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Manaf ZA, Rosli MHM, Noor NM, Jamil NA, Mazri FH, Shahar S. Exploring dietitians' views on digital nutrition educational tools in Malaysia: a qualitative study. Nutr Res Pract 2024; 18:294-307. [PMID: 38584814 PMCID: PMC10995771 DOI: 10.4162/nrp.2024.18.2.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/30/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND/OBJECTIVES Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians' perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.
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Affiliation(s)
- Zahara Abdul Manaf
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Mohd Hafiz Mohd Rosli
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
- Dietetics Unit, Kapar Health Clinic, Ministry of Health, 42200 Klang, Malaysia
| | - Norhayati Mohd Noor
- Pusat Genius @ Pintar, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia
| | - Nor Aini Jamil
- Dietetic Program and Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Fatin Hanani Mazri
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Meekers D, Elkins A, Obozekhai V. Tools for patient-centred family planning counselling: A scoping review. J Glob Health 2024; 14:04038. [PMID: 38303671 PMCID: PMC10846870 DOI: 10.7189/jogh.14.04038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background The focus of family planning counselling is gradually shifting from the tiered-effectiveness model to patient-centred counselling. Although tools exist that aim to make family planning counselling more patient-oriented without increasing the provider's workload, they are not widely used. This scoping review aims to address this by identifying key tools to make family planning care more patient-centred, reviewing the domains of patient-centred care they address, and identifying gaps in the evidence base. Methods We systematically searched PubMed and SCOPUS for documents on 'patient-centred family planning counselling or support' published between 2013 and 2022. Eligibility criteria included discussion of: 1) strategies for providing patient-centred care; 2) interventions using a patient-centred approach; or 3) the impact of patient-centred approaches. We identified tools for patient-centred care, and mapped them against an existing framework of the main domains of patient-centred care. We reported the available evidence of the impact on those tools. Results Our scoping review is based on 33 documents. We identified six tools for increasing the patient-centeredness of family planning counselling. None of the tools addressed all domains of patient-centred care. Evidence about the impact of these tools remains scarce. Although there is some evidence about the acceptability of the tools, key evidence gaps include the effect of the tools on quality of care and family planning outcomes. Conclusions Family planning implementers should be aware that existing tools differ in the extent to which they address key domains of patient-centred family planning counselling. There is a need for further research on factors that may deter providers from adopting these tools. A larger evidence base is needed to permit a future systematic review to determine the effect of these tools on family planning outcomes, such as method adoption and continuation.
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Affiliation(s)
- Dominique Meekers
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Aaron Elkins
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Vivian Obozekhai
- DKT International, A. G. Leventis Building, Iddo House, Lagos Mainland, Lagos, Nigeria
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Athey S, Bergstrom K, Hadad V, Jamison JC, Özler B, Parisotto L, Sama JD. Can personalized digital counseling improve consumer search for modern contraceptive methods? SCIENCE ADVANCES 2023; 9:eadg4420. [PMID: 37801502 PMCID: PMC10558117 DOI: 10.1126/sciadv.adg4420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
This paper analyzes a randomized controlled trial of a personalized digital counseling intervention addressing informational constraints and choice architecture, cross-randomized with discounts for long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs). The counseling intervention encourages shared decision-making (SDM) using a tablet-based app, which provides a tailored ranking of modern methods to each client according to their elicited needs and preferences. Take-up of LARCs in the status quo regime at full price was 11%, which increased to 28% with discounts. SDM roughly tripled the share of clients adopting a LARC at full price to 35%, and discounts had no incremental impact in this group. Neither intervention affected the take-up of short-acting methods, such as the pill. Consistent with theoretical models of consumer search, SDM clients discussed more methods in depth, which led to higher adoption rates for second- or lower-ranked LARCs. Our findings suggest that low-cost individualized recommendations can potentially be as effective in increasing unfamiliar technology adoption as providing large subsidies.
