Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling

Abstract

Objective We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Methods Drawing upon formative work around women’s preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Results Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool’s content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Conclusion Our decision support tool appears acceptable to women in the family planning setting. Practice implications Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial.

What consultation resources are available to support delivery of integrated sexual and reproductive health services? A scoping review

“…‘My Birth Control’ (MBC) (https://clinic.mybirthcontrol.org/),21 ‘Birth Control Navigator’ (BCN) (https://mydoctor.kaiserpermanente.org/ncal/birthcontrol/)22 and ‘My Contraception Tool’ (MCT) (https://www.brook.org.uk/our-services/category/my-contraception-tool)23 are all web-based decision aids. The first two were developed in the USA and the third in the UK.…”

“…Some pilot testing of MBC was undertaken as part of the development process. Using the tablet-based MBC decision aid prior to consultation, and then sharing the printout with the provider, was associated with greater client satisfaction, and most of the 41 women using it (96%) reported that it helped them choose a method 21…”

“…Incorporating the use of a contraceptive decision tool within integrated SRH services could be helpful in terms of improving client involvement and addressing some of the problems reported by Boog et al 9. Dehlendorf et al suggested that their tool (MBC) can help with the time constraints of a shared decision-making consultation 21…”

Society for Maternal-Fetal Medicine (SMFM) Consult Series #48: Immediate postpartum long-acting reversible contraception for women at high risk for medical complications

“…61 Additional shared decisionmaking tools are being developed that will increase future educational options for women and obstetric care providers, including integration of chronic health conditions into the recommendations. 62,63 We recommend that contraceptive counseling programs be patient-centered and provided in a shared decision-making framework to avoid coercion (BEST PRACTICE).…”

Preconception Care in the Veterans Health Administration

“…95 The tool includes newly developed content to help women consider their reproductive goals and to learn about fertility and preconception health, as well as an adapted version of a previously tested patient-centered contraceptive decision support module that helps women align their values and preferences with their contraceptive choices. 96 MyPath is designed to be used prior to a primary care visit, and provides women an opportunity to identify topics and questions they would like to discuss with their provider as they progress through the tool. These topics are then summarized at completion in a print-out that can be brought to the Veteran's visit to help them to communicate effectively with their providers and to promote patient-centered counseling.…”