Figure 1: Student-perceived barriers to sexual health product acquisition. Students were surveyed before the development and establishment of The Kit and subsequently surveyed one year later. The Euler diagrams show reported barrier(s) to acquiring contraceptives based on the question: “What would stop you from getting contraceptives at school?”. Percentages are listed as a proportion of the survey group that selected a given barrier. Overlapping circles indicate the relative proportion of students who selected multiple barriers.
Students reported cost, privacy, and confidentiality as significant barriers to acquiring sexual health products (Fig. 1). Survey data reveals that before the intervention implementation, 42% of students reported contraceptives being available on campus, and one-year post-intervention, that number grew to 71% (Fig. 2). Similar observations were made for student access to sexual health education (29% and 72% report access, respectively) and services (35% and 72% report access, respectively) pre- and post-intervention (Fig. 2).
Figure 2: Pre- and post-intervention analysis of contraceptive, education, and sexual health service access perceptions. Students were asked to rate "How does HSI provide access to.." (1) "on-site resources of contraceptives that do not require a prescription (ex. condoms, spermicides, etc.)?", (2) "sexual health education?" and (3) "sexual health services?".
Preliminary data from an ongoing campus needs assessment revealed a services gap impacting [NAME OF CAMPUS BLINDED] students’ sexual and reproductive health practices. A survey of 95 students revealed that 50% were uncertain if sexual health services are available on campus, and 14% and 23% indicated minimum to no access to sexual health services, respectively. 65% of students indicated that privacy concerns would prevent contraceptive attainment on campus (Fig. 1). When queried about the campus provision of non-prescriptive contraceptive access, 50% of the respondents indicated no or uncertain access (Fig. 1). Sixty-seven percent of the students surveyed suggested cost, privacy, and a combination of cost and confidentiality as significant barriers to obtaining contraceptives on campus (Fig. 1). The preliminary survey results were underpowered, yet evidence in undergraduate students’ sexual and reproductive health knowledge, attitudes, and perspectives in the context of health behaviors in college support these findings. For instance, even when attending campus context providing comprehensive health resources and services, undergraduates do not maximize the use of campus health services for their sexual and reproductive health needs [13].
Supplies included in The Kit, the wages of a part-time student coordinator, and general program costs were funded by student-initiated, faculty-mentored, institutionally-reviewed and managed grants (RO and AM), faculty research and development funds (AM and K.O.), and community monetary and in-kind donations. An essential component of this initiative’s success is the ability to analyze data to determine optimal purchasing of The Kit’s supplies. Students can request items ranging from reproductive health products such as over-the-counter contraceptives, barrier methods, emergency contraception and pregnancy tests, female hygiene products, and other personal hygiene supplies (Table 2). Currently, the highest items in demand include (listed in descending order):
-
Family planning (86.8%) & Sexual health (84.1%)
-
Condoms (74.7%), emergency contraceptives (74.2%), and pregnancy tests (73.6%)
-
Menstrual products (61%) and lubricants (54.4%)
-
Dental dams (21.4%) and dental hygiene kits (8.2%)
Table 2
Items requested during The Kit initiative. Proportions of total order requests are listed for each item, with composite item groupings listed in italicized bold.
Requestable Item
|
Proportion of Requests (n = 182)
|
Sexual Health
|
84.1%
|
|
Condoms
|
74.7%
|
|
Dental Dams
|
21.4%
|
|
Lube
|
54.4%
|
Family Planning
|
86.8%
|
|
Emergency Contraception
|
74.2%
|
|
Pregnancy Test
|
73.6%
|
Menstrual Products
|
61.0%
|
|
Menstrual Pads
|
29.7%
|
|
Midol
|
16.5%
|
|
Panty Liner
|
13.2%
|
|
Tampons
|
39.0%
|
Personal Hygiene
|
22.5%
|
|
Personal Wipes
|
14.3%
|
|
Razors
|
12.1%
|
|
Toothbrush/ Toothpaste Kit
|
8.2%
|
Table 3
Association Rules Mining of The Kit Order Requests. Thresholds for support and confidence were set at 20% and 80%, respectively. Values of support >50% were bolded, indicating a rule appeared in most order requests; values of confidence > 90% were also bolded, indicating a very high likelihood that if an antecedent was requested, so too would the corresponding consequent.
