Feasibility of Immediate Postpartum Long-acting Reversible Contraception Implementation

Study Overview
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Brief Summary
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The objective of this study is to test and disseminate tools that drive successful immediate postpartum Long-Acting Reversible Contraception (LARC) implementation. The long-term goal is to reduce unintended pregnancy soon after childbirth by increasing access to immediate postpartum LARC for women who desire it.

Detailed Description
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Based on previous work, the investigators have generated a toolkit to guide the integration of immediate postpartum LARC services into widespread clinical practice. In the proposed work, this toolkit will be used to initiate immediate postpartum LARC services in a single site with low baseline immediate postpartum LARC uptake (Michigan Medicine). The investigators will conduct a feasibility study using mixed methods to assess acceptability and appropriateness of toolkit items; patient experience of care; immediate postpartum LARC utilization rate; and prenatal contraceptive counseling rate.

Official Title
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Immediate Postpartum LARC Implementation: Pilot Study at Michigan Medicine

Conditions
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Pregnancy Related

Intervention / Treatment
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* Other: Implementation Toolkit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female (patients) Pregnant (patients) Receiving obstetrical care at Michigan Medicine (patients) L&D provider at Michigan Medicine (providers) Exclusion Criteria: non-English speaking unable to provide informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-Implementation Patients<br>Enrolled patients will take online surveys following a prenatal or a postpartum visit. | |
| Post-Implementation Patients<br>All enrolled patients will take online surveys following a prenatal or a postpartum visit. A subset will be interviewed after the postpartum survey. | Other: Implementation Toolkit<br>* Post-implementation patients and providers will be assessed after the implementation toolkit has been used to improve service delivery at the study site.<br>|
| Post-Implementation Providers<br>All enrolled providers will take online surveys at 6-12 months after program implementation, and a subset will be interviewed. | Other: Implementation Toolkit<br>* Post-implementation patients and providers will be assessed after the implementation toolkit has been used to improve service delivery at the study site.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient experience of care | Patient online surveys about their experience of care during prenatal visits, hospital stay, or postpartum office visit | Surveys will be collected from pregnant or postpartum women, during the 6-12 months after implementation of a new protocol for peripartum contraceptive care | 
| Acceptability of care process - patients | Online survey assessing experience of care, acceptability and appropriateness of implementation tools | Surveys will be collected from pregnant or postpartum women, during the 6-12 months after implementation of a new protocol for peripartum contraceptive care | 
| Appropriateness of care process - patients | Online survey assessing experience of care, acceptability and appropriateness of implementation tools | Surveys will be collected from pregnant or postpartum women, during the 6-12 months after implementation of a new protocol for peripartum contraceptive care | 
| Acceptability of implementation process - study site maternity care providers | Online survey assessing overall experience of care delivery, acceptability and appropriateness of implementation tools | Surveys will be collected during the 6-12 months after implementation of a new protocol for peripartum contraceptive care | 
| Appropriateness of implementation process - study site maternity care providers | Online survey assessing overall experience of care delivery, acceptability and appropriateness of implementation tools | Surveys will be collected during the 6-12 months after implementation of a new protocol for peripartum contraceptive care | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability of implementation toolkit items - patients | 30-minute follow-up in-person interview of subgroup of patients who completed surveys | Interviews will take place after the survey is completed, during the 6-18 months after implementation of a new protocol for peripartum contraceptive care | 
| Appropriateness of implementation toolkit items - patients | 30-minute follow-up in-person interview of subgroup of patients who completed surveys | Interviews will take place after the survey is completed, during the 6-18 months after implementation of a new protocol for peripartum contraceptive care | 
| Acceptability of implementation toolkit items - providers | 30-minute follow-up in-person interview of subgroup of providers who completed survey | Interviews will take place after the survey is completed, during the 6-18 months after implementation of a new protocol for peripartum contraceptive care | 
| Appropriateness of implementation toolkit items - providers | 30-minute follow-up in-person interview of subgroup of providers who completed survey | Interviews will take place after the survey is completed, during the 6-18 months after implementation of a new protocol for peripartum contraceptive care | 
| Perinatal contraceptive counseling rate | Proportion of delivered patients with documentation of prenatal counseling about postpartum contraception | Measured monthly, up to 24 months after toolkit implementation | 
| Immediate postpartum LARC provision rate | Proportion of delivered patients with documentation of preference for immediate postpartum LARC who receive a LARC device | Measured monthly, up to 24 months after toolkit implementation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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contraception, long-acting reversible contraception, postpartum, toolkit, implementation, feasibility