Development of a digital decision support tool to facilitate developmentally appropriate adolescent contraceptive counseling in primary care

项目摘要/摘要： 避孕咨询是健康专业人员对人们进行避孕相关教育的过程。 避孕选择，包括功效、正确使用和副作用，并帮助他们选择最佳的 方法。然而，通常在初级保健机构中实施的避孕咨询并不适用。 根据青少年独特的性、认知和社会发展量身定制，从而 次优的使用模式以及负面的性健康和生殖健康结果 影响脆弱社区并使健康和经济劣势的循环永久化。此外， 青少年，特别是有色人种青少年，表示感觉被提供者强迫选择并继续 长效方法。尽管青少年怀孕和生育率近年来稳步下降 过去二十年，美国青少年的怀孕率和 生育率高于其他高收入国家。种族/民族和性/性别 少数族裔青年的意外怀孕和性传播感染（STI）发生率特别高。 青少年意外怀孕的可能性比成人高得多。青春期母亲的孩子 出现负面出生结果、身心健康困难以及成为 青少年父母自己。在青少年时期首次生育的个体受教育程度较低， 他们一生中的经济成就。此外，美国青少年的性传播感染率正在上升。没有 如果及时治疗，性传播感染可能会导致严重的终生健康问题，包括患癌症、慢性疼痛、 以及成年后的不孕症。我们研究的长期目标是为青少年提供量身定制的避孕咨询 经验，以提高避孕满意度、持续性和一致性使用，减少 强迫经历，并减少意外怀孕和性传播感染。在这个项目中，我们将与年轻人合作 不同种族/民族和性/性别身份的数据，以创建数字决策支持工具来评估 青少年在访问前对避孕的了解、关注和偏好，然后提供 向提供者提供信息，以促进有针对性的、适合发育的避孕咨询 会议。具体来说，我们将确定年轻人认为必要的数字决策工具的功能 促进初级保健临床医生做出避孕决策，可行且有效 在初级保健就诊中实施。我们将设计该工具并优化其可用性。该项目将产生 支持该工具临床试验的未来 R01 应用的必要数据。

Project Summary/Abstract: Contraceptive counseling is the process by which a health professional educates a person about their contraceptive options, including efficacy, proper use, and side effects, and helps them choose their optimal method. However, contraceptive counseling as typically implemented in primary care settings is not developmentally tailored to adolescents’ unique sexual, cognitive, and social development, resulting in suboptimal patterns of use and negative sexual and reproductive health outcomes that disproportionately impact vulnerable communities and perpetuate a cycle of health and economic disadvantage. Further, adolescents, particularly youth of color, have reported feeling coerced by providers to choose and continue a long-acting method. Although rates of adolescent pregnancy and childbearing have declined steadily over the past two decades, adolescents in the U.S. continue to experience disproportionately higher pregnancy and childbearing rates than their counterparts in other high-income countries. Racial/ethnic and sexual/gender minority youth have particularly high rates of unintended pregnancy and sexually transmitted infections (STIs). Adolescents’ pregnancies are much more likely than adults’ to be unintended. Children of adolescent mothers are at elevated risk of negative birth outcomes, physical and mental health difficulties, and of becoming teenage parents themselves. Individuals who first give birth as adolescents experience lower educational and economic attainment across their lifetimes. Further, rates STIs are rising among US adolescents. Without timely treatment, STIs can result in serious lifelong health problems, including risks of cancer, chronic pain, and infertility in adulthood. The long-term goal of our research is to tailor adolescents’ contraceptive counseling experience in order to improve contraceptive satisfaction, continuation, and consistent use, reduce experiences of coercion, and reduce unintended pregnancies and STIs. In this project, we will work with youth of diverse racial/ethnic and sexual/gender identities to create a digital decision support tool to assess adolescent knowledge, concerns, and preferences on contraception prior to the visit, then deliver the information to the provider to facilitate a focused, developmentally appropriate contraceptive counseling session. Specifically, we will identify the features of a digital decision tool deemed necessary by youth to facilitate their contraceptive decision making and by primary care clinicians to feasibly and effectively implement in primary care visits. We will design the tool and optimize its usability. This project will yield the necessary data for a future R01 application supporting a clinical trial of the tool.