2gether
Melissa J. Kottke, M.D., M.P.H., M.B.A.; Jessica M. Sales, Ph.D.; Peggy Goedken, M.P.H.; Jennifer L. Brown, Ph.D.; Kendra Hatfield-Timajchy, Ph.D., M.P.H.; Joan Marie Kraft, Ph.D.; and Athena P. Kourtis, M.D., Ph.D., M.P.H.
2gether is a multicomponent, clinic-based intervention aimed to increase dual-protection (DP) strategies that target the concurrent prevention of sexually transmitted infections (STIs) and unintended pregnancies for African American females between ages 14 and 19. The intervention takes place over 11 months through a combination of two individual clinic visits and then follow-ups by phone. The first visit includes an interactive multimedia program on DP strategies (MMDP), one-on-one counseling on DP method selection, and one-on-one health education and counseling for correct and consistent DP use. The second visit includes an abbreviated version of the MMDP and health education and counseling to reinforce skills for correct and consistent DP use. The intervention also includes four individual phone counseling sessions delivered by nurse educators that reinforce the correct and consistent use of DP strategies.
2gether is designed for African American females between 14 and 19 years old. 2gether was evaluated with young African American women ages 14 to 17.
The program was designed for and evaluated in a health clinic.
Melissa Kottke, M.D., M.P.H., M.B.A.
49 Jesse Hill Jr. Drive, SE
Atlanta, GA 30303
404-712-8730
mkottke@emory.edu
Last updated in 2024
The data presented on this page reflect responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides information on seven types of program components including content, delivery mechanism, dosage, staffing, format, context, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program.
In the drop-down menu below, under “Has component,” there are four options that indicate a component as present in the program: (1) “Yes” indicates that the component is present in at least one version of the program (whether that be the program version that was evaluated, the current version, or both versions); (2) “Yes (both versions)” indicates that the component is present in both the evaluated version of the program and the current version of the program; (3) “Yes (current version)” indicates that the component is present in the current, but not the evaluated, version of the program; and (4) “Yes (evaluated version)” indicates that the component is present in the evaluated version of the program, only. Note that for dosage components, the dosage itself is described in the Notes when available.
Some of the components identified are noted as core components of the evidence-based program, but this does not necessarily mean that these components have been rigorously tested and show evidence of effectiveness. Most often developers denoted components as core based on theory or experience in the field. Click here for the list of evidence-based components.
For more details about program components, refer to the FAQ page.
| Category | Component | Core Component | Component present | Lesson number(s) / activities where present |
|---|---|---|---|---|
| Content | Boundary setting/refusal skills | No | Yes (evaluated version) | Nurse Educator Counseling |
| Content | Child development | No | ||
| Content | Communication skills | No | Yes (evaluated version) | Nurse Educator Counseling |
| Content | Conflict resolution/social problem solving | No | ||
| Content | Connections with trusted adults | No | ||
| Content | Cultural values | No | ||
| Content | No | |||
| Content | Sex roles | No | ||
| Content | Leadership | No | ||
| Content | Normative beliefs | No | ||
| Content | Parenting skills | No | ||
| Content | Social competence | No | ||
| Content | Social influence/actual vs. perceived social norms | No | ||
| Content | Social support/capital | No | ||
| Content | Identity development | No | ||
| Content | Morals/values | No | ||
| Content | Spirituality | No | ||
| Content | Volunteering/civic engagement | No | ||
| Content | Other | No | ||
| Content | Other | No | ||
| Content | Other | No | ||
| Delivery mechanism | Method: Anonymous question box | No | ||
| Delivery mechanism | Method: Artistic expression | No | ||
| Delivery mechanism | Method: Assessment/survey | No | ||
| Delivery mechanism | Method: Booster session | Yes | Yes (evaluated version) | Throughout |
| Delivery mechanism | Method: Case management | No | ||
| Delivery mechanism | Method: Cognitive behavioral therapy (CBT) | No | ||
| Delivery mechanism | Method: Demonstration | Yes | Yes (evaluated version) | Nurse Educator Counseling |
| Delivery mechanism | Method: Discussion/debrief | No | ||
| Delivery mechanism | Method: Family session | No | ||
| Delivery mechanism | Method: Game | No | ||
| Delivery mechanism | Method: Home visiting | No | ||
