Impact of a Mobile Application for Contraceptive Decision Making

Background: The original study, “A Delphi Study to Determine Military Women’s Health Research Priorities,” used a rigorous method to establish fifteen topics that women’s health experts agreed upon as taking priority in future research. The topics were determined to be relevant to medical readiness and feasible in terms of generating research that would impact the healthcare of Servicewomen. Throughout the phases of the Delphi process, two of these topics, contraception and unintended pregnancy, consistently met criteria for being ranked in the top five priorities for research. The goal of this proposed study is to fill a gap in healthcare for active duty women by enhancing effective contraceptive care and thereby addressing a key preventive measure for unintended pregnancy in this population.
Specific Aims: The objective of this proposed study is to determine if patient use of the “Decide + Be Ready: A Birth Control Decision Aid” mobile application is associated with a woman’s satisfaction with her contraceptive method, contraception adherence, and avoidance of unintended pregnancy. A secondary objective is to determine the level of user engagement with the mobile application during the study.
Design: The Decide + Be Ready (D+BR) app is a decision aid that was designed to include information particularly relevant to military women when choosing a method of contraception. A pragmatic clinical trial (PCT) will be conducted to compare the use of D+BR to usual care as a way to help women make their choice of a contraceptive method. Participants will be introduced to the D+BR prior to a contraceptive counseling session with a provider so that they can explore the app, use features in the app, and share their resulting contraceptive preferences with the provider during the contraceptive counseling visit. The comparison group will have had routine care prior to the onset of this study that resulted in their contraceptive method decision.
Rationale: A PCT is designed to inform decision-makers (clients and providers) about the balance of the benefits and burdens of a health intervention. It can be conducted in the clinical setting with the population for whom the decision is relevant. In this study, the clients are women seeking contraceptive care, the health intervention is the D+BR, and the setting is the clinic where she seeks routine care. In a PCT, the outcomes of the intervention are compared to a real-word alternative, such as the usual care provided to women in the same clinic, and therefore focus on the effectiveness of an intervention. The benefits of a using a PCT design are that it contributes evidence for the realistic use of an intervention with less cost and time than that of a randomized controlled trial. This makes a PCT well suited for testing this low risk intervention that addresses a current critical knowledge gap in the healthcare of military women and has the potential for immediate implementation.
Methods: The intervention to be tested is the use of the D+BR app prior to a study visit with a provider for contraceptive counseling. The sample will consist of active duty women and spouses of active duty members who have received, or are scheduled for, reproductive healthcare at a military treatment facility. Outcome measures of satisfaction with their chosen contraceptive method, adherence to their chosen method, and the occurrence of pregnancy will be administered to both the intervention and comparison groups. Data collection will be conducted by online surveys administered by a nationally recognized research and data storage system (REDCap). The comparison group will complete the data collection at 7 months after their contraception was prescribed, and the intervention group at 4 and 7 months after their study visit.