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

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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.