Reproductive Planning for Women Veterans



 DESCRIPTION (provided by applicant): BACKGROUND. Lisa Callegari, MD, MPH is a postdoctoral HSR&D fellow at VA Puget Sound, a VA Staff Gynecologist, and an Assistant Professor of Obstetrics & Gynecology at the University of Washington. Since beginning her fellowship in 2012, Dr. Callegari's research has reflected her commitment to addressing the reproductive health care needs of women Veterans. The proposed Career Development Award (CDA-2) will provide Dr. Callegari with the in-depth training and skills she needs to succeed as an independent health services researcher designing and testing interventions to improve reproductive health care for women Veterans. CAREER DEVELOPMENT PLAN. Dr. Callegari's proposed CDA-2 will employ innovative strategies, including reproductive planning and shared decision making, to address gaps in reproductive health services for women Veterans. Compared to civilians, women Veterans have higher rates of chronic medical and mental health illness. These comorbidities, in combination with low rates of documented contraception among women Veterans, result in increased risks of unplanned pregnancy and poor pregnancy outcomes. Reproductive planning discussions promote proactive planning for pregnancy and contraceptive use, yet rarely occur in practice. One novel approach to guide reproductive planning discussions is use of a decision aid based on shared decision making principles. Decision aids improve decision quality by aligning patients' health care decisions with their values and preferences. While decision aids have been used effectively for other reproductive health decisions, no decision aid has been developed for reproductive planning. This CDA-2 proposes to design and test a reproductive planning decision aid intervention in VA primary care to improve reproductive planning decision quality and use of contraception. Specifically, this CDA-2 aims to: 1) determine reproductive planning decision needs among women Veterans and VA primary care physicians using qualitative methods; 2) develop, refine, and pilot test a reproductive planning decision aid; and 3) conduct a two-site randomized controlled trial (RCT) to test the effect of the decision aid on decision quality (decisional conflict, knowledge, decision self-efficacy and decision satisfaction) and contraceptive outcomes, compared to reproductive planning information only. Barriers and facilitators to implementation will also be investigated to facilitate downstream implementation if the intervention is found to be effective. The experience Dr. Callegari will gain in conducting the proposed research will be supplemented with structured training in qualitative methods, decision science and decision aid development, RCT design, and implementation science. Dr. Callegari will conduct her research under the guidance and supervision of her mentorship and consultant team, which includes experts in health services interventions (Karin Nelson, MD, MSHS), shared decision making and decision aides (David Arterburn, MD, MPH and Suzanne Brodney, PhD), reproductive health and qualitative methods (Sonya Borrero, MD, MS and Alison Hamilton, PhD, MPH), RCT designs (Gayle Reiber, PhD and Eleanor Bimla Schwarz, MD, MS), implementation science (Alison Hamilton, PhD, MPH), and reproductive health policy (Laurie Zephyrin, MD, MPH, MBA). IMPACT. This CDA-2 will enable Dr. Callegari to collaborate with leaders in VA women's health research and shared decision making to design and test a patient centered intervention that improves reproductive decisions and the quality of reproductive health care services. The research proposed, in combination with the mentorship and training plan, will facilitate Dr. Callegari's successful transition to an independent VA health services researcher with a career dedicated to advancing the health of women Veterans.