Abstract
Despite a robust field of study in healthy romantic relationship education and risk prevention interventions that employ traditional forms of delivery, the field of digital health interventions (DHIs) in healthy relationship programming for adolescents remains undefined. The purpose of this scoping review was to summarize the scope of published research in DHIs that promote healthy romantic relationships in adolescents. We conducted database searches, 2000–2022; hand searches; reference list and literature review searches, and emailed study authors to identify articles. Included were experimental, development, and feasibility studies. We summarized features of selected studies and their healthy relationship aims/components and identified patterns of emphasis and areas of future need. Sixteen publications describing 15 unique DHIs were reviewed with interventions developed and or trialed in 11 countries. We identified 10 web-based or downloadable applications, four serious game applications, one video-voice program, and one social media-based program. DHIs focused on improving knowledge/attitudes/skills of healthy adolescent romantic relationships directly or through prevention-focused programs. Interventions that measured outcomes found small effects, primarily in healthy romantic relationship communication skills. DHIs offer unique opportunities to provide user-responsive and culturally specified programming for adolescents and to involve adolescents themselves in processes of program design, development, and evaluation. Further research is warranted to define relevant outcomes for adolescents and validated measures to evaluate them. Future research might seek to address the social ecology of adolescent romantic relationships beyond the individual and interpersonal and explore combinations of virtual and adult-moderated in-person delivery to ensure youth are adequately supported.
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References
American College of Obstetricians and Gynecologists. (2018). Committee opinion: Promoting healthy relationships in adolescents. No. 758. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2018/11/promoting-healthy-relationships-in-adolescents
Anderson, P., Coyle, K., Guinosso, S., Ferrand, J. L., Owora, A., Houghton, R. F., & Walsh-Buhi, E. (2021). Promoting adolescent healthy relationships (the About Us program): Protocol for a randomized clinical trial. JMIR Research Protocols, 10, e30499. https://doi.org/10.2196/30499
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. https://doi.org/10.1080/1364557032000119616
Atske, S., & Perrin, A. (2021). Home broadband adoption, computer ownership vary by race, ethnicity in the U.S. The Pew Research Center. https://www.pewresearch.org/fact-tank/2021/07/16/home-broadband-adoption-computer-ownership-vary-by-race-ethnicity-in-the-u-s/
Benham-Clarke, S., Roberts, G., Janssens, A., & Newlove-Delgado, T. (2022). Healthy relationship education programmes for young people: Systematic review of outcomes. Pastoral Care in Education. https://doi.org/10.1080/02643944.2022.2054024
Bonell, C., Hinds, K., Dickson, K., Thomas, J., Fletcher, A., Murphy, S., Melendez-Torres, G. J., Bonell, C., & Campbell, R. (2015). What is positive youth development and how might it reduce substance use and violence? A systematic review and synthesis of theoretical literature. BMC Public Health, 16, 135. https://doi.org/10.1186/s12889-016-2817-3
Bourdeau, B., Miller, B. A., Byrnes, H. F., Woodall, W. G., Buller, D. B., & Grube, J. W. (2021). Efficacy of a web-based intervention (Smart Choices 4 Teens) for facilitating parent-adolescent communication about relationships and sexuality: Randomized controlled trial. JMIR Pediatrics and Parenting, 4, e19114. https://doi.org/10.2196/19114
