Use of Long-Acting Reversible Contraception

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PROJECT SUMMARY This K23 Award will provide Dr. Jenny K Rodriguez Francis support to: (1) gain a strong grounding in the science of adolescent contraceptive decision-making; (2) acquire advanced training in mixed-methods; and (3) learn and apply intervention development approaches to translate observational findings into communication- focused interventions. To achieve these goals Dr. Francis has assembled a mentoring team and advisory committee spanning multiple disciplines and institutions. Her primary mentor, Jasmin Tiro, PhD, has an excellent track record of research funding and mentorship and is an expert in adolescent health promotion, mixed-methods, intervention development and patient-provider communication. Dr. Francis’ next mentor is Susan L. Rosenthal, PhD, internationally renowned for adolescent-parent communication, acceptability of vaccines and microbicides, mixed-methods, faculty development and mentoring junior faculty to become independent investigators. Dr. Francis’ advisory committee includes: Simon Craddock Lee, PhD, MPH, an expert of implementation science and qualitative methods; Melanie A. Gold, DO, a well-published expert in LARC for adolescents; and Nancy Kelly, MD, MPH, a community pediatrician who partners closely with local schools. Problem: Texas has the fifth highest rate of teen births in the nation, with 33,144 females under age 20 years giving birth last year. LARC (intrauterine devices and contraceptive implants) is the first line method for contraception for adolescents/young adults; yet uptake is sub-optimal. Interventions designed to increase uptake have insufficiently considered the provider’s communication with adolescents and mothers to initiate contraception. Informed by Dr. Francis’ prior research assessing discordance between adolescent-parent dyads and her clinical experience, this mixed methodology proposal will examine these gaps in knowledge to enhance the development of interventions to foster LARC uptake. Specific Aims seek to (1) characterize medical providers’ (pediatric house staff) knowledge of and communication about LARC when discussing with adolescent-mother dyads; (2) describe adolescents’ and mothers’ beliefs about the optimal ways that providers can support contraceptive decision-making among adolescents. Methods: For aim 1, we will recruit 200 University of Texas pediatric house officers to complete a brief online questionnaire. For aim 2, we will evaluate adolescents’ beliefs, mother’s beliefs, and their dyadic interactions about their contraceptive counseling preferences through separate semi-structured interviews with 30 adolescents, 30 mothers and 30 adolescent-mother dyads (90 interviews total). Outcomes: These hypothesis-generating mixed-methods findings will provide a strong grounding in the science of adolescent contraceptive decision-making to design a future communication-focused intervention tool to support LARC uptake. Results could also improve subspecialists’ ability to prevent pregnancy among adolescents with chronic conditions. This study impacts provider communication, addresses maternal needs and supports adolescent contraception decision-making.