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

亲密伴侣暴力（IPV）是美国的一个重大公共卫生问题，特别是在 育龄妇女（15-49岁）。三分之一的18岁及以上的女性经历过IPV，其中70%是第一次 在25岁之前遭受暴力。处于暴力关系中的妇女意外怀孕的风险更大 和性传播感染（STI），部分原因是生殖胁迫（RC）。RC包括妊娠 胁迫-男性伴侣试图迫使女性伴侣怀孕或终止妊娠，以及 破坏避孕措施四分之一的妇女参加计划生育（FP）诊所经历了RC，这 对于非裔美国人（37%）和多种族（29%）女性以及经历过IPV的女性来说， (35%).计划生育诊所往往是少数民族妇女获得医疗保健的唯一来源， 初级保健提供者，因此有可能作为RC的干预点。为数不多 在FP设置中解决IPV和RC的干预措施是ARCHES，一种简短的，依赖于提供商的 教育干预。ARCHES包括所有女性FP患者的IPV和RC筛查和教育， 减少行为策略，资源和转介。虽然ARCHES展示了减少 IPV和RC，需要解决结构性障碍的新交付方法，例如提供商的有限时间 成功交付。在这项研究中，我们首先提出将依赖于提供者的ARCHES适应于患者- ARCHES的定向计算机化版本（C-ARCHES）。通过计算机化平台提供ARCHES 不会依赖于提供者有限的时间来提供干预措施，但仍然允许提供者有机会 根据他们在计算机化的 版本.适应将涉及征求建议，以制定和实施病人- 通过与女性FP患者的焦点小组和与 提供者和专题专家，C-ARCHES的制作，专题专家的审查，患者的预测试， 整合反馈和最终生产。第二，我们将开展试点性的整群随机对照试验 (RCT)重点关注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-ARCHES和两个诊所将继续标准护理（即，IPV筛选）。供应商在 C-ARCHES诊所将在干预前接受培训。两组受试者均包括女性 FP患者年龄18-29岁。将通过基线（诊所访视前和诊所访视后）和3个月时的调查收集数据 跟进调查将收集人口统计信息和IPV/RC知识，自我效能和行为。 接受C-ARCHES治疗的患者还将被问及有关C-ARCHES可行性的问题。拟议 将依赖于提供者的干预调整为计算机化交付， 干预措施，这可能对IPV，RC和意外怀孕产生很大的公共卫生影响， 少数民族妇女在获得保健方面存在健康差距。

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.