Bowen, E., Walker, K., Mawer, M., Holdsworth, E., Sorbring, E., Helsing, B., Bolin, A., Leen, E., Held, P., Awouters, V., & Jans, S. (2014). “It’s like you’re actually playing as yourself”: Development and preliminary evaluation of “Green Acres High”, a serious game-based primary intervention to combat adolescent dating violence. Psychosocial Intervention, 23, 43–55. https://doi.org/10.5093/in2014a5
Brady, S. S., Sieving, R. E., Terveen, L. G., Rosser, B. S., Kodet, A. J., & Rothberg, V. D. (2015). An interactive website to reduce sexual risk behavior: Process evaluation of TeensTalkHealth. JMIR Research Protocols, 4, e106. https://doi.org/10.2196/resprot.3440
Breuner, C. C., Mattson, G., Committee on Adolescence, Committee on Psychosocial Aspects of Child and Family Health, Breuner, C. C., Adelman, W. P., Alderman, E. M., Garofalo, R., Marcell, A. V., Powers, M. E., Mph, M., Upadhya, K. K., Yogman, M. W., Bauer, N. S., Gambon, T. B., Lavin, A., Lemmon, K. M., Mattson, G., Rafferty, J. R., & Wissow, L. S. (2016). Sexuality education for children and adolescents. Pediatrics, 138, e20161348. https://doi.org/10.1542/peds.2016-1348
Cassidy, J., Jones, J. D., & Shaver, P. R. (2013). Contributions of attachment theory and research: A framework for future research, translation, and policy. Development and Psychopathology, 25, 1415–1434. https://doi.org/10.1017/S0954579413000692
Catalano, R. F., Hawkins, J. D., Berglund, M. L., Pollard, J. A., & Arthur, M. W. (2002). Prevention science and positive youth development: Competitive or cooperative frameworks? Journal of Adolescent Health, 31, 230–239. https://doi.org/10.1016/S1054-139X(02)00496-2
Celik, R., & Toruner, E. K. (2020). The effect of technology-based programmes on changing health behaviours of adolescents: Systematic review. Comprehensive Child and Adolescent Nursing, 43, 92–110. https://doi.org/10.1080/24694193.2019.1599083
Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. (2006). Strategic direction for intimate partner violence prevention program. Promoting respectful, nonviolent intimate partner relationships through individual, community, and societal change. https://www.cdc.gov/violenceprevention/pdf/ipv_strategic_direction_full-doc-a.pdf
Chu, S. K. W., Kwan, A. C. M., Reynolds, R., Mellecker, R. R., Tam, F., Lee, G., Hong, A., & Leung, C. Y. (2015). Promoting sex education among teenagers through an interactive game: Reasons for success and implications. Games for Health Journal, 4, 168–174. https://doi.org/10.1089/g4h.2014.0059
Connolly, J., McIsaac, C., Shulman, S., Wincentak, K., Joly, L., Heifetz, M., & Bravo, V. (2014). Development of romantic relationships in adolescence and emerging adulthood: Implications for community mental health. Canadian Journal of Community Mental Health, 33, 7–19. https://doi.org/10.7870/cjcmh-2014-002
Connolly, J., Nguyen, H. N. T., Pepler, D., Craig, W., & Jiang, D. (2013). Developmental trajectories of romantic stages and associations with problem behaviours during adolescence. Journal of Adolescence, 36, 1013–1024. https://doi.org/10.1016/j.adolescence.2013.08.006
Cook, T., Boote, J., Buckley, N., Vougioukalou, S., & Wright, M. (2017). Accessing participatory research impact and legacy: Developing the evidence base for participatory approaches in health research. Educational Action Research, 25, 473–488. https://doi.org/10.1080/09650792.2017.1326964
Cortese, J., & Lustria, M. L. A. (2012). Can tailoring increase elaboration of health messages delivered via an adaptive educational site on adolescent sexual health and decision making? Journal of the American Society for Information Science and Technology, 63, 1567–1580. https://doi.org/10.1002/asi.22700
Coulter, R. W. S., Mitchell, S., Prangley, K., Smallwood, S., Bonanno, L., Foster, E. N., Wilson, A., Miller, E., & Chugani, C. D. (2021). Generating intervention concepts for reducing adolescent relationship abuse inequities among sexual and gender minority youth: Protocol for a web-based, longitudinal, human-centered design study. JMIR Research Protocols, 10, e26554. https://doi.org/10.2196/26554
