Improving Contraceptive Care for Women with Chronic Conditions: A Novel, Web-Based Decision Aid in Primary Care

项目总结/摘要 候选人：Justine Wu，医学博士，公共卫生硕士，是一名家庭医生，具有家庭临床和教育专业知识 规划和初级保健。吴医生的长期职业目标是成为一名成功的临床医学家- 世卫组织领导制定基于实践的干预措施，以改善避孕药具的使用， 增加意外怀孕的几率。她特别感兴趣的是理解和解决- 满足患有慢性疾病的妇女的避孕需求，包括糖尿病和高血压， 张力在完成这5年的职业发展奖后，吴博士将获得经验， 作为一名独立调查员，开始职业生涯所需的知识和技能。 公共卫生背景：拟议的项目与NIH的使命相关，因为它解决了 意外怀孕和慢性病的交叉，两个重大的公共卫生问题 影响美国育龄妇女的疾病患有慢性病的成年妇女的发病率更高 意外怀孕的风险比没有慢性疾病的成年女性高。慢性疾病和unin- 有照料的怀孕都与怀孕相关的并发症和不利的孕产妇和 儿童健康成果。之前的研究表明，患有慢性病的女性没有接受过阿德治疗， 提供充足的避孕咨询，特别是关于高效避孕方法的咨询。有 迫切需要改善对慢性病妇女的避孕咨询和服务， 为了降低意外怀孕率，改善妇女的生殖健康结果， 这个人口。 拟议的研究：本提案的总体目标是设计和试点测试一个理论驱动的， 为患有慢性病的妇女和初级保健人员提供互动式网络避孕决策援助， 玛丽关心。这一决策援助将帮助妇女了解他们的避孕选择的背景下， 他们的医疗条件，正在进行的药物治疗，和个人喜好，并促进共享- 与他们的初级保健提供者（PCP）的决策过程。 这种混合方法、多阶段研究的具体目的是：1）确定影响 患者，提供者和实践层面，这对设计避孕干预措施至关重要， 初级保健中的慢性病妇女; 2）开发一种互动的、基于网络的避孕方法， 为患有慢性病的妇女、其PCP以及在初级保健中的实施提供决策援助; 3） 进行一项试验性随机对照试验（RCT），评估决策辅助与常规护理的可行性 并确定未来R 01 RCT所需的人群规模。 项目创新：拟议的避孕决策援助是创新的，因为它将：1）被消费者， 为患有慢性病的妇女切除，并在社区初级保健场所使用; 2） 由一个新的概念模型提供信息，该模型借鉴了传统行为健康模型的元素 和咨询方法; 3）为PCP提供临床决策支持（与 仅关注患者教育）; 4）通过严格设计的混合方法研究执行;以及5） 反映实施科学的原则，使决策辅助工具可以用于非 研究设置。 培训计划：吴博士提出的研究目标与导师指导的培训计划相协调， 在以下互补领域获得经验：1）混合方法研究; 2）决策科学- （3）基础护理实践研究;（4）传播和实施科学。博士 吴的培训目标将通过以下方式实现：来自经验丰富的跨学科团队的指导 研究人员;先进的教学课程工作;在国家和国际会议上的科学报告， 参加研讨会和期刊俱乐部;实施她的研究计划;和手稿 为拟议研究所产生的项目准备和拟订赠款建议。吴医生 我将准备在该奖项的第四年提交一份有竞争力的R 01申请，以测试她的决策辅助工具 在一项大型随机对照试验中 培训环境：密歇根大学（UM）和UM家庭医学系 为初级研究人员提供出色的研究基础设施和支持性环境。博士 吴的培训和研究计划将得到以下项目，研究所和 所有学校都位于UM校园：密歇根大学临床与健康研究所（UM- CTSA）、健康传播研究中心、妇产科系- 戈伊，妇女保健有效性研究方案，夏季调查研究所 在社会研究所、大学间政治和社会研究联合会的研究 研究，公共卫生学院和统计咨询和研究中心。

PROJECT SUMMARY/ABSTRACT Candidate: Justine Wu, MD, MPH, is a family physician with clinical and educational expertise in family planning and primary care. Dr. Wu's long-term career goal is to become a successful clinical investiga- tor who leads efforts to develop practice-based interventions that improve contraceptive use and de- crease the rate of unintended pregnancy. She is particularly interested in understanding and address- ing the contraceptive needs of women with chronic medical conditions, including diabetes and hyper- tension. Upon completion of this 5-year career development award, Dr. Wu will have obtained the expe- rience and skills necessary to launch a career as an independent investigator. Public Health Context: The proposed project is relevant to the mission of NIH because it addresses the intersection of unintended pregnancy and chronic conditions, two significant public health issues that affect reproductive-aged women in the US. Adult women with chronic conditions have a higher rate of unintended pregnancy than adult women without chronic conditions. Chronic conditions and unin- tended pregnancy are both associated with pregnancy-related complications and adverse maternal and child health outcomes. Prior studies show that women with chronic conditions are not receiving ade- quate contraceptive counseling, particularly regarding highly effective contraceptive methods. There is an urgent need to improve contraceptive counseling and services for women with chronic conditions in order to decrease the rate of unintended pregnancy and improve reproductive health outcomes among this population. Proposed Research: The overarching goal of this proposal is to design and pilot test a