CHOICE-AYA: adapting an evidence-based contraceptive counseling intervention for adolescents and young adults experiencing homelessness.

Introduction: Adolescents and young adults (AYA) experiencing homelessness face an increased risk of reproductive violence, unintended pregnancy, and barriers accessing healthcare. While interventions focused on efficacy-first contraceptive counseling are successful at increasing rates of long-acting reversible contraceptive (LARC) use, little is known about how an efficacy-first approach is received by AYA experiencing homelessness given unique factors associated with their reproductive health care. We aimed to adapt the evidence-based CHOICE contraceptive counseling approach for AYA experiencing homelessness. Methods: Focus groups discussion with AYA experiencing homelessness were conducted to understand prior reproductive health care experiences and contraception counseling preferences, comparing efficacy first and patient-centered approaches and counseling scripts. De-identified self-reported demographics and prior reproductive health history were collected. Results: Four focus groups were conducted with 41 AYA experiencing homelessness (age 12-23 years old). AYA preferred a patient-centered counseling approach and adapted a contraceptive counseling script accordingly. AYA's additional suggestions to improve contraceptive counseling were synthesized into three themes: (1) How counseling should be delivered, (2) What counseling should include, and (3) Where counseling should occur. Discussion: AYA preferred patient-centered counseling with critical nuance relevant to their lived experiences. The adapted CHOICE-AYA contraceptive counseling script will assist providers in meeting the needs and desires of AYA experiencing homelessness. Further suggestions to optimize counseling focus on individualized, confidential consultations for all patients regardless of pregnancy potential and extension of resources to community and non-traditional healthcare settings (e.g., emergency departments). Current reproductive health guidelines can be expanded to include these considerations relevant to AYA experiencing homelessness.