Davila, J., Mattanah, J., Bhatia, V., Latack, J. A., Feinstein, B. A., Eaton, N. R., Daks, J. S., Kumar, S. A., Lomash, E. F., Mccormick, M., & Zhou, J. (2017). Romantic competence, healthy relationship functioning, and well-being in emerging adults: Romantic competence. Personal Relationships, 24, 162–184. https://doi.org/10.1111/pere.12175
Dick, R. N., McCauley, H. L., Jones, K. A., Tancredi, D. J., Goldstein, S., Blackburn, S., Monasterio, E., James, L., Silverman, J. G., & Miller, E. (2014). Cyber dating abuse among teens using school-based health centers. Pediatrics, 134, e1560–e1567. https://doi.org/10.1542/peds.2014-0537
Fakoya, I., Cole, C., Larkin, C., Punton, M., Brown, E., & Ballonoff Suleiman, A. (2022). Enhancing human-centered design with youth-led participatory action research approaches for adolescent sexual and reproductive health programming. Health Promotion Practice, 23, 25–31. https://doi.org/10.1177/15248399211003544
Fincham, F. D., & Beach, S. R. H. (2010). Marriage in the new millennium: A decade in review. Journal of Marriage and Family, 72, 630–649. https://doi.org/10.1111/j.1741-3737.2010.00722.x
Furman, W., & Wehner, E. A. (1997). Adolescent romantic relationships: A developmental perspective. New Directions for Child and Adolescent Development, 1997, 21–36. https://doi.org/10.1002/cd.23219977804
Giovanelli, A., Ozer, E. M., & Dahl, R. E. (2020). Leveraging technology to improve health in adolescence: A developmental science perspective. Journal of Adolescent Health, 67, S7–S13. https://doi.org/10.1016/j.jadohealth.2020.02.020
Guerra, N. G., & Bradshaw, C. P. (2008). Linking the prevention of problem behaviors and positive youth development: Core competencies for positive youth development and risk prevention. New Directions for Child and Adolescent Development, 2008, 1–17. https://doi.org/10.1002/cd.225
Guse, K., Levine, D., Martins, S., Lira, A., Gaarde, J., Westmorland, W., & Gilliam, M. (2012). Interventions using new digital media to improve adolescent sexual health: A systematic review. Journal of Adolescent Health, 51, 535–543. https://doi.org/10.1016/j.jadohealth.2012.03.014
Hielscher, E., Moores, C., Blenkin, M., Jadambaa, A., & Scott, J. G. (2021). Intervention programs designed to promote healthy romantic relationships in youth: A systematic review. Journal of Adolescence, 92, 194–236. https://doi.org/10.1016/j.adolescence.2021.08.008
Hoehe, M. R., & Thibaut, F. (2020). Going digital: How technology use may influence human brains and behavior. Dialogues in Clinical Neuroscience, 22(2), 93–97. https://doi.org/10.31887/DCNS.2020.22.2/mhoehe
Ivankovich, M. B., Fenton, K. A., & Douglas, J. M. (2013). Considerations for national public health leadership in advancing sexual health. Public Health Reports, 128(2_suppl1), 102–110. https://doi.org/10.1177/00333549131282S112
Janssens, A., Blake, S., Allwood, M., Ewing, J., & Barlow, A. (2020). Exploring the content and delivery of relationship skills education programmes for adolescents: A systematic review. Sex Education, 20, 494–516. https://doi.org/10.1080/14681811.2019.1697661
Jordan, A., Carter, B., Forgeron, P., Fournier, K., & Sanders, K. (2021). Romantic relationships in young people with long-term health conditions: A scoping review. Journal of Pediatric Psychology, 46, 264–279. https://doi.org/10.1093/jpepsy/jsaa106
Kalke, K. M., Ginossar, T., Shah, S. F. A., & West, A. J. (2018). Sex ed to go: A content analysis of comprehensive sexual education apps. Health Education & Behavior, 45, 581–590. https://doi.org/10.1177/1090198117749259
Kansky, J., & Allen, J. P. (2018). Long-term risks and possible benefits associated with late adolescent romantic relationship quality. Journal of Youth and Adolescence, 47, 1531–1544. https://doi.org/10.1007/s10964-018-0813-x
