Development of a digital decision support tool to facilitate developmentally appropriate adolescent contraceptive counseling in primary care

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Project Summary/Abstract: Contraceptive counseling is the process by which a health professional educates a person about their contraceptive options, including efficacy, proper use, and side effects, and helps them choose their optimal method. However, contraceptive counseling as typically implemented in primary care settings is not developmentally tailored to adolescents’ unique sexual, cognitive, and social development, resulting in suboptimal patterns of use and negative sexual and reproductive health outcomes that disproportionately impact vulnerable communities and perpetuate a cycle of health and economic disadvantage. Further, adolescents, particularly youth of color, have reported feeling coerced by providers to choose and continue a long-acting method. Although rates of adolescent pregnancy and childbearing have declined steadily over the past two decades, adolescents in the U.S. continue to experience disproportionately higher pregnancy and childbearing rates than their counterparts in other high-income countries. Racial/ethnic and sexual/gender minority youth have particularly high rates of unintended pregnancy and sexually transmitted infections (STIs). Adolescents’ pregnancies are much more likely than adults’ to be unintended. Children of adolescent mothers are at elevated risk of negative birth outcomes, physical and mental health difficulties, and of becoming teenage parents themselves. Individuals who first give birth as adolescents experience lower educational and economic attainment across their lifetimes. Further, rates STIs are rising among US adolescents. Without timely treatment, STIs can result in serious lifelong health problems, including risks of cancer, chronic pain, and infertility in adulthood. The long-term goal of our research is to tailor adolescents’ contraceptive counseling experience in order to improve contraceptive satisfaction, continuation, and consistent use, reduce experiences of coercion, and reduce unintended pregnancies and STIs. In this project, we will work with youth of diverse racial/ethnic and sexual/gender identities to create a digital decision support tool to assess adolescent knowledge, concerns, and preferences on contraception prior to the visit, then deliver the information to the provider to facilitate a focused, developmentally appropriate contraceptive counseling session. Specifically, we will identify the features of a digital decision tool deemed necessary by youth to facilitate their contraceptive decision making and by primary care clinicians to feasibly and effectively implement in primary care visits. We will design the tool and optimize its usability. This project will yield the necessary data for a future R01 application supporting a clinical trial of the tool.