Use of Motivational Interviewing to Increase Contraception Use among Young Women

描述（由申请人提供）：背景：美国每年有310万例意外怀孕，占所有怀孕的49%。这些怀孕中只有不到一半会导致人工流产(2)。意外怀孕后，统计数据更加令人担忧：1-3年内的重复流产率为11-15%，高达21%的女性在终止妊娠的一年内会再次怀孕，青少年的风险明显更高（3,4）。申请人的长期职业目标：研究可以对有效避孕药具的使用产生重大影响的干预措施，从而降低美国妇女和女孩的意外怀孕率，特别是通过基于理论的干预措施在高风险人群中。资助期的主要教育目标：深入了解基于理论的干预措施，以激励行为改变，特别是动机性访谈（MI）的原则和实践以及支持其使用的行为理论。运用这些知识，改善意外怀孕高风险年轻妇女的避孕药具使用情况。研究设计：这是一个两阶段的研究。在第一阶段，我们将开发基于MI原则的避孕咨询干预措施，培训咨询师，并进行小型队列研究，以发展技能和完善干预措施。第二阶段将是可行性随机对照试验（RCT），以确定大规模随机对照试验是否可行。我们建议研究的高危人群：到芝加哥大学计划生育诊所寻求终止意外妊娠的15-24岁女性。假设：更大比例的随机接受MI咨询干预的妇女将在干预后6个月使用非常有效的避孕措施。大规模的随机对照试验是可行的。第一阶段的具体目标：制定干预措施。制定30-45分钟的心肌梗死干预措施，以改善高危妇女避孕措施的使用。a.与研究导师合作，应用课程作业来开发干预措施。b.基于一项小型队列研究的实施和结果，完善干预措施。第二阶段试验的具体目标：可行性随机对照试验2。进行可行性随机对照试验，比较随机分为：1)第一阶段设计的咨询干预与2)“常规”避孕咨询的妇女的结果。a.干预后1个月和6个月组间结果比较。b.利用结果设计大型RCT，用于R01授权的研究。

DESCRIPTION (provided by applicant): Background: There are 3.1 million unintended pregnancies in the United States annually, 49% of all pregnancies. Just under half of these pregnancies result in induced abortion(2). After an unintended pregnancy, the statistics are even more alarming: repeat abortion incidence is 11-15% over 1-3 years, and up to 21% of all women will experience repeat pregnancy within a year of pregnancy termination, with teens at significantly higher risk (3,4). Long-term career goal of applicant: To study interventions that can have a significant influence on the use of effective contraceptives and to therefore reduce the rate of unintended pregnancy among U.S. women and girls, especially via theory-based interventions in high risk populations. Primary educational goal for the grant period: To gain a deeper understanding of theory-based interventions to motivate behavior change, especially the principles and practice of motivational interviewing (MI) and the behavioral theories that support its use. To apply this knowledge to improve contraceptive use among young women at high risk for unintended pregnancy. Study design: This is a 2-phase study. During the first phase, we will develop a contraceptive counseling intervention based on the principles of MI, train counselors, and conduct a small cohort study to develop skills and refine the intervention. The second phase will be a feasibility randomized controlled trial (RCT) to determine if a large-scale RCT will be feasible. High risk population we propose to study: Women, aged 15-24 years, presenting to the University of Chicago family planning clinic for termination of an unintended pregnancy. Hypothesis: A larger proportion of women who are randomized to receive the MI counseling intervention will be using very effective contraception 6 months after the intervention. A large RCT will be feasible. Specific aims for phase 1: development of the intervention 1. Develop a 30-45 minute MI intervention to improve contraceptive use in high risk women. a. Work with research mentors and apply coursework to develop the intervention. b. Refine the intervention based on implementation and results of a small cohort study. Specific aims for phase 2 of trial: Feasibility RCT 2. Conduct a feasibility RCT comparing outcomes for women randomized to: 1) the counseling intervention designed in phase 1 vs. 2) "usual" contraceptive counseling. a. Compare outcomes between groups at 1 and 6 months after intervention. b. Use results to design large RCT for study in an R01 grant.