Koziol-McLain, J., Wilson, D., Vandal, A. C., Eruera, M., Nada-Raja, S., Dobbs, T., Roguski, M., & Barbarich-Unasa, T. W. (2021). Evaluation of a healthy relationship smartphone app with indigenous young people: Protocol for a co-designed stepped wedge randomized trial. JMIR Research Protocols, 10, e24792. https://doi.org/10.2196/24792
Lehtimaki, S., Martic, J., Wahl, B., Foster, K. T., & Schwalbe, N. (2021). Evidence on digital mental health interventions for adolescents and young people: Systematic overview. JMIR Mental Health, 8, e25847. https://doi.org/10.2196/25847
Levesque, D. A., Johnson, J. L., & Prochaska, J. M. (2017). Teen Choices, an online stage-based program for healthy, nonviolent relationships: Development and feasibility trial. Journal of School Violence, 16, 376–385. https://doi.org/10.1080/15388220.2016.1147964
Liverpool, S., Mota, C. P., Sales, C. M. D., Čuš, A., Carletto, S., Hancheva, C., Sousa, S., Cerón, S. C., Moreno-Peral, P., Pietrabissa, G., Moltrecht, B., Ulberg, R., Ferreira, N., & Edbrooke-Childs, J. (2020). Engaging children and young people in digital mental health interventions: Systematic review of modes of delivery, facilitators, and barriers. Journal of Medical Internet Research, 22, e16317. https://doi.org/10.2196/16317
Manning, W. D., Longmore, M. A., Copp, J., & Giordano, P. C. (2014). The complexities of adolescent dating and sexual relationships: Fluidity, meaning(S), and implications for young adults’ well-being: The complexities of adolescent dating and sexual relationships. New Directions for Child and Adolescent Development, 2014, 53–69. https://doi.org/10.1002/cad.20060
McCuistian, C., Peteet, B., Burlew, K., & Jacquez, F. (2021). Sexual health interventions for racial/ethnic minorities using community-based participatory research: A systematic review. Health Education & Behavior. https://doi.org/10.1177/10901981211008378
McElwain, A., McGill, J., & Savasuk-Luxton, R. (2017). Youth relationship education: A meta-analysis. Children and Youth Services Review, 82, 499–507. https://doi.org/10.1016/j.childyouth.2017.09.036
Meier, A., & Allen, G. (2009). Romantic relationships from adolescence to young adulthood: Evidence from the National Longitudinal Study of Adolescent Health. The Sociological Quarterly, 50, 308–335. https://doi.org/10.1111/j.1533-8525.2009.01142.x
Melles, M. O., & Ricker, C. L. (2018). Youth participation in HIV and sexual and reproductive health decision-making, policies, programmes: Perspectives from the field. International Journal of Adolescence and Youth, 23(2), 159–167. https://doi.org/10.1080/02673843.2017.1317642
Michie, S., Yardley, L., West, R., Patrick, K., & Greaves, F. (2017). Developing and evaluating digital interventions to promote behavior change in health and health care: Recommendations resulting from an international workshop. Journal of Medical Internet Research, 19, e232. https://doi.org/10.2196/jmir.7126
Mitchell, K. R., Lewis, R., O’Sullivan, L. F., & Fortenberry, J. D. (2021). What is sexual wellbeing and why does it matter for public health? The Lancet Public Health, 6, e608–e613. https://doi.org/10.1016/S2468-2667(21)00099-2
Murta, S. G., de Parada, P. D., da Silva Meneses, S., Medeiros, J. V., Balbino, A., Rodrigues, M. C., Miura, M. A., dos Santos, T. A., & de Vries, H. (2020). Dating SOS: A systematic and theory-based development of a web-based tailored intervention to prevent dating violence among Brazilian youth. BMC Public Health, 20, 391. https://doi.org/10.1186/s12889-020-08487-x
Mustanski, B., Greene, G. J., Ryan, D., & Whitton, S. W. (2015). Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGTB youth: The Queer Sex Ed intervention. The Journal of Sex Research, 52(2), 220–230. https://doi.org/10.1080/00224499.2013.867924
