The aim of this Mentored Patient-Oriented Research Career Development Award (K23) application is to provide a period of mentored research and career development activities, which will assist me in my long-term goal of becoming an independent investigator in the area of women's contraceptive decision making. I propose an innovative research project using a web-based contraceptive decision aid to help inform women's decision- making processes. My proposed career development plan will allow me to meet my following short term goals: pursue continued training in research methodology;acquire new skills in qualitative research methods, shared decision making, and decision analysis;and acquire skills to design and conduct randomized clinical trials. These skills will be essentially in learning to effectively plan, implement, and analyze studies in contraceptive decision making. I will collaborate closely with mentors experienced in patient-oriented research to facilitate completion of this project. Washington University School of Medicine has excellent clinical research infrastructure and the diverse and multidisciplinary academic community fosters scholarly investigation. Additionally, there are resources required to succeed in this project are available to me including Masters level courses in research methods. Unintended pregnancy continues to be a significant public health problem in the United States despite the fact that more than 60% of women currently use contraception. Contraceptive counseling is an important mediator of contraceptive selection and use, but there is little data to indicate what constitutes effective contraceptive counseling. An intervention which improves patient education and counseling has the potential to improve contraceptive use. Patient decision aids have been successfully employed in other areas of healthcare decision making and have been shown to result in increased knowledge, more realistic expectations, and decreased decisional conflict. In this innovative study, I propose to evaluate, refine, and test a web-based contraceptive decision aid.
My specific aims are to: 1) refine a contraceptive decision aid and evaluate ease of use, understandability, and ability to clarify the values and preferences that influence women's contraceptive decisions;2) build an algorithm within the decision aid that effectively narrows the recommended contraceptive options to methods that reflect the woman's unique contraceptive preferences;and 3) compare the effectiveness of a contraceptive decision aid on reducing decisional conflict compared to women undergoing usual contraceptive counseling in a randomized clinical trial. This project is novel in its focus on a web-based contraceptive decision aid which incorporates women's values and preferences in contraceptive decision making. Additionally, the decision aid will incorporate an algorithm which will recommend contraceptive methods based on these values and preferences. We will evaluate the primary outcome of decisional conflict, which has been used in multiple clinical trials of patient decision aids to measure the effectiveness of decision aids. If successful, this intervention will improve contraceptive use by improving contraceptive knowledge, satisfaction with contraceptive method chosen, and decreasing decisional conflict. This has the potential to significantly impact the rates of unintended pregnancy.

Public Health Relevance

Unintended pregnancy is a common problem in the United States. There are multiple methods of reversible contraception available;however, it is not clear how women decide which method to choose. This career development award proposal will evaluate, refine and test a decision aid to help women effectively choose contraceptive methods.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HD070979-02
Application #
8443391
Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Kaufman, Steven
Project Start
2012-03-08
Project End
2015-01-31
Budget Start
2013-02-01
Budget End
2014-01-31
Support Year
2
Fiscal Year
2013
Total Cost
$122,442
Indirect Cost
$9,070
Name
Washington University
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Min, Jaspur; Buckel, Christina; Secura, Gina M et al. (2015) Performance of a checklist to exclude pregnancy at the time of contraceptive initiation among women with a negative urine pregnancy test. Contraception 91:80-4
Diedrich, Justin T; Desai, Sanyukta; Zhao, Qiuhong et al. (2015) Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. Am J Obstet Gynecol 212:50.e1-8
McNicholas, Colleen; Madden, Tessa; Secura, Gina et al. (2014) The contraceptive CHOICE project round up: what we did and what we learned. Clin Obstet Gynecol 57:635-43
Madden, Tessa; McNicholas, Colleen; Zhao, Qiuhong et al. (2014) Association of age and parity with intrauterine device expulsion. Obstet Gynecol 124:718-26
Xu, Hanna; Eisenberg, David L; Madden, Tessa et al. (2014) Medical contraindications in women seeking combined hormonal contraception. Am J Obstet Gynecol 210:210.e1-5
Secura, Gina M; Madden, Tessa; McNicholas, Colleen et al. (2014) Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med 371:1316-23
Grunloh, Danielle S; Casner, Teya; Secura, Gina M et al. (2013) Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use. Obstet Gynecol 122:1214-21
Vickery, Zevidah; Madden, Tessa; Zhao, Qiuhong et al. (2013) Weight change at 12 months in users of three progestin-only contraceptive methods. Contraception 88:503-8
Nault, Ashley M; Peipert, Jeffrey F; Zhao, Qiuhong et al. (2013) Validity of perceived weight gain in women using long-acting reversible contraception and depot medroxyprogesterone acetate. Am J Obstet Gynecol 208:48.e1-8
Allsworth, Jenifer E; Secura, Gina M; Zhao, Qiuhong et al. (2013) The impact of emotional, physical, and sexual abuse on contraceptive method selection and discontinuation. Am J Public Health 103:1857-64

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