A Pilot Feasibility Study of a Patient-Directed Computerized Intervention to Address Reproductive Coercion

亲密伴侣暴力(IPV)在美国是一个重大的公共卫生问题，特别是在 育龄妇女(15-49岁)。三分之一的18岁及以上女性经历过IPV，其中70%是第一次 在25岁之前经历过暴力。处于暴力关系中的女性意外怀孕的风险更大 性传播感染(STI)，部分原因是生殖胁迫(RC)。RC包括怀孕 胁迫--男性伴侣试图迫使女性伴侣怀孕或终止妊娠的行为，以及 避孕破坏行为。每四个去计划生育诊所就诊的女性中就有一个经历过RC，这 对于非裔美国人(37%)和多种族女性(29%)以及经历过IPV的女性来说，这一比例更高 (35%)。计划生育诊所往往是少数民族妇女唯一的医疗保健来源，她们不太可能患有 初级保健提供者，因此有可能成为RC的干预点。为数不多的 在FP环境中同时解决IPV和RC的干预措施是ARCES，一种简短的、取决于提供商的干预措施 教育干预。ARCES包括对所有女性FP患者进行IPV和RC筛查和教育，危害 减少行为策略、资源和推荐。而拱门显示出了降低 IPV和RC，需要新的交付方法来解决结构性障碍，如供应商的有限时间 才能成功交付。在这项研究中，我们首先建议将提供者依赖的拱门改造成患者- 定向计算机版本的拱门(C形拱门)。通过计算机化平台提供拱门 不会依赖于提供者提供干预的有限时间，但仍然允许提供者有机会 从患者在计算机上阅读的信息谈IPV/RC 版本。适应将包括征求建议，以制定和实施患者- 通过焦点小组对女性FP患者进行定向计算机版本的ARES，并与 提供者和专题专家，C形拱形的生产，专题专家的审查，患者的预测试， 将反馈与最终生产相结合。第二，进行试点整群随机对照试验 (RCT)侧重于C-ARCHES的可行性：可接受性、需求/使用、实用性和安全性。两家诊所 将接受C-ARCH，两家诊所将继续接受标准护理(即IPV筛查)。中的提供程序 C-ARCHES诊所将在干预前接受培训。两边的参与者都将包括女性 年龄在18-29岁的FP患者。数据将通过基线调查(门诊前和门诊后访问)和3个月的调查来收集 继续跟进。调查将收集人口统计信息和IPV/RC知识、自我效能感和行为。 接受C-Arch手术的患者还将被问及有关C-Arch手术可行性的问题。建议数 将依赖于提供商的干预适应于计算机化的交付，增强了 这项干预措施可能会对IPV、RC和意外怀孕产生很大的公共卫生影响 在获得保健方面存在健康差距的少数族裔妇女。

Intimate partner violence (IPV) is a significant public health problem in the United States, especially among women of reproductive age (15-49 years). One third of women age 18 and older experience IPV, with 70% first experiencing violence prior to age 25. Women in violent relationships are at greater risk of unintended pregnancy and sexually transmitted infections (STIs), due in part to reproductive coercion (RC). RC includes pregnancy coercion - a male partner’s attempts to pressure a female partner to become pregnant or to end a pregnancy, and contraceptive sabotage. One in four women attending family planning (FP) clinics has experienced RC, and this is even higher for African American (37%) and multiracial (29%) women and women who have experienced IPV (35%). FP clinics are often the sole source of health care for racial minority women, who are less likely to have primary care providers, and therefore has the potential to act as an intervention point for RC. One of the few interventions that addresses both IPV and RC within a FP setting is ARCHES, a brief, provider-dependent education intervention. ARCHES includes IPV and RC screening and education for all female FP patients, harm reduction behavioral strategies, resources, and referrals. While ARCHES demonstrated potential for reducing IPV and RC, new delivery methods that address structural barriers, such as providers’ limited time, are needed for successful delivery. In this study, we first propose to adapt the provider-dependent ARCHES into a patient- directed computerized version of ARCHES (C-ARCHES). The provision of ARCHES via a computerized platform will not rely on the limited time of providers to deliver the intervention, but still allows providers an opportunity to talk about IPV/RC through patient-directed initiation based on information they read in the computerized version. Adaptation will involve solicitation of recommendations for developing and implementing the patient- directed computerized version of ARCHES via focus groups with female FP patients and interviews with providers and topical experts, production of C-ARCHES, review by topical experts, pre-testing by patients, integration of feedback, and final production. Second, we will conduct a pilot cluster randomized controlled trial (RCT) focused on the feasibility of C-ARCHES: acceptability, demand/use, practicality, and safety. Two clinics will receive C-ARCHES and two clinics will continue with standard of care (i.e., IPV screening). The providers in the C-ARCHES clinic will receive training prior to the intervention. Participants in both arms will include female FP patients ages 18-29. Data will be collected via surveys at baseline (pre- and post-clinic visit) and at a 3-month follow up. Surveys will collect demographic information and IPV/RC knowledge, self-efficacy, and behavior. Patients who receive C-ARCHES will also be asked questions about the feasibility of C-ARCHES. The proposed adaptation of a provider-dependent intervention for computerized delivery enhances the scalability and reach of the intervention, which could have high public health impact on IPV, RC, and unintended pregnancy among racial minority women with health disparities in access to care.