Ozer, E. J. (2017). Youth-led participatory action research: Overview and potential for enhancing adolescent development. Child Development Perspectives, 11, 173–177. https://doi.org/10.1111/cdep.12228
Patchen, L., Ellis, L., Ma, T. X., Ott, C., Chang, K. H., Araya, B., Atreyapurapu, S., Alyusuf, A., & Gaines Lanzi, R. (2020). Engaging African American youth in the development of a serious mobile game for sexual health education: Mixed methods study. JMIR Serious Games, 8, e16254. https://doi.org/10.2196/16254
Paul, F., Thompson, K., & Gupta, N. K. (2020). Information. Support. Connection: How are young people engaging with digital spaces to learn about bodies, sex and relationships? Health & Education Section, UNESCO. https://unesdoc.unesco.org/ark:/48223/pf0000373884
Pence, E., & Paymar, M. (1993). Education groups for men who batter. Springer. https://doi.org/10.1891/9780826179913
Peskin, M. F., Markham, C. M., Shegog, R., Baumler, E. R., Addy, R. C., & Tortolero, S. R. (2014). Effects of the It’s Your Game … Keep It Real program on dating violence in ethnic-minority middle school youths: A group randomized trial. American Journal of Public Health, 104, 1471–1477. https://doi.org/10.2105/AJPH.2014.301902
Pike, J. M., Moore, C. M., Yazel, L. G., Lynch, D. O., Haberlin-Pittz, K. M., Wiehe, S. E., & Hannon, T. S. (2021). Diabetes prevention in adolescents: Co-design study using human-centered design methodologies. Journal of Participatory Medicine, 13, e18245. https://doi.org/10.2196/18245
Piolanti, A., & Foran, H. M. (2022). Efficacy of interventions to prevent physical and sexual dating violence among adolescents: A systematic review and meta-analysis. JAMA Pediatrics, 176, 142. https://doi.org/10.1001/jamapediatrics.2021.4829
Rizzo, C. J., Houck, C., Barker, D., Collibee, C., Hood, E., & Bala, K. (2021). Project Strong: An online, parent–son intervention for the prevention of dating violence among early adolescent boys. Prevention Science, 22, 193–204. https://doi.org/10.1007/s11121-020-01168-6
Rothman, E. F., Bair-Merritt, M., & Broder-Fingert, S. (2021). A feasibility test of an online class to prevent dating violence for autistic youth: A brief report. Journal of Family Violence, 36, 503–509. https://doi.org/10.1007/s10896-020-00194-w
Russell, K. N., Voith, L. A., & Lee, H. (2021). Randomized controlled trials evaluating adolescent dating violence prevention programs with an outcome of reduced perpetration and/or victimization: A meta-analysis. Journal of Adolescence, 87, 6–14. https://doi.org/10.1016/j.adolescence.2020.12.009
Shegog, R., Craig Rushing, S., Gorman, G., Jessen, C., Torres, J., Lane, T. L., Gaston, A., Revels, T. K., Williamson, J., Peskin, M. F., D’Cruz, J., Tortolero, S., & Markham, C. M. (2017). Native-It’s Your Game: Adapting a technology-based sexual health curriculum for American Indian and Alaska Native youth. The Journal of Primary Prevention, 38, 27–48. https://doi.org/10.1007/s10935-016-0440-9
Simpson, D. M., Leonhardt, N. D., & Hawkins, A. J. (2018). Learning about love: A meta-analytic study of individually-oriented relationship education programs for adolescents and emerging adults. Journal of Youth and Adolescence, 47, 477–489. https://doi.org/10.1007/s10964-017-0725-1
Steinka-Fry, K. T., Tanner-Smith, E. E., Dakof, G. A., & Henderson, C. (2017). Culturally sensitive substance use treatment for racial/ethnic minority youth: A meta-analytic review. Journal of Substance Abuse Treatment, 75, 22–37. https://doi.org/10.1016/j.jsat.2017.01.006
Tong, H. L., Quiroz, J. C., Kocaballi, A. B., Fat, S. C. M., Dao, K. P., Gehringer, H., Chow, C. K., & Laranjo, L. (2021). Personalized mobile technologies for lifestyle behavior change: A systematic review, meta-analysis, and meta-regression. Preventive Medicine, 148, 106532. https://doi.org/10.1016/j.ypmed.2021.106532
