Improving Postpartum Contraceptive Decision-Making Among Women With Substance Use Disorders

患有药物使用障碍的妇女的生殖健康需求没有得到满足。超过80%的 SUD女性的怀孕是意外的，而一般人群的这一比例为45%， 20%的SUD女性的解释间隔很短（即妊娠18个月内）， 出生前）。由于医疗保健的增加，怀孕是解决避孕需求的独特机会 扩大医疗补助资格，增加获得高效避孕方法的机会， 长效可逆避孕（LARC）和增强的动机，以避免快速，重复怀孕。尽管 因此，超过75%的阿片类药物使用障碍的妇女没有使用产后避孕药，只有不到2%的妇女接受 产后期间的LARC。目前，还没有有效的策略来改善产后避孕 为患有SUD的女性做出决策。为了解决这一差距，我们将进行混合1型有效性- 在350名患有SUD的产后妇女中实施随机对照试验，以测试一种新的 以患者为中心的生殖计划决策支持工具，由研究小组开发，名为MyPath， 产后避孕方法选择与延续，持续避孕，意外妊娠 和解释间隔，直到产后18个月。主要研究目的是：1）评估 以患者为中心的生殖计划决策支持（MyPath）对产后避孕药具使用的影响， SUD女性的生殖健康结局; 2）确定MyPath与 避孕药具的使用是由决策质量介导的; 3）确定整合的障碍和促进因素 MyPath进入常规产后临床护理。这项研究意义重大，因为使用以病人为中心， 避孕决策的生殖规划方法代表了我们如何 在患有SUD的妇女中制定和处理生殖健康结果。我们的发现将产生重大影响 如果成功，决策支持工具是一种低成本、可扩展的解决方案，可用于大多数临床环境 我们的研究设计增强了将我们的发现快速转化为常规临床实践的潜力。 最后，它是可行的，因为它建立在一个具有决策科学专门知识的研究小组先前工作的基础上， 执行、计划生育、产科和SUD。

The reproductive health needs of women with substance use disorders (SUDs) are unmet. Over 80% of pregnancies among women with SUDs are unintended, compared to 45% of the general population, and over 20% of women with SUDs have had a short interpregnancy interval (i.e. pregnancy within 18 months of a previous birth). Pregnancy is a unique opportunity to address contraceptive needs due to increased healthcare access from expanded Medicaid eligibility, increased access to highly effective contraceptive methods such as long-acting reversible contraception (LARC) and enhanced motivation to avoid rapid, repeat pregnancy. Despite this, over 75% of women with opioid use disorder fail to use postpartum contraception and less than 2% receive LARC in the postpartum period. Currently, there are no effective strategies to improve postpartum contraceptive decision-making for women with SUDs. To address this gap, we will conduct a hybrid type 1 effectiveness- implementation randomized controlled trial among 350 postpartum women with SUDs to test the effect of a novel patient-centered, reproductive planning decision support tool, developed by the research team, called MyPath on postpartum contraceptive method choice and continuation, continuous contraceptive use, unintended pregnancy and interpregnancy interval until 18 months postpartum. The primary research aims are to 1) assess the effect of patient-centered, reproductive planning decision support (MyPath) on postpartum contraceptive utilization and reproductive health outcomes among women with SUDs; 2) determine if the relationship between MyPath and contraceptive utilization is mediated by decision quality; and 3) identify barriers and facilitators to integrating MyPath into routine postpartum clinical care. This research is significant because using a patient-centered, reproductive planning approach to contraceptive decision-making represents a paradigm shift in both how we frame and approach reproductive health outcomes among women with SUDs. Our findings will have high impact if successful as decision support tools are a low-cost, scalable solution that can be used in most clinical settings and our study design enhances the potential for rapid translation of our findings into routine clinical practice. Finally, it is feasible because it builds on prior work by a research team with expertise in decision sciences, implementation, family planning, obstetrics and SUDs.