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Affiliation(s)
- Susan Athey
- Graduate School of Business, Stanford University, Stanford, CA 94305, USA
| | - Katy Bergstrom
- Department of Economics, Tulane University, New Orleans, LA 70118, USA
| | | | - Julian C. Jamison
- Business School, University of Exeter, Exeter EX44PU, UK
- Global Priorities Institute, Oxford University, Oxford OX2 0DJ, UK
| | - Berk Özler
- Development Research Group, The World Bank, Washington DC, DC 20433, USA
| | - Luca Parisotto
- Department of Economics, Bocconi University, Milano, MI 20100, Italy
| | - Julius Dohbit Sama
- Department of Gynaecology-Obstetrics, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Yaoundé, Cameroon
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Kus LH, Paul R, Nigaglioni Rivera A, Zeal C, Madden T. Improvement in contraceptive knowledge after using an online educational resource. Contraception 2023; 126:110095. [PMID: 37331460 PMCID: PMC10760799 DOI: 10.1016/j.contraception.2023.110095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES To measure the change in contraceptive knowledge after interaction with a web-based contraception education resource in an online cohort of potential users. STUDY DESIGN We conducted a cross-sectional online survey of reproductive-aged, biologically female respondents using Amazon Mechanical Turk. Respondents provided demographic characteristics and responded to 32 contraceptive knowledge questions. We assessed contraceptive knowledge before and after interaction with the resource and compared the number of correct answers using Wilcoxon signed-rank test. We used univariate and multivariable logistic regression to identify respondent characteristics associated with an increase in the number of correct answers. We calculated System Usability Scale scores to assess ease of use. RESULTS A convenience sample of 789 respondents were included in our analysis. Prior to resource use, respondents had a median of 17/32 correct contraceptive knowledge responses (interquartile range [IQR] 12-22). The number of correct answers increased to 21/32 (IQR 12-26, p < 0.001) after viewing the resource; 556 (70.5%) had an increase contraceptive knowledge. In adjusted analyses, respondents who were never married (adjusted odds ratio [aOR] 1.47, 95% CI 1.01-2.15), or thought decisions about birth control should be made by themselves (aOR 1.95, 95% CI 1.17-3.26) or in conjunction with a clinician (aOR 2.09, 95% CI 1.20-3.64) were more likely to have an increase in contraceptive knowledge. Respondents reported a median system usability score of 70 out of 100 (IQR 50-82.5). CONCLUSIONS These results support the effectiveness and usability of this online contraception education resource among this sample of online respondents. The educational resource could effectively augment contraceptive counseling in the clinical setting. IMPLICATIONS Use of an online contraception education resource improved contraceptive knowledge among reproductive-age users.
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Affiliation(s)
- Lauren H Kus
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Rachel Paul
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Adriana Nigaglioni Rivera
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Carley Zeal
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics and Gynecology, Mercy Health, Beloit, WI, United States
| | - Tessa Madden
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States.
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Zeal C, Paul R, Dorsey M, Politi MC, Madden T. Young women's preferences for contraceptive education & development of an online educational resource. PEC INNOVATION 2022; 1:100046. [PMID: 37213738 PMCID: PMC10194227 DOI: 10.1016/j.pecinn.2022.100046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 05/23/2023]
Abstract
Objectives To explore young women's preferences for contraceptive education to inform the development of an educational resource and to pilot test the resource with patients and clinicians. Methods We performed a mixed-methods study to elicit preferences for contraceptive educational resources among patients, develop an online resource, and pilot test the resource with clinicians and patients to assess feasibility, systems usability, and contraceptive knowledge. Results Forty-one women aged 16-29 completed in-depth interviews: they preferred an online format which was recommended by a clinician, presented contraceptive methods in order of effectiveness, and contained information from experts and experiences from individual users. We adapted an existing website (bedsider.org) to create an online educational resource. Thirty clinicians and thirty patients completed surveys after use. System Usability Scale scores were high among patients (median [IQR]: 80 [72-86]) and clinicians (84 [75-90]). Patients answered more contraceptive knowledge questions correctly after interacting with the resource (9.9±2.7 vs 12.0±2.8, p<0.001). Conclusions We developed a contraceptive educational resource incorporating end-user feedback that was highly usable and increased patients' contraceptive knowledge. Future research should assess effectiveness and scalability among a larger sample of patients. Innovation This contraceptive educational resource can supplement clinician counseling to increase patient contraceptive knowledge.
