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%。在这些怀孕中，只有不到一半会导致人工流产(2)。在意外怀孕后，统计数据更加令人震惊：1-3年内重复流产的发生率为11%-15%，高达21%的妇女将在终止妊娠一年内经历再次怀孕，青少年的风险明显更高(3，4)。申请者的长期职业目标：研究能够对有效避孕措施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，特别是通过对高危人群进行基于理论的干预。授权期的主要教育目标：更深入地了解以理论为基础的干预措施，以推动行为改变，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。将这一知识应用于改善意外怀孕高危年轻女性的避孕措施使用情况。研究设计：本研究分为两个阶段。在第一阶段，我们将开发基于MI原则的避孕咨询干预，培训咨询人员，并进行小规模队列研究，以发展技能和完善干预。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：年龄在15-24岁之间的女性，她们因意外怀孕而到芝加哥大学计划生育诊所就诊。假设：随机接受MI咨询干预的女性中，有更大比例的人在干预6个月后将使用非常有效的避孕措施。一个大规模的随机对照试验将是可行的。阶段1的具体目标：制定干预措施1.制定30-45分钟的心肌梗死干预措施，以改善高危妇女的避孕药使用情况。A.与研究导师合作，并应用课程作业来开发干预措施。B.根据一项小型队列研究的实施情况和结果，改进干预措施。试验第二阶段的具体目标：可行性随机对照试验2。对随机选择的妇女进行一项可行性随机对照试验，比较结果：1)在第一阶段设计的咨询干预措施与2)“通常”的避孕咨询。A.比较干预后1个月和6个月两组的结果。B.使用结果设计大型随机对照试验，以便在R01拨款中进行研究。

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.