Title: Improving Contraceptive Counseling for Immigrant Latinas: Development and Testing of a Point-of- Care Shared Decision-Making Tool for Providers The PI, Diana N. Carvajal, MD MPH, is an Assistant Professor of Family Medicine at the University of Mary- land School of Medicine with a clinical and research focus on improving family planning outcomes for vulnera- ble populations. Her long-term goal is to be an independent researcher and leader in women?s reproductive health, focused on decreasing rates of unintended pregnancy and associated adverse outcomes for vulnerable populations. To that end, the proposed project will develop and test an ethnically-responsive contraceptive counseling tool to improve healthcare providers? shared decision-making (SDM) skills with Latina immigrants. Many contextual factors including immigration experiences, language barriers, access to care, and partner in- volvement, can influence the contraceptive decision-making and use of Latina immigrants. My recent work in Baltimore, MD has also found that Latina immigrants perceive poor communication with providers about con- traceptive priorities as negatively affecting their decision-making. Patient-provider communication impacts contraceptive use and adherence, and the provision of patient-centered communication during contraceptive counseling is consistent with an SDM approach. SDM provides a model to support patient decisions in a way that is informed by and responds to important patient-identified contextual factors. Few support tools focus on improving providers? SDM skills during contraceptive counseling, and none are ethnically-responsive to Latina immigrants. Therefore, I propose to build upon established relationships with the immigrant Latino communi- ty and with providers in Baltimore to achieve three specific aims with help from my mentors who are experts in family planning, patient-provider communication, and intervention development and evaluation. I will: 1) conduct a qualitative study of providers to elicit their perspectives about: a) current counseling practices; b) barriers to use of SDM; c) immigrant Latinas? contraceptive preferences and factors for these; and d) the design of an SDM POC tool; 2) measure provider use and patient experience of SDM during counseling visits and patient outcomes; 3) develop and test the usability and acceptability of a provider-targeted POC tool to facilitate SDM with Latina Immigrants. With specific expertise and guidance from my mentors and advisors, I propose a career development plan to achieve: 1) expansion of my qualitative research skills (Drs. Zambrana and DeForge); 2) expertise in SDM and its measurement (Drs. Barnet, Duggan, and Dehlendorf); 3) skills in the development and testing of clinical tools; and 4) skills in advanced research techniques to establish psychometric properties of instruments (Drs. Barnet and Duggan). This training award will prepare me to submit an R01 to test the tool?s effectiveness in a large-scale RCT ?with the potential to decrease unintended pregnancy and associated health disparities.
The empowerment of women and families to prevent unintended pregnancy and to plan births is a critical public health goal. A contraceptive shared decision-making tool for providers who work with vulnerable populations such as poor, immigrant Latinas has the potential to decrease rates of unintended pregnancy and associated health disparities. This study advances NICHD?s mission that every person is born healthy and wanted and that women suffer no harmful effects related to reproduction.