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Affiliation(s)
- Carley Zeal
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Mercy Health – Beloit, Beloit, WI, USA
| | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Megan Dorsey
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mary C. Politi
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Corresponding author at: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005, St. Louis, MO 63108, USA.
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Goueth RC, Maki KG, Babatunde A, Eden KB, Darney BG. Effects of technology-based contraceptive decision aids: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:705-713.e9. [PMID: 35779590 PMCID: PMC9800645 DOI: 10.1016/j.ajog.2022.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/22/2022] [Accepted: 06/16/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of the effects of technology-based decision aids on contraceptive use, continuation, and patient-reported and decision-making outcomes. DATA SOURCES A systematic search was conducted in OVID MEDLINE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, Embase, PsycINFO, and SocINDEX databases from January 2005 to April 2022. Eligible references from a concurrent systematic review evaluating contraceptive care were also included for review. STUDY ELIGIBILITY CRITERIA Studies were included if a contraceptive decision aid was technology-based (ie, mobile/tablet application, web, or computer-based) and assessed contraceptive use and/or continuation or patient-reported outcomes (knowledge, self-efficacy, feasibility/acceptability/usability, decisional conflict). The protocol was registered under the International Prospective Register of Systematic Reviews (CRD42021240755). METHODS Three reviewers independently performed data abstraction and quality appraisal. Dichotomous outcomes (use and continuation) were evaluated with an odds ratio, whereas continuous outcomes (knowledge and self-efficacy) were evaluated with the mean difference. Subgroup analyses were performed for the mode of delivery (mobile and tablet applications vs web and computer-based) and follow-up time (immediate vs >1 month). RESULTS This review included 18 studies evaluating 21 decision aids. Overall, there were higher odds of contraceptive use and/or continuation among decision aid users compared with controls (odds ratio, 1.27; 95% confidence interval, [1.05-1.55]). Use of computer and web-based decision aids was associated with higher odds of contraceptive use and/or continuation (odds ratio, 1.36; 95% confidence interval, [1.08-1.72]) than mobile and tablet decision aids (odds ratio, 1.27; 95% confidence interval, [0.83-1.94]). Decision aid users also had statistically significant higher self-efficacy scores (mean difference, 0.09; 95% confidence interval, [0.05-0.13]), and knowledge scores (mean difference, 0.04; 95% confidence interval, [0.01-0.07]), with immediate measurement of knowledge having higher retention than measurement after 1 month. Other outcomes were evaluated descriptively (eg, feasibility, applicability, decisional conflict) but had little evidence to support a definite conclusion. Overall, the review provided moderate-level evidence for contraceptive use and continuation, knowledge, and self-efficacy. CONCLUSION The use of technology-based contraceptive decision aids to support contraceptive decision-making has positive effects on contraceptive use and continuation, knowledge, and self-efficacy. There was insufficient evidence to support a conclusion about effects on other decision-making outcomes.
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Affiliation(s)
- Rose C Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
| | - Kristin G Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ayo Babatunde
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR; Pacific Northwest Evidence-based Practice Center, Portland, OR
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University -Portland State University, Portland, OR; Instituto Nacional de Salud Publica, Center for Population Health Research, Cuernavaca, Mexico
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Yam EA, Namukonda E, McClair T, Souidi S, Chelwa N, Muntalima N, Mbizvo M, Bellows B. Developing and Testing a Chatbot to Integrate HIV Education Into Family Planning Clinic Waiting Areas in Lusaka, Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100721. [PMID: 36316140 PMCID: PMC9622293 DOI: 10.9745/ghsp-d-21-00721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia. CHATBOT DEVELOPMENT We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform. CHATBOT USER TEST Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP. CONCLUSIONS Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services.