| Delivery mechanism | Method: Homework assignment | No | ||
| Delivery mechanism | Method: In-session assignment | No | ||
| Delivery mechanism | Method: Introduction | No | ||
| Delivery mechanism | Method: Lecture | No | ||
| Delivery mechanism | Method: Motivational interviewing | Yes | Yes (evaluated version) | Throughout |
| Delivery mechanism | Method: Music | No | ||
| Delivery mechanism | Method: Parent-focused activity | No | ||
| Delivery mechanism | Method: Peer-to-peer | No | ||
| Delivery mechanism | Method: Public service announcement | No | ||
| Delivery mechanism | Method: Reading | No | ||
| Delivery mechanism | Method: Role play/Practice | Yes | Yes (evaluated version) | Provider and Nurse Educator Counseling |
| Delivery mechanism | Method: Self-guided activity | No | ||
| Delivery mechanism | Method: Service learning | No | ||
| Delivery mechanism | Method: Slide show | Yes | Yes (evaluated version) | MMDP |
| Delivery mechanism | Method: Social media | No | ||
| Delivery mechanism | Method: Spiral learning | No | ||
| Delivery mechanism | Method: Storytelling | No | ||
| Delivery mechanism | Method: Text message | No |
2gether strives to increase the knowledge and use of DP strategies throughout the intervention period to concurrently prevent STIs and unintended pregnancies.
2gether is informed by the Information-Motivation-Behavior Theory. It uses motivational interviewing techniques focused on skills, self-perceptions of risk, and motivations for preventing both unintended pregnancies and STIs. The intervention is delivered through two individual clinic visits and four individual counseling session phone calls.
During the first clinic visit, participants take part in the following activities:
- Use the multi-media dual protection (MMDP) platform to watch video vignettes of young African American females sharing their experiences with relationships; use visual aids to compare DP strategies; answer reflection questions; and participate in interactive activities including games that address common myths and misconceptions about pregnancy, contraception, and STIs
- Receive a one-on-one, structured counseling session with medical providers, who use the participant’s answers to the MMDP reflection questions, self-perceptions of risk for STI and pregnancy, and motivations for DP use to select a DP strategy
- Receive structured health education and counseling with a nurse educator to build skills for correct and consistent DP use in the participant’s unique context
During the second clinic visit, participants (1) use an abbreviated version of the MMDP that is focused on DP strategies and adherence and (2) receive a one-on-one post-method selection counseling session to reinforce their use of the DP method that was selected. Nurse educators deliver four booster counseling sessions to participants over the phone. These sessions reinforce the correct and consistent use of DP strategies by discussing the participant’s successes, challenges, and plans for the future.
2gether combines several strategies for supporting behavior change. The program uses an interactive, multimedia platform with video vignettes, informational slides, and visual aids. The program also includes motivational interviewing techniques delivered through structured counseling sessions and booster phone calls as well as interactive activities that include role-plays, condom use demonstrations, and journaling.
The 2gether intervention takes place over 11 months through a combination of two individual, in-person clinic visits and four individual counseling sessions by phone. During the first individual clinic visit, participants (1) use the multi-media dual protection (MMDP) platform on the web (about 25 minutes), (2) receive a one-on-one DP method selection counseling session (about 15 minutes), and (3) receive a one-on-one, post-method selection counseling session to reinforce DP method use (ranging from about 20 minutes to 45 minutes). During the second individual clinic visit, which occurs six months after the first visit, participants access an abbreviated version of the MMDP (about 10 minutes) and receive counseling with a nurse educator focused on DP strategies, use, and adherence.
The length of each clinic visit and booster phone call varies depending on each participant’s clinical and counseling needs. Participants receive counseling session calls at three weeks, five months, seven months, and 11 months after the first clinic visit. Clinical services, including testing, should be individualized to the patient and situational needs.
The 2gether program is designed to be delivered by medical providers and nurse educators. Medical providers deliver counseling on the selection of DP strategies and nurse educators deliver structured counseling on DP during clinic visits and over the phone.
