Developing a Primary Care Intervention to Support Reproductive Decision-Making among Black and Latina Women of Reproductive Age with Type 2 Diabetes

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Project Summary/Abstract Candidate: The goal of this K01 Award is to support the training and research of Dr. Cassondra Marshall, who's long-term goal is to advance reproductive and maternal health equity through the translation of evidence into practice using tailored interventions that address the needs of racial/ethnic minority women with chronic medical conditions. Her research has examined young women's contraceptive decision-making and has explored the ways in which health care providers and systems can deliver patient-centered contraceptive care. Research Plan: Women with diabetes prior to pregnancy have elevated rates of maternal and neonatal morbidity and mortality. Type 2 diabetes is increasingly prevalent among women during their childbearing years, disproportionately impacting Black and Latina women. To prevent maternal and infant health complications, there is an urgent need for enhanced efforts to improve reproductive health outcomes among reproductive-aged women with type 2 diabetes, particularly racial/ethnic minorities. However, there are currently no evidence-based strategies to implement clinical guidelines for improving reproductive outcomes among adult women with type 2 diabetes. Patient decision support tools in primary care represent a promising implementation strategy. The research aims are: Aim 1: Elucidate reproductive decision-making processes and reproductive health care preferences among Black and Latina women of reproductive age with type 2 diabetes, using person-centered and structural competency frameworks. Aim 2: Adapt an existing patient decision support intervention to support reproductive decision-making and reproductive health counseling delivery in primary care to meet the needs of Black and Latina reproductive-aged women with type 2 diabetes. Aim 3: Assess acceptability and feasibility of the adapted intervention among patients and providers and examine the implementation context for the intervention. Career Development and Training Plan: The candidate's training plan capitalizes on an interdisciplinary mentoring team with expertise in person-centered family planning care, diabetes care, implementation science, and organizational research in primary care. Through coursework, workshops, apprenticeships, and mentored research experiences, Dr. Marshall will receive training in Person- Centered and Structurally Competent Reproductive Health Interventions, Advanced Mixed Methods, Implementation Science and Stakeholder Engagement, and Designing and Implementing Trials in the Primary Care Setting. UC Berkeley and close partners UCSF and Kaiser Permanente Northern California provide an excellent research infrastructure and training environment for Dr. Marshall. Summary: The training and research proposed in this application position Dr. Marshall to be competitive for R01 funding to support a multisite effectiveness-implementation trial of the adapted intervention and facilitate her transition to independence as a researcher.