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Affiliation(s)
| | | | | | - Samir Souidi
- International Rescue Committee, New York, NY, USA
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Dev R, Kohler P, Begnel E, Achwoka D, McGrath CJ, Pintye J, Muthigani W, Singa B, Gondi J, Ng'ang'a L, Langat A, John-Stewart G, Kinuthia J, Drake AL. Contraceptive counseling experiences among women attending HIV care and treatment centers: A national survey in Kenya. Contraception 2021; 104:139-146. [PMID: 33894251 PMCID: PMC8286320 DOI: 10.1016/j.contraception.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To characterize contraceptive counseling experiences among women living with HIV (WLWH) receiving HIV care in Kenya. STUDY DESIGN Sexually active, WLWH aged 15 to 49 years were purposively sampled from 109 high-volume HIV Care and Treatment Centers in Kenya between June and September 2016. Cross-sectional surveys were administered to enroll women on a tablet using Open Data Kit. Poisson generalized linear regression models adjusted for facility-level clustering were used to examine cofactors for receiving family planning (FP) counseling with a provider. RESULTS Overall, 4805 WLWH were enrolled, 60% reported they received FP counseling during the last year, 72% of whom reported they were counseled about benefits of birth spacing and limiting. Most women who received FP counseling were married (64%) and discussed FP with their partner (78%). Use of FP in the last month (adjusted Prevalence Ratio [aPR] = 1.74, 95% confidence interval [CI]: 1.41-2.15, p < 0.001), desire for children in >2 years (aPR = 1.18, 95% CI: 1.09-1.28, p < 0.001), and concern about contraceptive side-effects (aPR = 1.13, 95% CI 1.02-1.25, p < 0.05) were significantly higher among WLWH who received FP counseling compared to those that did not. CONCLUSIONS Over one-third of WLWH did not receiving FP counseling with an HIV care provider during the last year, and counseling was more commonly reported among women who were using FP or desired children in >2 years. IMPLICATIONS There are missed opportunities for FP counseling in HIV care. FP integration in HIV care could improve FP access and birth spacing or limiting among WLWH.
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Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Emily Begnel
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Dunstan Achwoka
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Christine J McGrath
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Jillian Pintye
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Wangui Muthigani
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Joel Gondi
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Lucy Ng'ang'a
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Agnes Langat
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Grace John-Stewart
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Research and Programs, Kenyatta Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States.
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Evaluation of a computerized contraceptive decision aid: A randomized controlled trial. Contraception 2020; 102:339-345. [PMID: 32771369 DOI: 10.1016/j.contraception.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a contraceptive decision aid in reducing decisional conflict among women seeking reversible contraception. STUDY DESIGN We conducted a randomized trial of a computer-based decision aid compared to a control group for women presenting for reversible contraception at two clinics affiliated with an academic medical center. The primary outcome was change in decisional conflict, measured before and after the healthcare visit using the validated Decisional Conflict Scale. We hypothesized the decision aid would reduce the decisional conflict score by 10 points on a 100-point scale (0 = no conflict, 100 = high conflict) compared to the control group. Secondary outcomes included contraceptive method chosen and satisfaction with the healthcare visit. RESULTS We enrolled and randomized 253 women, and 241 had complete data for our primary outcome. Overall, pre-visit decisional conflict scores were low, reflecting low levels of decisional conflict in our sample; median score 15 (range 0-80) in the decision aid and 10 (0-85) in the control group (p = 0.45). Both groups had a similar reduction in median decisional conflict after the healthcare visit: -10 (-80 to 25) and -10 (-60 to 5) in the decision aid and control groups respectively (p = 0.99). Choice of contraception (p = 0.23) and satisfaction with healthcare provider (p = 0.79) also did not differ by study group. CONCLUSIONS Decisional conflict around contraception was low in both groups at baseline. Use of a computerized contraceptive decision aid did not reduce decisional conflict, alter method choice, or impact satisfaction compared to the control group among women choosing reversible contraception. IMPLICATIONS Use of a computerized contraceptive decision aid did not reduce decisional conflict or alter method choice compared to the control group among women choosing reversible contraception. Future studies could focus on testing the decision aid in different clinical settings, especially where barriers to providing comprehensive contraceptive counseling exist.
