Patient-Centered Support for Contraceptive Decision-Making
Condition: Contraception; Contraceptive Behavior
Study type: Interventional

Summary: 
      The investigators have designed a tablet-based decision support tool to help women learn more
      about their birth control options and support them in choosing a method they are happy with.
      The investigators will test whether the decision support tool helps women choose a birth
      control method they can continue using successfully by having some women use the tool before
      their birth control-related visit to a health care provider, and some women not use the tool
      before their visit. The investigators will then follow up with all the women at four months
      and seven months after their visit to see if they are still using the birth control method
      they chose at the visit and how happy they are with the method.

      Hypotheses:

        1. Women who use the contraceptive decision support tool will be more likely to continue
           using their chosen method at 4 and 7 months follow-up, compared to women who receive
           usual care.

        2. The contraceptive decision support tool will increase women's knowledge, choice of, and
           use of highly effective reversible contraception, compared to usual care.

        3. The contraceptive decision support tool will decrease decision conflict, compared to
           usual care.

        4. The contraceptive decision support tool will increase patient satisfaction with the
           clinic visit and with their method, compared to usual care.

        5. Women who use the contraceptive decision support tool will have fewer unintended
           pregnancies during the follow-up period, compared to women who received usual care.

        6. The contraceptive decision support tool will increase shared patient-provider decision
           making in contraceptive counseling visits, compared to usual care.

        7. The contraceptive decision support tool will decrease provider frustration when
           providing contraceptive counseling and increase provider job satisfaction.

        8. Women using the tool will be more likely to report use of any moderately or highly
           effective method of contraception at 4 and 7 months follow-up, compared to women not
           using the tool.
    

Detailed description: 
      The impacts of unintended pregnancy include adverse maternal and infant outcomes for women
      who continue their pregnancies, with higher rates of infant low birth weight, infant
      mortality, and maternal mortality and morbidity for these pregnancies as compared to planned
      pregnancies. In addition, children resulting from unplanned pregnancies have been found to be
      more likely to experience developmental delay.

      Over the past several decades, the proportion of unintended pregnancy in the United States
      has remained stubbornly high at approximately 50%. Each year, one in 20 women of reproductive
      age experiences an unintended pregnancy, and it is estimated that over half of women will
      have an unintended pregnancy in their lifetime. This high rate of unintended pregnancy in the
      United States places a heavy burden on both women and the health care system. A
      disproportionate amount of this burden is experienced by minority women and women of lower
      socioeconomic status. Given the high rate of unintended pregnancies in this country,
      interventions designed to help women achieve their fertility goals could have a substantial
      impact on their health outcomes and life course. In addition, identifying strategies that are
      appropriate for use in high-risk, diverse populations could address disparities in women's
      ability to plan their pregnancies.

      The investigators propose a cluster randomized trial to investigate the effect of an
      interactive, tablet-based contraceptive decision support tool that women will use immediately
      prior to their contraceptive counseling visits. The goal of the tool is to facilitate shared
      decision-making between the woman and her health care provider, with the ultimate goal of
      helping the woman to choose a contraceptive method that is consistent with her values and
      preferences, and is therefore best suited to helping her to avoid an unplanned pregnancy. The
      tool will be available in both English and Spanish.

      The investigators will measure the tool's effect on women's contraceptive continuation, as
      well as on their experience of contraceptive counseling, measured both quantitatively and
      qualitatively. In addition, the investigators will collect quantitative and qualitative data
      to determine the impact of the implementation of this tool on the experiences of providers
      and the clinics in which they work.
    

Intervention name(s): Contraceptive Decision Support Tool
Intervention type(s): Behavioral
Intervention description(s): The decision support tool:
Provides an educational session about different aspects of contraception
Elicits patient preferences about different aspects of contraception
Identifies potential contraindications to certain contraceptive methods
Allows the patient to view details about and compare available contraceptive methods
Suggests methods most appropriate based on the patient's preferences
Collects questions the patient may have for her provider
Generates a printout the patient can bring to her contraceptive counseling visit
Intervention MeSH terms: Contraceptive Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: contraception; patient decision support; patient decision aid; shared decision making; Decision Making, Shared; Patient-Centered Outcomes Research