A Pilot Feasibility Study of a Patient-Directed Computerized Intervention to Address Reproductive Coercion

点击翻译按钮获取中文摘要

Intimate partner violence (IPV) is a significant public health problem in the United States, especially among women of reproductive age (15-49 years). One third of women age 18 and older experience IPV, with 70% first experiencing violence prior to age 25. Women in violent relationships are at greater risk of unintended pregnancy and sexually transmitted infections (STIs), due in part to reproductive coercion (RC). RC includes pregnancy coercion - a male partner’s attempts to pressure a female partner to become pregnant or to end a pregnancy, and contraceptive sabotage. One in four women attending family planning (FP) clinics has experienced RC, and this is even higher for African American (37%) and multiracial (29%) women and women who have experienced IPV (35%). FP clinics are often the sole source of health care for racial minority women, who are less likely to have primary care providers, and therefore has the potential to act as an intervention point for RC. One of the few interventions that addresses both IPV and RC within a FP setting is ARCHES, a brief, provider-dependent education intervention. ARCHES includes IPV and RC screening and education for all female FP patients, harm reduction behavioral strategies, resources, and referrals. While ARCHES demonstrated potential for reducing IPV and RC, new delivery methods that address structural barriers, such as providers’ limited time, are needed for successful delivery. In this study, we first propose to adapt the provider-dependent ARCHES into a patient- directed computerized version of ARCHES (C-ARCHES). The provision of ARCHES via a computerized platform will not rely on the limited time of providers to deliver the intervention, but still allows providers an opportunity to talk about IPV/RC through patient-directed initiation based on information they read in the computerized version. Adaptation will involve solicitation of recommendations for developing and implementing the patient- directed computerized version of ARCHES via focus groups with female FP patients and interviews with providers and topical experts, production of C-ARCHES, review by topical experts, pre-testing by patients, integration of feedback, and final production. Second, we will conduct a pilot cluster randomized controlled trial (RCT) focused on the feasibility of C-ARCHES: acceptability, demand/use, practicality, and safety. Two clinics will receive C-ARCHES and two clinics will continue with standard of care (i.e., IPV screening). The providers in the C-ARCHES clinic will receive training prior to the intervention. Participants in both arms will include female FP patients ages 18-29. Data will be collected via surveys at baseline (pre- and post-clinic visit) and at a 3-month follow up. Surveys will collect demographic information and IPV/RC knowledge, self-efficacy, and behavior. Patients who receive C-ARCHES will also be asked questions about the feasibility of C-ARCHES. The proposed adaptation of a provider-dependent intervention for computerized delivery enhances the scalability and reach of the intervention, which could have high public health impact on IPV, RC, and unintended pregnancy among racial minority women with health disparities in access to care.