents as well as increased self-esteem and self-efficacy in adolescents.