United Kingdom, Department for Education. (2019). Relationships education, relationships and sex education (RSE) and health education. Statutory guidance for governing bodies, proprietors, head teachers, principals, senior leadership teams, teachers. https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education
Velosa, A., Ramos, I., & Bragança, J. (2021). Preventing dating violence: The GoodVibes Project. Proceedings of the International Conference on Gender Research (ICGR). https://www.proquest.com/openview/94fea61f62c4d7f8c36d86d8c941fa03/1?pq-origsite=gscholar&cbl=4451209
Vives-Cases, C., Davo-Blanes, M. C., Ferrer-Cascales, R., Sanz-Barbero, B., Albaladejo-Blázquez, N., Sánchez-San Segundo, M., Lillo-Crespo, M., Bowes, N., Neves, S., Mocanu, V., Carausu, E. M., Pyżalski, J., Forjaz, M. J., Chmura-Rutkowska, I., Vieira, C. P., & Corradi, C. (2019). Lights4Violence: A quasi-experimental educational intervention in six European countries to promote positive relationships among adolescents. BMC Public Health, 19, 389. https://doi.org/10.1186/s12889-019-6726-0
Wadham, E., Green, C., Debattista, J., Somerset, S., & Sav, A. (2019). New digital media interventions for sexual health promotion among young people: A systematic review. Sexual Health. https://doi.org/10.1071/SH18127
Widman, L., Evans, R., Javidi, H., & Choukas-Bradley, S. (2019). Assessment of parent-based interventions for adolescent sexual health: A systematic review and meta-analysis. JAMA Pediatrics, 173, 866. https://doi.org/10.1001/jamapediatrics.2019.2324
Widman, L., Golin, C. E., Noar, S. M., Massey, J., & Prinstein, M. J. (2016). Projectheartforgirls.com: Development of a web-based HIV/STD prevention program for adolescent girls emphasizing sexual communication skills. AIDS Education and Prevention, 28(5), 365–377. https://doi.org/10.1521/aeap.2016.28.5.365
Widman, L., Kamke, K., Evans, R., Stewart, J. L., Choukas-Bradley, S., & Golin, C. E. (2020). Feasibility, acceptability, and preliminary efficacy of a brief online sexual health program for adolescents. The Journal of Sex Research, 57, 145–154. https://doi.org/10.1080/00224499.2019.1630800
Williamson, H., Hamlet, C., White, P., Marques, E. M. R., Paling, T., Cadogan, J., Perera, R., Rumsey, N., Hayward, L., & Harcourt, D. (2019). A web-based self-help psychosocial intervention for adolescents distressed by appearance-affecting conditions and injuries (Young Persons’ Face It): Feasibility study for a parallel randomized controlled trial. JMIR Mental Health, 6, e14776. https://doi.org/10.2196/14776
World Health Organization. (2019). WHO guideline recommendations on digital interventions for health system strengthening. Geneva. https://www.who.int/publications/i/item/9789241550505
Ybarra, M. L., Bull, S. S., Prescott, T. L., Korchmaros, J. D., Bangsberg, D. R., & Kiwanuka, J. P. (2013). Adolescent abstinence and unprotected sex in CyberSenga, an internet-based HIV prevention program: Randomized clinical trial of efficacy. PLoS ONE, 8, e70083. https://doi.org/10.1371/journal.pone.0070083
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The author(s) disclosed receipt of the following financial support for the research: All authors received support from National Cancer Institute/National Institutes of Health, study R01CA181047, Sexual Health Empowerment for Cervical Health Literacy and Cancer Prevention, Principal Investigator, Megha Ramaswamy. The funding agency had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.
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Emerson, A., Pickett, M., Moore, S. et al. A Scoping Review of Digital Health Interventions to Promote Healthy Romantic Relationships in Adolescents. Prev Sci 24, 625–639 (2023). https://doi.org/10.1007/s11121-022-01421-0
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DOI: https://doi.org/10.1007/s11121-022-01421-0