Improving contraceptive decision support for individuals with chronic conditions

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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.