Medical providers and nurse educators should have a background in the foundations of clinical care in sexual and reproductive health for adolescents before program delivery. For example, staff should be comfortable discussing or delivering DP strategies, comprehensive contraceptive counseling and management, and sexually transmitted infection testing and treatment. Foundations for this information are available in the program.
Medical providers who deliver counseling to youth on contraception and STIs receive training on motivational interviewing and the medical provider facilitator guides from the developer. Medical providers are required to practice using the facilitator guides until they are comfortable with the content. The amount of practice varies based on each facilitator’s baseline experience, although most facilitators can be trained to deliver the program in four to six half-day sessions.
Program materials include the multi-media dual protection (MMDP) web platform, the medical provider facilitator guide, the nurse educator facilitator guide, and a facilitator guide for the counseling sessions by phone.
A computer with access to the internet is needed to deliver the MMDP platform.
Fidelity guides have not been developed.
None
The developer has not prespecified any allowable adaptations.
| Citation | High-Quality Randomized Trial | Moderate-Quality Randomized Trial | Moderate-Quality Quasi-Experiment | Low Study Rating | Did Not Meet Eligibility Criteria |
|---|---|---|---|---|---|
| Kottke et al. 2022 |
|||||
| Kottke et al. 2023 |
| Citation | Setting | Majority Age Group | Majority Racial/Ethnic Group | Gender | Sample Size |
|---|---|---|---|---|---|
Kottke et al. 2022 |
Health clinic or medical facility | 14 to 17 | African American or Black | Young female | 714 |
Kottke et al. 2023 |
n.a. | n.a. | n.a. | n.a. | n.a. |
Evidence by Outcome Domain and Study
| Citation | Sexual Activity | Number of Sexual Partners | Contraceptive Use | STIs or HIV | Pregnancy |
|---|---|---|---|---|---|
Kottke et al. 2022 |
n.a. | n.a. | n.a. |
|
|
Kottke et al. 2023 |
n.a. | n.a. | n.a. | n.a. | n.a. |
| Citation | Details |
|---|---|
Kottke et al. 2022 |
The 2gether intervention was evaluated in a randomized controlled trial implemented in a clinical setting. Participants were African American female adolescents who were not pregnant at enrollment, had vaginal sex with a male partner at least once in the previous six months, were self-reported HIV negative, were planning on staying in the study area for the study period, were not previously enrolled in the pilot study, and had a desire to avoid pregnancy for at least 12 months. A total of 1,396 adolescents were assessed, with about half being deemed ineligible; 714 adolescents were randomized, but some were subsequently determined to not be eligible because they either (1) did not complete the enrollment visit, (2) were diagnosed with HIV at enrollment, or (3) were pregnant at enrollment. This left an analytic sample of 685 participants, with 337 assigned to the treatment group and 348 assigned to the control group. Data were collected at a three-month follow-up call, a six-month follow-up visit, a nine-month follow-up call, and a 12-month final follow-up visit. In addition, data on positive STI or pregnancy tests for all participants were collected from medical records. The data collected from these follow-ups were pooled and analyzed cumulatively. The primary analytic approach for assessing program effectiveness was to estimate time to an event (positive STI test or pregnancy) using a proportional hazard model. In addition, the study presented differences in overall rates of outcomes pooled across all observed data collection events. Only the time-to-event analyses meet TPPER reporting requirements. The study's main outcomes of interest were biologic outcomes (testing positive for chlamydia, gonorrhea, trichomonas, and pregnancy). The study showed a statistically significant and favorable effect on the time to trichomonas event (adjusted hazard ratio = 0.59; CI = [0.36, 0.94]; TPPER-calculated effect size based on prevalence rates of the outcomes = -0.27). That is, it took significantly longer for adolescents in the treatment group to experience a trichomonas event than it took for adolescents in the control group. There were no statistically significant differences observed for any of the other outcomes. There were a number of outcomes outside the scope of review. The combined biologic outcomes were not eligible for review because they pool information across multiple measures (testing positive for STIs and pregnancy). Other outcomes outside of the scope of the review include contraceptive knowledge, contraceptive self-efficacy, STI knowledge, intentions to use a contraceptive, intentions to use condoms, and reports of verbal or physical threats from a partner. |
Kottke et al. 2023 |
This study was ineligible because it did not meet review's screening criteria. |
Language directly from the program model developer or authors.