Improving Postpartum Contraceptive Decision-Making Among Women With Substance Use Disorders

改善患有药物使用障碍的女性的产后避孕决策

• 批准号: 10408727
• 负责人: Elizabeth E Krans
• 金额: $ 63.39万
• 依托单位: MAGEE-WOMEN'S RES INST AND FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10408727
• 关键词: Address; Birth; Characteristics; Child; Clinical; Conflict (Psychology); Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Decision Making; Discipline of obstetrics; Effectiveness; Evaluation; Failure; Family Planning; Fertility; General Population; Goals; Health; Health system; Hospital Planning; Hybrids; Interview; Knowledge; Learning; Maternity Hospitals; Measures; Mediating; Medicaid eligibility; Methods; Motivation; Observational Study; Outcome; Patients; Postpartum Period; Postpartum Women; Pregnancy; Provider; Randomized Controlled Trials; Reproductive Health; Research; Research Design; Science; Substance Use Disorder; Testing; Thinking; Translations; Woman; Work; arm; base; child bearing; clinical care; clinical practice; condoms; cost; design; effectiveness-implementation RCT; future implementation; health care availability; health inequalities; illicit drug use; improved; novel; opioid use disorder; patient oriented; postpartum contraception; preference; pregnant; pressure; process evaluation; reproductive; reproductive coercion; sex; sexually active; side effect; support tools; treatment as usual; unintended pregnancy

The reproductive health needs of women with substance use disorders (SUDs) are unmet. Over 80% of pregnancies among women with SUDs are unintended, compared to 45% of the general population, and over 20% of women with SUDs have had a short interpregnancy interval (i.e. pregnancy within 18 months of a previous birth). Pregnancy is a unique opportunity to address contraceptive needs due to increased healthcare access from expanded Medicaid eligibility, increased access to highly effective contraceptive methods such as long-acting reversible contraception (LARC) and enhanced motivation to avoid rapid, repeat pregnancy. Despite this, over 75% of women with opioid use disorder fail to use postpartum contraception and less than 2% receive LARC in the postpartum period. Currently, there are no effective strategies to improve postpartum contraceptive decision-making for women with SUDs. To address this gap, we will conduct a hybrid type 1 effectiveness- implementation randomized controlled trial among 350 postpartum women with SUDs to test the effect of a novel patient-centered, reproductive planning decision support tool, developed by the research team, called MyPath on postpartum contraceptive method choice and continuation, continuous contraceptive use, unintended pregnancy and interpregnancy interval until 18 months postpartum. The primary research aims are to 1) assess the effect of patient-centered, reproductive planning decision support (MyPath) on postpartum contraceptive utilization and reproductive health outcomes among women with SUDs; 2) determine if the relationship between MyPath and contraceptive utilization is mediated by decision quality; and 3) identify barriers and facilitators to integrating MyPath into routine postpartum clinical care. This research is significant because using a patient-centered, reproductive planning approach to contraceptive decision-making represents a paradigm shift in both how we frame and approach reproductive health outcomes among women with SUDs. Our findings will have high impact if successful as decision support tools are a low-cost, scalable solution that can be used in most clinical settings and our study design enhances the potential for rapid translation of our findings into routine clinical practice. Finally, it is feasible because it builds on prior work by a research team with expertise in decision sciences, implementation, family planning, obstetrics and SUDs.

患有物质使用障碍(SUDS)的妇女的生殖健康需求没有得到满足。超过80%的 患有肥皂泡的妇女的怀孕是意外的，与总人口的45%相比，甚至更多。 患有肥皂泡的妇女中有20%的人有过较短的解释间隔(即怀孕18个月内 上一次出生)。由于医疗保健的增加，怀孕是解决避孕需求的独特机会 扩大了医疗补助资格，增加了获得高效避孕方法的机会，如 长效可逆避孕(LARC)和增强动力，以避免快速、重复怀孕。尽管 超过75%的患有阿片类药物使用障碍的妇女没有使用产后避孕措施，只有不到2%的妇女接受了 LARC在产后期。目前，还没有有效的策略来改进产后避孕措施 有肥皂泡的女性的决策。为了解决这一差距，我们将进行混合类型1的有效性- 在350名患有肥胖症的产后妇女中进行随机对照试验，以测试一种新的药物的效果 以患者为中心的生殖计划决策支持工具，由研究团队开发，名为MyPath on 产后避孕方法选择和继续、持续使用避孕药、意外怀孕 产后18个月为口译间隔期。研究的主要目的是：1)评估 以患者为中心的生殖计划决策支持(MyPath)对产后避孕措施的利用和 患有肥胖症的妇女的生殖健康结果；2)确定MyPath和 避孕措施的使用受决策质量的影响；以及3)确定整合的障碍和促进者 MyPath进入常规产后临床护理。这项研究具有重要意义，因为使用了以患者为中心的 避孕决策的生殖计划方法代表着我们如何 制定和处理患有肥胖症的妇女的生殖健康结果。我们的发现将产生很大的影响 如果成功，因为决策支持工具是可在大多数临床环境中使用的低成本、可扩展的解决方案 我们的研究设计增强了将我们的发现快速转化为常规临床实践的可能性。 最后，它是可行的，因为它建立在一个拥有决策科学专业知识的研究团队之前的工作基础上， 实施、计划生育、产科和肥胖症。