MyPath: A Patient-Centered Web-Based Intervention to Improve Reproductive Planning for Women Veterans

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Background: High rates of medical and mental health comorbidities result in elevated risks of poor maternal and neonatal outcomes among women Veterans compared to their civilian counterparts. Proactive planning and optimization of physical and mental health prior to pregnancy can mitigate these risks; however, nearly 40% of pregnancies among Veterans are unintended. National guidelines recommend routine delivery of patient-centered reproductive planning services in primary care, including assessment of reproductive goals followed by tailored contraceptive and/or preconception counseling, to reduce unintended pregnancy and improve pregnancy outcomes. Only 38% of women Veterans at risk of pregnancy, however, report having contraceptive or preconception health discussions with their primary care provider in the past year. We developed “MyPath,” a novel patient-facing web-based decision support tool, to address gaps in reproductive planning services in VA primary care. MyPath’s objectives are to help women Veterans consider their reproductive goals, increase their knowledge, align contraceptive and pregnancy timing decisions with their goals and health needs, and engage in shared decision making with providers. In pilot testing among 58 Veterans, use of MyPath prior to clinic visits was highly acceptable to Veterans and increased reproductive planning discussions compared to usual care without increasing providers’ perceived workload. MyPath use was also associated with increased decision quality and effective contraceptive use. Additional evaluation of MyPath in a pragmatic randomized trial is needed to assess effectiveness and collect implementation data. Significance/Impact: Patient-centered, scalable interventions that can enhance delivery of VA reproductive planning services without creating burden on primary care providers are urgently needed. The MyPath intervention leverages interactive patient-facing technology to empower women to make high-quality informed decisions and engage with providers about their reproductive health needs. If found to be successful, MyPath will lead to increased access to patient-centered reproductive planning services in VA primary care, addressing key HSR&D priorities, including access, primary care practice, women’s health, and whole health. Innovation: MyPath is the first online decision support tool designed to promote patient-centered reproductive planning services in primary care settings and to facilitate high-quality decisions aligned with reproductive goals. We will deliver the tool using the innovative strategy of partnering with the national VEText program to send the MyPath link to Veterans before appointments in an automated text message appointment reminder. Specific Aims: 1) Aim 1 will test the effect of the MyPath tool used before primary care visits on occurrence of reproductive planning discussions with shared decision making (primary outcome), patient-provider communication self-efficacy, and contraceptive decision quality, compared to usual care; 2) Aim 2 will test the longer-term effect of MyPath on contraceptive utilization, unintended pregnancy, and preconception health behaviors, compared to usual care; 3) Aim 3 is an implementation process evaluation, including quantitative and qualitative data collection to identify implementation barriers and facilitators and intervention costs. Methodology: This study is a 3-site hybrid type 1 pragmatic randomized controlled trial clustered at the provider level among 24 women’s health primary care providers and their reproductive-aged Veteran patients. We will assess outcomes among a minimum of 342 women Veterans by telephone surveys post-visit and at 3- and 6-month follow up. We will collect information on barriers and facilitators to implementation using quantitative and qualitative methods, including interviews with Veterans, providers, and clinic leaders. Next Steps/Implementation: The pragmatic design, in combination with strong operational partnerships, will enable rapid translation of research findings into practice if MyPath is found to be effective, with the ultimate objective of improving reproductive health outcomes and well-being among women Veterans nationally.