Document Type

Article

Publication Date

4-9-2026

Identifier

DOI: 10.3389/frph.2026.1787996; PMCID: PMC13106319

Abstract

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.

Journal Title

Front Reprod Health

Volume

8

First Page

1787996

Last Page

1787996

PubMed ID

42040759

Keywords

adolescents; contraception; homelessness; patient-centered communication; unhoused; young adults

Comments

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Publisher's Link: https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2026.1787996/full

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