Use of Motivational Interviewing to Increase Contraception Use among Young Women

背景：美国每年有310万例意外怀孕，占所有怀孕的49%。不到一半的怀孕导致人工流产（2）。意外怀孕后，统计数据更加令人震惊：重复堕胎的发生率在1-3年内为11-15%，高达21%的妇女在怀孕终止后一年内会经历重复怀孕，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，特别是通过在高危人群中进行基于理论的干预。补助金期间的主要教育目标：更深入地了解以理论为基础的干预措施，以激励行为改变，特别是动机访谈（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，提高意外怀孕高风险年轻妇女的避孕药具使用率。研究设计：这是一项2期研究。在第一阶段，我们将根据MI的原则制定避孕咨询干预措施，培训咨询师，并进行一项小型队列研究，以发展技能并完善干预措施。第二阶段将是一项可行性随机对照试验（RCT），以确定大规模RCT是否可行。我们建议研究的高危人群：女性，年龄15-24岁，到芝加哥大学计划生育诊所终止意外怀孕。假设：更大比例的随机接受MI咨询干预的女性将在干预后6个月使用非常有效的避孕措施。大型RCT是可行的。第一阶段的具体目标：制定干预措施1。制定30-45分钟的MI干预措施，以改善高危妇女的避孕药具使用。 a.与研究导师合作，并应用课程来开发干预措施。 B.根据小型队列研究的实施和结果完善干预措施。2期试验的具体目标：可行性RCT 2。进行一项可行性随机对照试验，比较随机分配至以下两组的女性的结局：1）第1阶段设计的咨询干预与2）“常规”避孕咨询。 a.比较干预后1个月和6个月两组的结果。 B.使用结果设计R 01资助研究的大型RCT。

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.