Patient perceptions of a decision support tool to assist with young women’s contraceptive choice

https://doi.org/10.1016/j.pec.2016.08.022Get rights and content

Highlights

  • We assessed patient perceptions of the value of a decision support tool (DST) for contraceptive decision-making.

  • Contraceptive DSTs have the potential to address patients’ informational needs.

  • Patients believe that contraceptive DSTs may serve as preparation for a clinical visit.

  • The DST was valuable when it allowed users to tailor information by contraceptive attributes deemed personally important.

Abstract

Objective

Contraceptive decision support tools (DSTs) have been suggested as a way to provide patient-centered contraceptive care, but little is known about the role they play in women’s decision-making. The aim of this study is to understand patients’ perceptions of the value of a contraceptive DST.

Methods

We conducted 21 semi-structured interviews with unmarried women aged 18–29 from an integrated health care system who viewed the DST. Thematic analysis was conducted to identify common themes in the participants’ experience.

Results

Four themes were identified: Informative; Narrowing down options; Tool vs. doctor; and Preparation for a clinical visit. In general, participants felt the tool was valuable because it provided them relevant information and facilitated their decision-making process by narrowing down contraceptive options. Participants felt the tool could prepare them for a visit with their health care provider by helping them identify questions for their provider, but also saw distinctions between the DST and what their provider could offer.

Conclusion

Contraceptive DSTs are valuable to their users when they include information on contraceptive attributes women deem important and allow for user-driven tailoring.

Practice implications

Contraceptive DSTs may address patient informational needs and can serve as a complement to provider counseling.

Introduction

Increasing and improving contraceptive use among women who want to avoid a pregnancy is critical to reducing unintended pregnancy in the United States (US). A patient-centered approach to providing contraceptive care is recommended by researchers and reproductive health organizations to improve quality of care and outcomes, including correct and consistent contraceptive use [1], [2], [3]. In the area of contraceptive services, a patient-centered approach involves tailoring care to a woman’s specific sexual history, reproductive goals, and attitudes towards and knowledge of contraceptive methods. It also involves assessing a woman’s individual story, including the unique circumstances and needs that affect her ability to access and use contraception effectively [2]. Contraceptive decision support tools (DSTs) have been suggested as a way to provide patient-centered contraceptive care and assist women with their contraceptive decision-making [4], [5], [6]. DSTs refer to a broad set of patient-centered interventions that can help patients when they are faced with a decision regarding their health and/or medical care [7], [8]. Their purpose is generally two-fold: 1) to provide patients information so they can assess available options and their possible outcomes, and, 2) to help patients make a decision that best accounts for their individual needs and values [9], [10]. An informed decision, one that aligns with an individual’s values, is seen as an important component of high quality and ethical health care [11]. Decision-making is different across health domains, and research suggests that women may desire more autonomy in their contraceptive decisions than in general health care [12].

Usually designed to complement, not replace, counseling from a health care provider, decision support tools are considered well suited for contraception because of the large number of available contraceptive methods and the highly individualized nature of contraceptive decision-making [4], [13]. Women choose contraceptive methods based on their knowledge, personal preferences and experiences, and evaluation of what would be the best fit for their current life situation [14]. DSTs have the potential to help women choose methods they are satisfied with, which is important as method dissatisfaction has been associated with inconsistent contraceptive method use and frequent contraceptive method switching, both of which are linked to a woman’s risk of unintended pregnancy [1]. Further, DSTs may also assist health care providers with contraceptive counseling given the challenges of providing accurate and comprehensive information in the limited time available during a typical clinical encounter. In the US, there is some evidence suggesting a positive role for decision support tools in impacting women’s contraceptive decision-making. A handful of studies have shown that use of a contraceptive DST is associated with greater knowledge about contraception overall and about specific methods, method choice, and satisfaction with method choice [15], [16], [17].

At present, a number of contraceptive DSTs are being developed and/or tested [18], [19], [20]. While DSTs may be an important component of contraceptive care services, a systematic assessment of how women use such tools to assist with their decision-making and their perceptions of whether and to what extent contraceptive DSTs are valuable is lacking. A better understanding of how DSTs may fit into the contraceptive decision-making process is needed to enhance available tools and can provide insight on how patients prefer to use these tools clinically. We conducted a qualitative study designed to assess patient perceptions of a recently designed contraceptive decision support tool for a large integrated health care delivery system. Our research objectives were: 1) to identify and describe the perceived value of the DST for women’s contraceptive decision-making, and 2) to determine patients’ preferences for using the tool in clinical settings.

Section snippets

Decision support tool description

The contraceptive decision support tool, called the “Birth Control Navigator”, was developed at Kaiser Permanente Northern California, an integrated health care delivery system that cares for approximately 650,000 women of reproductive age annually. The navigator, which resides on a publically-available website (https://mydoctor.kaiserpermanente.org/ncal/mdo/birthcontrol/index.htm), was developed as a preconception health quality improvement initiative by members of the women’s health,

Results

Participants ranged from 18 to 29 with a mean age of 22.4 years. The majority (86%) were non-Hispanic black or Hispanic/Latina. All participants were high school graduates and nearly all (95%) had completed at least some college. All women were unmarried, 4 lived with a partner, and approximately a third had children.

Four overarching themes that describe participants’ perceptions of the contraceptive decision support tool were identified. The first three themes captured perceptions of the value

Discussion

Overall, study participants drawn from an integrated health care delivery system who were young, unmarried and predominately of color, had a positive perception of the contraceptive decision support tool in this study, and nearly all believed using the tool would be useful to them if they were choosing a contraceptive method. Our study contributes to this small but growing body of literature by providing in-depth information on how DSTs can be useful to contraceptive decision-making, and

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