Improving contraceptive decision support for individuals with chronic conditions

项目摘要 患有慢性疾病的女性更有可能经历意外怀孕和 妊娠并发症比没有慢性病的同龄人高。因为不使用避孕药具（不是 使用任何避孕方法）造成意外怀孕的风险最大，而且更为普遍 在慢性病患者中，迫切需要支持该群体的避孕目标。 避孕决策是避孕药具使用的关键前提，也是一个高度个人化的过程。一个 重大的临床护理差距是缺乏满足独特的避孕决策需求的资源 患有慢性病的患者，例如了解哪些方法可以改善或恶化他们的病情 症状（例如贫血）或疾病自我管理（例如体重）。患者还应该知道他们的慢性病是否 条件对特定方法构成健康禁忌，如果是，可以使用哪些其他方法 安全。然而，临床医生，包括初级保健提供者，通常不会询问患者的偏好或 应用循证避孕指南为慢性病患者提供咨询。为了解决这些 为了弥补这一差距，我们设计了一个基于网络的工具“我的健康我的选择”(MHMC)，以教育慢性病患者 她们的避孕选择情况，并促进临床医生遵守避孕指南 疾病控制和预防中心 (CDC)。 MHMC 具有创新性，因为它是第一个理论—— 知情且经过用户测试的避孕决策支持工具，针对慢性病患者和 他们的临床医生。我们的长期目标是通过避孕干预措施改善生殖健康 一般护理设置。基于我们有希望的试点数据，研究目标是评估 使用混合方法比较 MHMC 的双组平行整群随机试验中的 MHMC（干预） 到 14 个提供避孕服务的初级保健诊所进行常规避孕护理（对照）。我们假设 MHMC 的使用将提高患者报告的避孕决策质量和避孕质量 临床医生的咨询，这将导致避孕药具的使用增加和避孕药具减少 不使用。研究目的是： 目标 1（主要）：评估 MHMC 对不使用避孕药具的影响。目标 2（次要）：评估 MHMC 对遵守 CDC 避孕指南的影响，使用 混合方法。目标 3：（探索性）：定量探索决策质量和避孕措施 作为 MHMC 对主要和次要措施影响的中介提供咨询。预期的 结果是关于新型避孕决策工具对患有以下疾病的个体的功效的新发现 慢性病。该项目将为可扩展的、以人为本的避孕方法的开发提供信息 在现实临床环境中对有医疗风险的患者进行干预。

PROJECT ABSTRACT Women with pre-existing chronic conditions are more likely to experience unplanned pregnancy and pregnancy complications than their peers without chronic conditions. Because contraceptive nonuse (not using any contraceptive method) poses the greatest risk of unplanned pregnancy and is more prevalent among those with chronic conditions, there is an urgent need to support the contraceptive goals of this group. Contraceptive decision-making is a critical antecedent to contraceptive use, and a highly personal process. A significant clinical care gap is the lack of resources that address the unique contraceptive decision needs of patients with chronic conditions, such as understanding which methods may improve or worsen their symptoms (e.g., anemia) or disease self-management (e.g., weight). Patients should also know if their chronic conditions pose a health contraindication to a specific method, and if so, which other methods can be used safely. However, clinicians, including primary care providers, do not routinely elicit patient preferences or apply evidence-based contraceptive guidelines to counsel patients with chronic conditions. To address these gaps, we designed a web-based tool, My Health My Choice (MHMC), to educate patients with chronic conditions about their contraceptive options and promote clinician adherence to contraceptive guidelines from the Centers for Disease Control and Prevention (CDC). MHMC is innovative because it is the first theory- informed, user-tested contraceptive decision support tool that targets both patients with chronic conditions and their clinicians. Our long-term goal is to improve reproductive health through contraceptive interventions in general care settings. Building upon our promising pilot data, the study objective is to evaluate the efficacy of MHMC in a two-arm, parallel cluster-randomized trial using mixed methods to compare MHMC (intervention) to usual contraceptive care (control) in 14 primary care clinics that provide contraception. We hypothesize that MHMC use will improve patient-reported quality of contraceptive decision-making and quality of contraceptive counseling from their clinicians, which will lead to increased contraceptive use and decreased contraceptive nonuse. The study aims are: Aim 1(Primary): To evaluate the impact of MHMC on contraceptive nonuse. Aim 2 (Secondary): To assess the impact of MHMC on adherence to the CDC Contraceptive Guidelines using mixed methods. Aim 3: (Exploratory): To quantitatively explore decisional quality and contraceptive counseling as mediators of the effects of MHMC on primary and secondary measures. The expected outcomes are new findings regarding the efficacy of a novel contraceptive decision tool for individuals with chronic conditions. This project will inform the development of scalable, person-centered contraceptive interventions for medically at-risk patients in real-world clinical settings.