{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:04:30Z","timestamp":1789794270765,"version":"4.0.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","funder":[{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","award":["FAM-81-8832"],"award-info":[{"award-number":["FAM-81-8832"]}],"id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","award":["FAM-81-8832"],"award-info":[{"award-number":["FAM-81-8832"]}],"id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Sexual and reproductive health is critical for the readiness of the warfighter, as costs of sexually transmitted infections and unintended pregnancy result in added health care costs, lost mission time, and impact on morale. The Multiphase Optimization Strategy (MOST) is an engineering-inspired framework used to optimize biobehavioral interventions. The Military Active-Duty Reproductive and Sexual Health (MARSH) research team applied the MOST framework to develop \u201cMission Wellness\u201d\u2014an electronic health intervention to promote sexual and reproductive health within the U.S. Military.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>From 2017 to 2022, the MARSH team implemented the first and second phases of MOST to develop and optimize \u201cMission Wellness.\u201d All phases received institutional review board approval. The first phase consisted of expert and literature review, qualitative interviews, and beta testing to identify intervention components and the optimization objective and to inform study design. The second phase consisted of a factorial trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Figures\u00a01\u20134 outline the research program approach, demographics of the sample, and format of the app. Service members who used the application found it to be acceptable and, overall, reported that it would be easier to talk to a sexual partner about risk behaviors and history at the post-intervention assessment compared to baseline. This iterative optimization approach using both local and strategic engagement enhanced program development and set the stage for dissemination and implementation efforts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In line with the iterative nature of MOST, the lessons learned during the optimization trial led the MARSH team to return \u201cMission Wellness\u201d to the preparation phase. The utilization of mixed (i.e., qualitative and quantitative) research methods and engagement with stakeholders at multiple levels of the military enterprise provided the information necessary to further optimize \u201cMission Wellness.\u201d This programmatic approach also provides a blueprint for the development of research design and testing in military health care balancing rigor and agility.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae099","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T16:35:45Z","timestamp":1724085345000},"page":"306-313","source":"Crossref","is-referenced-by-count":3,"title":["Enhancing Mission Wellness: Iterative Optimization and Stakeholder Engagement to Promote Sexual and Reproductive Health in the United States Military"],"prefix":"10.1093","volume":"189","author":[{"given":"Sara","family":"Vargas","sequence":"first","affiliation":[{"name":"Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, RI 02906, USA"},{"name":"Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University , Providence, RI 02906, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Landoll","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate M","family":"Guthrie","sequence":"additional","affiliation":[{"name":"Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, RI 02906, USA"},{"name":"Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University , Providence, RI 02906, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9335-6820","authenticated-orcid":false,"given":"Jeffrey","family":"Quinlan","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Iowa Carver College of Medicine, University of Iowa Health Care , Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison F","family":"Clark","sequence":"additional","affiliation":[{"name":"Henry M. 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