A digital tool to support pregnancy planning, preparation and prevention

“要么你在避孕，要么你怀孕了，中间这一步就不见了。”在我们的定性研究中，一位女性在描述我们试图填补的空白时如是说。我们正在开发一种数字工具，以支持育龄人群了解他们的怀孕偏好，并制定和实施生殖生活计划；帮助预防意外怀孕，改善怀孕计划、准备和结果，并减少孕产妇健康方面的不平等。英国近一半的怀孕是计划外怀孕，在医疗保健环境中，围绕怀孕计划的讨论并不是例行公事；这导致错过了优化孕前健康的机会。目前，十分之九以上的妇女怀孕时至少有一个可改变的风险因素；这被广泛认为是造成产妇死亡率和发病率的主要因素，特别是导致黑人和少数族裔群体结局不平等的主要原因。与此同时，在过去的几年里，在英国获得避孕措施也变得越来越困难，再加上对避孕的不满和停止避孕，导致了意外怀孕，这与死产、早产、低出生体重、新生儿死亡和产后抑郁的风险增加有关。在育龄人群中，有一种未得到满足和明确表示的需求，即支持他们发展和实现他们的生育目标。此外，市场上缺乏一种能够支持育龄人口、确定其生育意向并制定生殖生活计划的工具。我们的应用程序在一个地方独一无二地结合了怀孕预防和准备需求。我们广泛的定性和定量研究(对3000人进行了100小时的采访和调查数据)促使我们决定创建一个数字工具，而这款应用的内容、外观和感觉都是严格共同开发的，这意味着整个工具是以证据为基础的，以用户为中心。我们已经共同开发了这款应用的最低可行产品，它可以引导用户回答一系列关于他们的生殖偏好的问题。我们的算法基于经过验证的避免怀孕的愿望，并通过广泛的数据分析得出，准确地预测了怀孕的可能性。我们已经将这一算法数字化，并将其整合到应用程序中，并将其映射到生育意图类型(FIT)，为用户创建了一个简单易用的工具，向用户展示他们的适合度、怀孕可能性和量身定做的建议(参见支持数据1)。我们计划通过构建交互式生殖生活计划来进一步开发这款应用程序，将用户从简单地识别他们的偏好转变为采取行动实现这些偏好。这款应用程序将通过问题和提示的动态路径引导用户；支持个人反思自己的生育目标。他们的回答将塑造所提出的问题，鼓励更深入的参与。化身将被用来提高可用性和参与度，以及内置的可选待办事项和提醒，以帮助用户实现他们的目标。我们将使用行为变化的COM-B模型来指导开发；这种以人为中心的方法可以提高自主性和自我效能，并使医疗保健专业人员能够更好地支持个人实现他们的目标。一旦开发完成，我们将在相关设置(包括教育和医疗设置)中试点该应用程序，以获得初步数据。在项目结束时，我们将有一个完全共同开发的应用程序，将准备好实施。

"You're either on contraception or you're pregnant, and that middle step is missing". So said one woman in our qualitative research, describing the gap that we are attempting to fill. We are developing a digital tool to support people of reproductive age to understand their pregnancy preferences and to develop and implement a reproductive life plan; helping prevent unplanned pregnancies, improve pregnancy planning, preparations and outcomes, and reduce inequalities in maternal health.Nearly half of all pregnancies in the UK are unplanned, and discussions around pregnancy planning are not routine in healthcare settings; this results in missed opportunities to optimise health before pregnancy. Currently, over nine out of ten women conceive with at least one modifiable risk factor; this is widely recognised to be a major contributor to maternal mortality and morbidity, and particularly to the inequalities in outcomes for black and minority ethnic groups. Meanwhile, it has also become increasingly difficult to access contraception in the UK over the last few years which, when coupled with dissatisfaction and discontinuation of contraception, contributes to unplanned pregnancies, which are associated with increased risks of stillbirth, preterm birth, low birthweight, neonatal mortality and postnatal depression.There is an unmet and expressed need among people of reproductive age for support to develop and meet their reproductive goals. Furthermore there is a gap in the market for a tool that can support people of reproductive age identify their fertility intentions and develop a reproductive life plan. Our app uniquely combines both pregnancy prevention and preparation needs, in one place. Our extensive qualitative and quantitative research (>100 hours of interviews and survey data from >3000 people) has informed our decision to create a digital tool, while the content, look and feel of the app has been rigorously co-developed, meaning the whole tool is evidence-based and user centred.We have already co-developed a minimum viable product of the app which guides users through a series of questions about their reproductive preferences. Our algorithm, based on the validated Desire to Avoid Pregnancy Scale and derived through extensive data analysis, accurately predicts the probability of pregnancy. We have digitised this algorithm, incorporated it into the app, and mapped it to the Fertility Intention Typology (FIT), creating a simple-to-use tool for users who are presented with their FIT, likelihood of pregnancy, and tailored advice (see Supporting data 1).We plan to further develop this app by building in an interactive reproductive life plan, taking the user from simply identifying their preferences to taking actions to achieve them. The app will guide users through a dynamic pathway of questions and prompts; supporting the individual to reflect on their own reproductive goals. Their answers will shape the questions presented, encouraging deeper engagement. Avatars will be used to improve usability and engagement, along with in-built optional to-do items and reminders to help users achieve their goals.We will use the COM-B model of behaviour change to guide the development; this person-centred approach can increase autonomy and self-efficacy and will enable healthcare professionals to better support individuals to meet their aims. Once developed, we will pilot the app in relevant settings (including education and healthcare settings) to gain preliminary data. At project end we will have a fully co-developed app which will be ready for implementation.