Reproductive Planning for Women Veterans

 描述(由申请人提供)： 背景资料。Lisa Cregari，医学博士，公共卫生硕士，VA Puget Sound的博士后HSR&D研究员，VA工作人员妇科医生，华盛顿大学妇产科助理教授。自2012年开始担任研究员以来，卡拉加里博士的研究反映出她致力于解决退伍军人女性的生殖保健需求。拟议的职业发展奖(CDA-2)将为Cregari博士提供她作为一名独立的卫生服务研究人员取得成功所需的深入培训和技能，设计和测试干预措施，以改善女性退伍军人的生殖保健。职业发展计划。Cregari博士提议的CDA-2将采用创新战略，包括生殖规划和共同决策，以解决退伍军人女性生殖健康服务方面的差距。与平民相比，女性退伍军人患慢性医疗和心理健康疾病的比例更高。这些共病，再加上退伍军人中有记录的低避孕率，导致意外怀孕和不良妊娠结局的风险增加。生殖规划讨论促进了对怀孕和避孕使用的前瞻性规划，但在实践中很少发生。指导生殖规划讨论的一种新方法是使用基于共同决策原则的决策辅助。决策辅助工具通过使患者的医疗保健决策与他们的价值观和偏好保持一致来提高决策质量。虽然决策辅助工具已被有效地用于其他生殖健康决策，但尚未开发出用于生殖规划的决策辅助工具。CDA-2建议在退伍军人初级保健中设计和测试生殖规划决策辅助干预措施，以提高生殖规划决策质量和避孕措施的使用。具体地说，CDA-2旨在：1)使用定性方法确定退伍军人和退伍军人初级保健医生中的生殖规划决策需求；2)开发、改进和试行生殖规划决策辅助工具；3)进行两点随机对照试验(RCT)，以测试决策辅助工具对决策质量(决策冲突、知识、决策自我效能和决策满意度)和避孕结果的影响，与仅提供生殖规划信息相比。还将调查实施的障碍和促进者，以便在下列情况下促进下游实施 这次干预被证明是有效的。卡拉加里博士将在指导 拟议的研究将得到定性方法、决策科学和决策辅助开发、随机对照试验设计和实施科学方面的结构化培训的补充。Cregari博士将在她的导师和顾问团队的指导和监督下进行她的研究，其中包括卫生服务干预专家(Karin Nelson，MD，MSHS)，共享决策和决策助手(David Arterburn，MD，公共卫生硕士和Suzanne Broney，PhD)，生殖健康和定性方法(Sonya Borrero，MD，MS和Alison Hamilton，PhD，MPH)，随机对照试验设计(Gayle Reiber，PhD和Eleanor Bimla Schwarz，MD，MSH)，实施科学(Alison Hamilton，PhD，公共卫生硕士)和生殖健康政策(Laurie ZePhyrin，医学博士、公共卫生硕士和MBA)。冲击力。这一CDA-2将使Cregari博士能够与退伍军人管理局妇女健康研究和共享决策方面的领导人合作，设计和测试以患者为中心的干预措施，以改善生殖决策和生殖健康保健服务的质量。拟议的研究与指导和培训计划相结合，将促进Cregari博士成功地转变为一名独立的退伍军人健康服务研究员，其职业生涯致力于促进女性退伍军人的健康。

 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.