Antecedent
|
Consequent
|
Count
|
Support
|
Confidence
|
Coverage
|
Lift
|
Dental Dams
|
Condoms
|
37
|
20.33%
|
94.87%
|
21.43%
|
1.270
|
Emergency Contraception, Lubricant
|
65
|
35.71%
|
83.33%
|
42.86%
|
1.115
|
Emergency Contraception, Pregnancy Test
|
92
|
50.55%
|
82.88%
|
60.99%
|
1.109
|
Lubricant
|
83
|
45.60%
|
83.84%
|
54.40%
|
1.122
|
Lubricant, Pregnancy Test
|
71
|
39.01%
|
83.53%
|
46.70%
|
1.118
|
Lubricant, Tampons
|
43
|
23.63%
|
81.13%
|
29.12%
|
1.086
|
Condoms, Pregnancy Test
|
Emergency Contraception
|
92
|
50.55%
|
86.79%
|
58.24%
|
1.170
|
Condoms, Tampons
|
43
|
23.63%
|
81.13%
|
29.12%
|
1.094
|
Lubricant, Pregnancy Test
|
72
|
39.56%
|
84.71%
|
46.70%
|
1.142
|
Lubricant, Tampons
|
44
|
24.18%
|
83.02%
|
29.12%
|
1.119
|
Menstrual Pads, Pregnancy Test
|
40
|
21.98%
|
85.11%
|
25.82%
|
1.147
|
Pregnancy Test
|
111
|
60.99%
|
82.84%
|
73.63%
|
1.117
|
Pregnancy Test, Tampons
|
50
|
27.47%
|
84.75%
|
32.42%
|
1.142
|
Condoms, Tampons
|
Lubricant
|
43
|
23.63%
|
81.13%
|
29.12%
|
1.492
|
Emergency Contraception, Tampons
|
44
|
24.18%
|
80.00%
|
30.22%
|
1.471
|
Pregnancy Test, Tampons
|
48
|
26.37%
|
81.36%
|
32.42%
|
1.496
|
Condoms, Emergency Contraception
|
Pregnancy Test
|
92
|
50.55%
|
88.46%
|
57.14%
|
1.201
|
Condoms, Lubricant
|
71
|
39.01%
|
85.54%
|
45.60%
|
1.162
|
Condoms, Menstrual Pads
|
37
|
20.33%
|
90.24%
|
22.53%
|
1.226
|
Condoms, Tampons
|
46
|
25.27%
|
86.79%
|
29.12%
|
1.179
|
Emergency Contraception
|
111
|
60.99%
|
82.22%
|
74.18%
|
1.117
|
Emergency Contraception, Lubricant
|
72
|
39.56%
|
92.31%
|
42.86%
|
1.254
|
Emergency Contraception, Menstrual Pads
|
40
|
21.98%
|
95.24%
|
23.08%
|
1.294
|
Emergency Contraception, Tampons
|
50
|
27.47%
|
90.91%
|
30.22%
|
1.235
|
Lubricant
|
85
|
46.70%
|
85.86%
|
54.40%
|
1.166
|
Lubricant, Tampons
|
48
|
26.37%
|
90.57%
|
29.12%
|
1.230
|
Menstrual Pads
|
47
|
25.82%
|
87.04%
|
29.67%
|
1.182
|
Tampons
|
59
|
32.42%
|
83.10%
|
39.01%
|
1.129
|
Table 2 shows the left-hand side (if - support) and the right side (then - coverage) to determine the likelihood (confidence) of students requesting both items. For example, if a student requests emergency contraception, there is an 83% chance of them also asking for a pregnancy test. Furthermore, the Lift column is a ratio between adding the support and coverage and dividing by the confidence to create a score. If a lift value is greater than one, then the request of the primary and secondary together will occur more often than these items being requested separately. This information provides greater insight into bundling purchases for items instead of focusing on the purchase history of each item individually.
Part of the larger project aims to understand personal behaviors to advise future programming and demand for The Kit. For example, 68% of students who received at least one of The Kit’s boxes were sexually active at least once in the last six months, with 34% engaging in sex at least once a week (Table 2). Also, educational materials within The Kit support informed decision-making, such as 12% of the students were motivated to get tested for STIs from the information sources contained within The Kit. With most students comfortable obtaining The Kit at no cost or purchasing contraceptives online at their own expense, The Kit's popularity will probably grow as more students become aware of the program (data not shown).
Using The Kit: Pre- and Post-Analyses
The Kit usage increased students' perception of contraception availability on campus. Students were asked about contraceptive product availability on campus. Using a Chi-square test of independence, we found a statistically significant difference (p = 0.000478) between the pre and post-surveys for students' reports of contraceptive availability on campus. 42% of respondents in the pre-survey reported on-campus contraceptive availability, compared to 71% of respondents reporting this post-survey (Fig. 2).
This student-led, anonymous, and discreet delivery strategy and method impacted students’ perception of available sexual health education on campus. We asked students how [BLINDED NAME OF CAMPUS] provides access to sexual health education. Using a Chi-square test of independence, we found a statistically significant difference (p = 4.315e-15) between the pre and post-surveys for students’ reported level of access to sexual health education at this campus. Reports of “Easy Access” rose from 5–34%, with drops in “Minimum Access,” “No Access,” and “Uncertain” responses (Fig. 2).
The Kit product use increased students’ perception of access to health services on campus (Fig. 2). The pre-and post-survey asked how HSI provides access to sexual health services. Using a Chi-square test of independence, a statistically significant difference (p = 9.241e-13) was found between the pre-and post-surveys for students’ reported level of access to sexual health services on this campus. Reports of “Easy Access” rose from 13–30%. No respondents in the post-survey responded with “No Access,” compared to 14% who did in the pre-survey. Decreases were also seen in the “Minimum Access” and “Some Access” response groups.
The availability of The Kit increased students' perception of access to emergency contraceptives on campus. Both surveys asked how [CAMPUS NAME BLINDED] provided access to on-site resources of contraceptives that do not require a prescription, such as condoms, both female and male, spermicides, and others. Using a Chi-square test of independence, we noticed a statistically significant difference (7.137e-10) between the pre and post-surveys for students' reported level of access to over-the-counter contraceptives at UMR. For instance, "Easy Access" rose from 21–49%, nearly half of post-survey respondents. There were also significant decreases in the "Minimum Access," "No Access," and "Uncertain" response groups. The availability of The Kit and connected activities to this larger initiative likely played a significant role in this change.