Use of Long-Acting Reversible Contraception

项目摘要 这个K23奖将提供博士.珍妮K罗德里格斯弗朗西斯支持：（1）获得一个强大的接地在 青少年避孕决策科学;（2）获得混合方法的高级培训;以及（3） 学习和应用干预发展方法，将观察结果转化为交流- 重点干预。为了实现这些目标，弗朗西斯博士组建了一个指导团队， 委员会跨越多个学科和机构。她的主要导师，Jasmin Tiro博士， 优秀的研究资金和指导记录，是青少年健康促进方面的专家， 混合方法、干预发展和医患沟通。弗朗西斯博士的下一位导师是 Susan L.罗森塔尔，博士，国际知名的亲子沟通， 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 独立调查员。弗朗西斯博士的咨询委员会包括：西蒙克拉多克李，博士，公共卫生硕士， 实施科学和定性方法专家;黄金，做，一个很好的出版专家， LARC为青少年;和南希凯利，医学博士，公共卫生硕士，社区儿科医生谁与当地密切合作伙伴 学校问题：德克萨斯州的青少年生育率在全国排名第五，有33，144名未成年女性 去年生了20年的孩子。LARC（宫内节育器和避孕植入物）是一线方法 用于青少年/年轻成年人避孕;然而，采用情况并不理想。旨在提高 没有充分考虑到提供者与青少年和母亲的沟通， 避孕。根据弗朗西斯博士先前的研究， 二人组和她的临床经验，这种混合方法的建议将检查这些知识的差距， 加强干预措施的制定，以促进LARC的采用。具体目标是：（1） 医疗服务提供者（儿科住院工作人员）在讨论时对LARC的了解和沟通 描述青少年和母亲对提供者最佳方式的信念 可以支持青少年的避孕决策。方法：为实现目标1，我们将招募200名 得克萨斯大学儿科住院人员完成一份简短的在线问卷。对于目标2，我们将 评估青少年的信念，母亲的信念，以及他们对避孕的二元互动 咨询偏好通过单独的半结构化访谈与30名青少年，30名母亲和30名 双胞胎母亲（共90次访谈）。结果：这些产生假设的混合方法 研究结果将为青少年避孕决策科学提供坚实的基础， 未来以沟通为重点的干预工具，以支持LARC的采用。结果也可以改善 预防慢性病青少年怀孕的能力。这项研究影响 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.