Patient-Centered Support for Contraceptive Decision-Making

The impacts of unintended pregnancy include adverse maternal and infant outcomes for women
who continue their pregnancies, with higher rates of infant low birth weight, infant
mortality, and maternal mortality and morbidity for these pregnancies as compared to planned
pregnancies. In addition, children resulting from unplanned pregnancies have been found to be
more likely to experience developmental delay.

Over the past several decades, the proportion of unintended pregnancy in the United States
has remained stubbornly high at approximately 50%. Each year, one in 20 women of reproductive
age experiences an unintended pregnancy, and it is estimated that over half of women will
have an unintended pregnancy in their lifetime. This high rate of unintended pregnancy in the
United States places a heavy burden on both women and the health care system. A
disproportionate amount of this burden is experienced by minority women and women of lower
socioeconomic status. Given the high rate of unintended pregnancies in this country,
interventions designed to help women achieve their fertility goals could have a substantial
impact on their health outcomes and life course. In addition, identifying strategies that are
appropriate for use in high-risk, diverse populations could address disparities in women's
ability to plan their pregnancies.

The investigators propose a cluster randomized trial to investigate the effect of an
interactive, tablet-based contraceptive decision support tool that women will use immediately
prior to their contraceptive counseling visits. The goal of the tool is to facilitate shared
decision-making between the woman and her health care provider, with the ultimate goal of
helping the woman to choose a contraceptive method that is consistent with her values and
preferences, and is therefore best suited to helping her to avoid an unplanned pregnancy. The
tool will be available in both English and Spanish.

The investigators will measure the tool's effect on women's contraceptive continuation, as
well as on their experience of contraceptive counseling, measured both quantitatively and
qualitatively. In addition, the investigators will collect quantitative and qualitative data
to determine the impact of the implementation of this tool on the experiences of providers
and the clinics in which they work.

Inclusion Criteria:

Patients

- Women of reproductive age (15-45)

- Wish to discuss starting or changing a contraceptive method during their visit

- Speak, read, and understand English or Spanish (Note: for the pre- and
post-intervention audio recording phases, only patients who can speak, read, and
understand English easily will be enrolled.)

- History of sexual activity with men

Providers

- Provide contraceptive counseling in one of the participating clinics

- Plan to remain in job role for at least six months

Clinic staff

- Work at one of the participating clinics

- Had a job that included patient contact, but did not solely consist of family planning
counseling at the time of the implementation of the intervention

Exclusion Criteria:

Patients

- Previously enrolled in the study

- Previously used the decision support tool at the Women's Community Clinic in San
Francisco

- Are unable to get pregnant

- Appointment reason is for insertion of IUD or contraceptive implant

- Currently pregnant

- Desire pregnancy currently or in the next seven months (Note: The last criterion is
designed to ensure we will have limited numbers of women that will discontinue their
contraceptive methods during the study due to planning a pregnancy.)