Development of a Decision Support Tool for Contraception

Investigator: Christine Dehlendorf, MD, MAS
Sponsor: NIH National Institute of Child Health and Human Development

Location(s): United States


Women in the United States have extraordinarily high rates of unintended pregnancy, with poor and minority women disproportionately experiencing this adverse reproductive health outcome. This high rate of unintended pregnancy is caused in part by the under-use and misuse of effective contraceptive methods. As in the United States all non-barrier methods of contraception require consultation with a health care provider, clinicians who provide family planning have an opportunity to positively impact contraceptive use during contraceptive counseling. Little research has investigated this interaction, however, and there have been few attempts to use decision support in the family planning context. Dr. Dehlendorf's specific aims consist of analysis of her observational cohort study of contraceptive counseling to determine which aspects of counseling are associated with continuation of contraception and use of effective contraceptive methods (Aim 1) as well as to study the extent to which there are racial/ethnic disparities in contraceptive counseling (Aim 2); development of an interactive computerized contraceptive decision support tool for use in waiting rooms of clinics providing family planning services (Aim 3); and pilot testing of this tool in four clinics (Aim 4). The development and testing of this computerized contraceptive decision support tool will be informed by the field of implementation and dissemination science, so that if this intervention is found to be successful, it will be appropriate for widespread application. Approximately 50% of pregnancies in the United States are unintended, which results in poor maternal and child outcomes and contributes to the cycle of disadvantage experienced by racial and ethnic minorities. Improving the use of contraception has the potential to improve this important public health outcome and decrease reproductive disparities. Dr. Dehlendorf proposes the development and pilot testing of an interactive computerized decision support tool for contraception that is targeted towards the needs of diverse populations and is designed to increase the use of effective contraceptive methods, as well as decrease discontinuation of and improve adherence to these methods.