Use of Long-Acting Reversible Contraception

项目总结 这一K23奖项将为Jenny K Rodriguez Francis博士提供支持，以：(1)在 青少年避孕决策科学；(2)获得混合方法的高级培训；和(3) 学习和应用干预发展方法，将观察结果转化为交流- 有针对性的干预。为了实现这些目标，弗朗西斯博士组建了一个指导团队和顾问 由多个学科和机构组成的委员会。她的主要导师，Jasmin Tiro博士，有一个 在研究资助和指导方面有良好的记录，是青少年健康促进方面的专家， 混合方法、干预发展和患者与提供者的沟通。弗朗西斯博士的下一位导师是 苏珊·L·罗森塔尔博士，在青少年与父母沟通方面享誉国际，可接受 疫苗和杀微生物剂，混合方法，教师发展和指导初级教师成为 独立调查人员。弗朗西斯博士的顾问委员会成员包括：Simon Craddock Lee，博士，公共卫生硕士， 实施科学和定性方法专家；Melanie A.Gold，Do，一位出版广泛的 为青少年服务的LARC；以及Nancy Kelly，医学博士，公共卫生硕士，社区儿科医生，与当地儿童密切合作 学校。问题：德克萨斯州的青少年出生率在全国排名第五，有33144名未成年女性 20年过去了，去年生了孩子。LARC(宫内节育器和避孕植入物)是第一线方法 用于青少年/青壮年避孕；然而，摄取率不是最理想的。旨在增加 收容没有充分考虑提供者与青少年和母亲的沟通，以发起 避孕。弗朗西斯博士先前评估青少年与父母之间不和谐的研究提供了信息 和她的临床经验，这一混合方法学提案将检查这些知识的差距，以 加强制定干预措施，以促进LARC的普及。特定的目标寻求(1)表征 医疗提供者(儿科医院工作人员)在讨论时对LARC的了解和沟通 青少年-母亲二元型；(2)描述青少年和母亲关于提供服务的最佳方式的信念 可以支持青少年的避孕决策。方法：对于目标1，我们将招募200人 德克萨斯大学儿科医生完成一份简短的在线调查问卷。对于目标2，我们将 评估青少年对避孕的信念、母亲的信念以及他们之间的相互作用 通过分别对30名青少年、30名母亲和30名青少年进行半结构化访谈，获得咨询偏好 青春期-母亲双亲(共90次访谈)。结果：这些产生假设的混合方法 这些发现将为青少年避孕决策的科学提供坚实的基础，以设计一种 未来以沟通为重点的干预工具，以支持LARC的吸收。结果也可能有所改善 小组专家预防患有慢性病的青少年怀孕的能力。这项研究影响了 服务提供者沟通，满足产妇需求，并支持青少年避孕决策。

PROJECT SUMMARY This K23 Award will provide Dr. Jenny K Rodriguez Francis support to: (1) gain a strong grounding in the science of adolescent contraceptive decision-making; (2) acquire advanced training in mixed-methods; and (3) learn and apply intervention development approaches to translate observational findings into communication- focused interventions. To achieve these goals Dr. Francis has assembled a mentoring team and advisory committee spanning multiple disciplines and institutions. Her primary mentor, Jasmin Tiro, PhD, has an excellent track record of research funding and mentorship and is an expert in adolescent health promotion, mixed-methods, intervention development and patient-provider communication. Dr. Francis’ next mentor is Susan L. Rosenthal, PhD, internationally renowned for adolescent-parent communication, acceptability of vaccines and microbicides, mixed-methods, faculty development and mentoring junior faculty to become independent investigators. Dr. Francis’ advisory committee includes: Simon Craddock Lee, PhD, MPH, an expert of implementation science and qualitative methods; Melanie A. Gold, DO, a well-published expert in LARC for adolescents; and Nancy Kelly, MD, MPH, a community pediatrician who partners closely with local schools. Problem: Texas has the fifth highest rate of teen births in the nation, with 33,144 females under age 20 years giving birth last year. LARC (intrauterine devices and contraceptive implants) is the first line method for contraception for adolescents/young adults; yet uptake is sub-optimal. Interventions designed to increase uptake have insufficiently considered the provider’s communication with adolescents and mothers to initiate contraception. Informed by Dr. Francis’ prior research assessing discordance between adolescent-parent dyads and her clinical experience, this mixed methodology proposal will examine these gaps in knowledge to enhance the development of interventions to foster LARC uptake. Specific Aims seek to (1) characterize medical providers’ (pediatric house staff) knowledge of and communication about LARC when discussing with adolescent-mother dyads; (2) describe adolescents’ and mothers’ beliefs about the optimal ways that providers can support contraceptive decision-making among adolescents. Methods: For aim 1, we will recruit 200 University of Texas pediatric house officers to complete a brief online questionnaire. For aim 2, we will evaluate adolescents’ beliefs, mother’s beliefs, and their dyadic interactions about their contraceptive counseling preferences through separate semi-structured interviews with 30 adolescents, 30 mothers and 30 adolescent-mother dyads (90 interviews total). Outcomes: These hypothesis-generating mixed-methods findings will provide a strong grounding in the science of adolescent contraceptive decision-making to design a future communication-focused intervention tool to support LARC uptake. Results could also improve subspecialists’ ability to prevent pregnancy among adolescents with chronic conditions. This study impacts provider communication, addresses maternal needs and supports adolescent contraception decision-making.