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The family planning quotient and reproductive life index (FPQ/RepLI) tool: a solution for family planning, reproductive life planning and contraception counseling. Reprod Health 2019; 16:125. [PMID: 31426800 PMCID: PMC6700782 DOI: 10.1186/s12978-019-0787-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective Access to comprehensive and culturally appropriate reproductive life planning is essential to women’s health. Although many strategies and tools exist, few are designed for longitudinal use or provide visual aids. Our objective is to present the Family Planning Quotient (FPQ) and Reproductive Life Index (RepLI) (FPQ/RepLI) tool we created to facilitate the discussion of family planning and reproductive life goals between patients and providers and to provide a summary our evaluation of the tool. This tool was developed as a response to the Centers for Disease Control and Prevention’s charge of developing a tool that could help facilitate reproductive life planning by giving the patient a better understanding of their reproductive goals and trajectory. Study design This cross-sectional evaluation of our tool took place with patients and providers at an urban, public hospital in Chicago. Patients spoke with a health educator about their sexual, gynecological, and obstetric history to complete the FPQ/RepLI tool. Our primary objective was to measure the proportion of women who indicated the tool was helpful and that they would use it to track their reproductive goals. Main outcome measures Patients and providers completed an evaluation survey rating their satisfaction with the tool. Survey responses were summarized using frequencies and percentages. Results During the study, 790 patients completed the evaluation.. Most patients (n = 725, 91.9%) agreed that the tool was helpful and that they would use it to track their reproductive goals. Fifty-five (83.5%) providers agreed that there is a need for reproductive health tools in clinical practice. Conclusions Most agreed that the tool helped the patient communicate goals, aided in educating about contraception, and facilitated the discussion and decision-making process about available contraceptives. The tool gives patients a resource for family and reproductive goal planning. Broad dissemination amongst other medical specialties beyond obstetrics and gynecology may make reproductive life planning accessible to more women.
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Electronic interventions for changing knowledge, attitudes or practices regarding contraception: a systematic review. Contraception 2019; 100:10-25. [PMID: 30998928 DOI: 10.1016/j.contraception.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/22/2019] [Accepted: 04/05/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We conducted a systematic review of the effectiveness of electronic health education tools designed to improve knowledge, attitudes or practices related to contraception. METHODS Eligible studies consisted of English-language reports published after 1990 that quantified the effects of an electronic intervention on any of the following outcomes: contraceptive knowledge, attitude toward contraceptives, contraceptive method choice, contraceptive use or pregnancy. We conducted a systematic search of multiple electronic databases including MEDLINE, Global Health, Academic Search Complete, Cochrane Library and Grey Literature Report. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting. RESULTS Of 143 full-text reports assessed for eligibility, 13 studies described in 16 reports were eligible for inclusion. Of six studies that evaluated video interventions, all were randomized controlled trials, and four reported any statistically significant difference between intervention groups on knowledge, method choice or pregnancy. Of seven studies of interactive computer applications, five were randomized controlled trials, and two were nonrandomized comparison studies. Four of these seven studies found statistically significant difference between study arms in contraceptive knowledge, attitudes or contraceptive use. While most differences favored the intervention, effects were generally limited with respect to clinical relevance and the number of outcomes impacted. CONCLUSIONS Published assessments of electronic interventions for improving contraception-related outcomes are limited. Formal evaluations of interventions and publication of results are needed to determine the efficacy of electronic tools for contraceptive education and guide development of new interventions.
