Department of Family & Community Medicine, University of California, San Francisco; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco; Department of Epidemiology & Biostatistics, University of California, San Francisco.
Department of Family & Community Medicine, University of California, San Francisco.
Am J Obstet Gynecol. 2019 Jun;220(6):565.e1-565.e12. doi: 10.1016/j.ajog.2019.02.015. Epub 2019 Feb 11.
Research suggests the need for improvement in the patient-centeredness and comprehensiveness of contraceptive counseling. My Birth Control is a tablet-based decision support tool designed to improve women's experience of contraceptive counseling and to help them select contraceptive methods that are consistent with their values and preferences.
The objective of this study was to evaluate the effect of My Birth Control on contraceptive continuation, experience of contraceptive care, and decision quality.
Using a cluster randomized design, randomized at the provider level, patient participants interested in starting or changing contraception interacted with My Birth Control before their family planning visit (intervention) or received usual care (control). A postvisit survey assessed experience of care method satisfaction, decision quality, and contraceptive knowledge. Surveys at 4 and 7 months assessed the primary outcome of contraceptive continuation, along with method use, satisfaction, and unintended pregnancy. Mixed-effects logistic regression models with multiple imputation for missing data were used to examine the effect of treatment assignment.
Twenty-eight providers participated and 758 patients enrolled between December 5, 2014, and February 5, 2016. Participants were racially/ethnically diverse; less than a quarter self-identified as white. No effect was found on 7-month continuation (56.6% and 59.6% for intervention and control group respectively, odds ratio, 0.89; 95% confidence interval, 0.65-1.22). However, assignment to the intervention group increased reporting of the greatest Interpersonal Quality of Family Planning score (66.0% vs 57.4%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), the greatest scores on the informed decision and uncertainty subscales of the Decisional Conflict Scale (50.5% vs 43.2%, odds ratio, 1.34; 95% confidence interval, 1.0-1.80 and 41.6% vs 33.3%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), and greater knowledge.
My Birth Control had no effect on contraceptive continuation. The intervention did enhance the experience of contraceptive counseling and informed decision making, as well as contraceptive knowledge., The intervention's effect on patient experience is important, particularly given the personal nature of contraceptive decision making and the social and historical context of family planning care.
研究表明，需要提高避孕咨询的以患者为中心和全面性。My Birth Control 是一款基于平板电脑的决策支持工具，旨在改善女性避孕咨询体验，并帮助她们选择符合自身价值观和偏好的避孕方法。
本研究旨在评估 My Birth Control 对避孕续用率、避孕护理体验和决策质量的影响。
使用集群随机设计，按提供者进行随机分组，有兴趣开始或改变避孕方法的患者参与者在计划生育就诊前（干预组）或接受常规护理（对照组）时与 My Birth Control 互动。就诊后调查评估护理方法满意度、决策质量和避孕知识。在 4 个月和 7 个月时评估避孕续用率的主要结局，以及方法使用、满意度和意外怀孕情况。使用混合效应逻辑回归模型和多重插补处理缺失数据，以检验处理分配的效果。
28 名提供者参与，2014 年 12 月 5 日至 2016 年 2 月 5 日期间有 758 名患者入组。参与者种族/民族多样，不到四分之一的人自认为是白人。在 7 个月的续用率上没有发现效果（干预组为 56.6%，对照组为 59.6%，比值比为 0.89；95%置信区间为 0.65-1.22）。然而，分配到干预组的患者报告最大的计划生育人际质量评分更高（66.0%比 57.4%，比值比为 1.45；95%置信区间为 1.03-2.05），知情决策和决策冲突量表不确定性分量表的评分更高（50.5%比 43.2%，比值比为 1.34；95%置信区间为 1.0-1.80 和 41.6%比 33.3%，比值比为 1.45；95%置信区间为 1.03-2.05），知识也更多。
My Birth Control 对避孕续用率没有影响。该干预确实增强了避孕咨询和知情决策的体验，以及避孕知识。该干预对患者体验的影响很重要，特别是考虑到避孕决策的个人性质以及计划生育护理的社会和历史背景。
