The Perspectives of Youth with Histories of Commercial Sexual Exploitation on the Acceptability and Feasibility of mHealth to Increase Engagement in Care

Background and Purpose: Youth with histories of commercial sexual exploitation (CSE) are often involved in institutional systems of care (i.e. juvenile justice and child welfare systems) in which they receive referrals to access services and treatment related to their behavioral, reproductive, and physical health. Despite receiving referrals for a range of health services, when utilized, delivery of these services tends to be fragmented. Mobile Health (mHealth) technology has shown potential to increase engagement in care among diverse populations, including youth. However, research is lacking on the acceptability and feasibility of mHealth tools to enhance access, service engagement, care coordination, and case management support among youth with CSE history.

Objective: To examine the acceptability and feasibility of a mHealth application to address the healthcare needs of youth with CSE history and increase their engagement in court-referred programming. The research team sought the perspectives of girls and young women impacted by CSE on the acceptability and feasibility of a mHealth application to understand if and how mHealth technology could bolster their engagement in healthcare services.

Methods: Four focus groups with a total of 14 girls and young women (ages 14-21) with CSE history were conducted from March through August 2018. Partner organizations (i.e. service provider agency, a specialty court, and a residential group home) referred youth for study participation. Findings were examined utilizing iterative and inductive analytic strategies; a constructivist grounded theoretical framework was used to analyze data.

Results: Girls and young women impacted by CSE perceived mHealth and digital technologies as viable mechanisms to integrate into their lives for accessing, navigating, and engaging with health and social services as well as with judicial systems (i.e., justice, child welfare). Participants perceived that mHealth tools could benefit them by increasing their self-efficacy and ability to self-navigate health systems and services, and satisfy court requirements. Recommended examples of mHealth functionality included: sending notifications of appointments and mandated obligations, promoting safety and communication with service providers, facilitating peer-to-peer communication and support, and providing access to health education and community resources.

Conclusions and Implications: Our study provides insight into ways that mHealth technologies may be leveraged to increase self-management skills, and access and engagement in healthcare services for girls and young women impacted by CSE, as well as success in fulfilling court requirements. Girls and young women impacted by CSE have a high degree of transience and thus, can likely benefit from both flexible and on-demand communication methods with healthcare and social service providers, as well as court personnel. Our findings can assist researchers, practitioners, and policy makers in considering novel strategies, such as digital and mobile technologies, that may be developed and adapted to enhance engagement in treatment and services. Finally, findings underscore how emergent technologies can reflect intersectional identities, account for mandated obligations, and create digital spaces that are safe and inclusive for all youth with CSE history.