Barriers to Referring Adolescent Women for Etonogestrel Implant.

Study Overview
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Brief Summary
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This study seeks to understand how much pediatric providers in Central Florida know about the etonogestrel contraceptive implant. The investigators also seek to understand the barriers that may prevent them from referring adolescent women for this highly effective and recommended method of contraception. Finally the study will consider if an expanded education and coaching improves their ability to referring patients for this method of birth control.

Detailed Description
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This study is comprised of two phases. During the first phase 500 medical providers who provide care to adolescents will be recruited to complete a 30 question anonymous survey that evaluates their attitudes towards recommending and referring for adolescent women for the etonogestrel contraceptive device. This survey will also test participant's knowledge of indications, side effects and side effect management related to this contraceptive device as well. During phase 2, 100 pediatric providers will be randomized to two groups. One group will receive standard continuing medical education on the use of the etonogestrel device in adolescents focusing on themes that emerged as knowledge deficits in phase 1. The other group will receive standard continuing medical education plus continued coaching on management of medication side effects. The referring patterns of physicians in each group will be studied.

Official Title
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A Study to Understand the Barriers in Referring Adolescent Women for the Etonogestrel Implant and to Evaluate Whether Intensive Coaching on the Management of Common Side Effects of the Implant Influences Referrals for the Implant.

Conditions
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Contraceptive Usage

Intervention / Treatment
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* Behavioral: Education plus Coaching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A primary care provider that cares for children under the age of 18. This includes physician's assistants, advanced nurse practitioners, residents or fellows, and physicians in pediatrics, internal medicine, and family medicine. Must currently be practicing in Central Florida. Be able to speak and write in English For phase two of the study an additional requirement is that you must have a medical license to practice independently in the state of Florida. Exclusion Criteria: Not a primary care provider who cares for children. A pediatric provider who only provides specialty care Not able to speak or write in English For phase two of study does not have a medical license to practice independenly in the State of Florida.

Ages Eligible for Study
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Minimum Age: 22 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard Education<br>Pediatric Providers in this arm will receive a continuing medical education on etonogestrel contractive implant but will not receive specialist coaching on how to manage side effects. | |
| Experimental: Standard Education plus Coaching<br>Pediatric Providers in this arm will receive a continuing medical education program on etonogestrel contraceptive implant. Providers in this arm will also receive a tip-sheet on how to manage side effects as well as a number to directly access a specialist who places them if needed. | Behavioral: Education plus Coaching<br>* Providers in Intervention group will receive standard education (1.5 hr CME), a tip sheet on how to manage side effects for quick reference and a number to directly reach a provider experienced with managing etonogestrel side effects with questions regarding how to manage side effects.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Types of barriers to referral for etonogestrel implant based on questionnaire | Barriers to recommending and referring adolescent women for etonogestrel contraceptive implant | 6 months | 
| Number of adolescent women referred | Number of adolescent women who were referred for etonogestrel contraceptive implant | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Categories of knowledge deficit in pediatric providers based on questionaire | Understanding whether pediatric providers main knowledge deficit around etonogestrel implant is indications, side effects, or decreasing side effects. | 6 months | 
| Aspects in Coaching that changed pediatric providers' behaviors | Qualitative analysis on which parts of coaching or standard intervention were most considered in referring. | 18 months |