theory-driven, interactive web-based contraceptive decision aid for women with chronic conditions and for use in pri- mary care. This decision aid will help women understand their contraceptive options within the context of their medical conditions, ongoing drug therapy, and personal preferences, and facilitate a shared- decision making process with their primary care providers (PCPs). The specific aims of this mixed methods, multi-phase study are: 1) to identify key factors on the patient-, provider-, and practice-level that are critical to the design of a contraceptive intervention for women with chronic conditions in primary care; 2) to develop an interactive, web-based contraceptive decision aid for women with chronic conditions, their PCPs, and implementation in primary care; 3) to conduct a pilot randomized controlled trial (RCT) decision aid versus usual care to assess the feasibility of the intervention and to determine the population size needed for a future R01 RCT. Project Innovation: The proposed contraceptive decision aid is innovative because it will: 1) be cus- tomized for women with chronic conditions and for use in community-based primary care sites; 2) be informed by a new conceptual model that draws upon elements of traditional behavioral health models and counseling methods; 3) provide clinical decision support for PCPs (in contrast to decision aids that focus only on patient education); 4) be executed via a rigorously-designed mixed methods study; and 5) reflect principals of implementation science such that the decision aid can be adopted for use in non- research settings. Training Plan: Dr. Wu's proposed research aims are coordinated with a mentor-guided training plan to gain experience in the following complementary areas: 1) mixed methods research; 2) decision sci- ence; 3) primary care practice-based research ; and 4) dissemination and implementation science. Dr. Wu's training aims will be achieved through: mentorship from an interdisciplinary team of experienced investigators; advanced didactic course work; scientific presentations at national and international con- ferences; participation in seminars and journal clubs; implementing her research plan; and manuscript preparation and grant proposal development for projects arising from the proposed research. Dr. Wu will be prepared to submit a competitive R01 application in Year 4 of this award to test her decision aid in a large randomized controlled trial. Training Environment: The University of Michigan (UM) and the UM Department of Family Medicine provide an outstanding research infrastructure and supportive environment for junior investigators. Dr. Wu's training and research plan will be directly supported by the following programs, institutes, and schools all located on the UM campus: the Michigan Institute for Clinical and Health Research (UM- CTSA), the Center for Health Communications Research, the Department of Obstetrics and Gynecolo- gy, the Program on Women's Health Care Effectiveness Research, the Summer Institute for Survey Research at the Institute for Social Research, the Inter-university Consortium for Political and Social Research, the School of Public Health, and the Center for Statistical Consultation and Research.