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Baldwin MK, Overcarsh P, Patel A, Zimmerman L, Edelman A. Pregnancy intention screening tools: a randomized trial to assess perceived helpfulness with communication about reproductive goals. Contracept Reprod Med 2018; 3:21. [PMID: 30574355 PMCID: PMC6296099 DOI: 10.1186/s40834-018-0074-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Federal and clinical guidelines support integration of reproductive life planning in the care of female patients to aid in the reduction of unplanned pregnancies. A multitude of tools have been created to help in the counseling component, but further research is needed regarding how and whether they facilitate patient-provider communication. Research We performed a randomized controlled trial to evaluate if patients report whether a detailed or simple pregnancy intention screening tool is helpful for communication of reproductive life plans. We compared a novel reproductive counseling aid, the Family Planning Quotient (FPQ), to a simple tool based on the One Key Question® (OKQ). Providers also evaluated whether they thought the tool used at the visit was helpful. We randomized 93 patients to complete a survey including identical demographic questions and either the FPQ or OKQ reproductive counseling tool. We did not provide further instructions to either the patient or provider. Following the visits, we collected 84 subject evaluations and 79 provider evaluations. A similar proportion of subjects using either reproductive counseling tool found it helpful in communicating their reproductive life plans to their providers (approximately 66%), but there was no difference between the two tools studied. Less than half of providers reported that the FPQ tool was helpful (FPQ: 16/43, 37.2% versus OKQ: 18/36, 50%; p = 0.25). Conclusion Two-thirds of patients reported either a detailed or simple reproductive plan screening tool was helpful to facilitate communication with their provider, but only half of providers found either tool helpful. Use of reproductive screening tools should be followed by patient-centered counseling to help patients meet their reproductive life goals.
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Affiliation(s)
- Maureen K Baldwin
- 1Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Patricia Overcarsh
- 1Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Ashlesha Patel
- 2Division of Family Planning, Department of Obstetrics and Gynecology, John H Stroger Jr., Hospital of Cook County, 1969 Ogden Ave, Chicago, IL 60612 USA
| | - Lindsay Zimmerman
- 2Division of Family Planning, Department of Obstetrics and Gynecology, John H Stroger Jr., Hospital of Cook County, 1969 Ogden Ave, Chicago, IL 60612 USA
| | - Alison Edelman
- 1Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
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Hooiveld T, Molenaar JM, van der Heijde CM, Meijman FJ, Groen TP, Vonk P. End-user involvement in developing and field testing an online contraceptive decision aid. SAGE Open Med 2018; 6:2050312118809462. [PMID: 30455946 PMCID: PMC6236861 DOI: 10.1177/2050312118809462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/26/2018] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Decision aids in the field of healthcare contribute to informed decision making. To increase the usefulness and effectiveness of decision aids, it is important to involve end-users in the development of these tools. This article reports on the development of an online contraceptive decision aid. METHODS An exploratory, qualitative study was conducted in the Netherlands between 2014 and 2016. The development process of the decision aid consisted of six steps and included a needs assessment and field test. Interviews were conducted with 17 female students. RESULTS The needs assessment provided information on the preferred content and structure of a contraceptive decision aid and guided the development of the online contraceptive decision aid prototype. Participants had an overall positive impression of the decision aid prototype during the field test. Minor revisions were made based on participants' feedback. Participants expected that the decision aid would positively contribute to decision making by increasing knowledge and awareness regarding the available contraceptive methods and their features and attributes, and by opening up to other options than the known methods. CONCLUSION The developed contraceptive decision aid can contribute to better informed decision making and consultation preparation. Involving end-users in development seems valuable to adapt decision aids to specific needs and to identify in what way a decision aid influences decision making.
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Affiliation(s)
- Truus Hooiveld
- Department of Research, Development and
Prevention, Student Health Service, University of Amsterdam, Amsterdam, The
Netherlands
| | - Joyce M Molenaar
- Department of Research, Development and
Prevention, Student Health Service, University of Amsterdam, Amsterdam, The
Netherlands
| | - Claudia M van der Heijde
- Department of Research, Development and
Prevention, Student Health Service, University of Amsterdam, Amsterdam, The
Netherlands
| | - Frans J Meijman
- Department of General Practice &
Elderly Care Medicine, VUmc School of Medical Sciences, Amsterdam, The
Netherlands
| | - Theo P Groen
- Section of Biology and Society, VU
University, Amsterdam, The Netherlands
| | - Peter Vonk
- Department of General Practice, Student
Health Service, University of Amsterdam, Amsterdam, The Netherlands
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Koo HP, Wilson EK, Minnis AM. A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:45-53. [PMID: 28222240 DOI: 10.1363/psrh.12016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 05/05/2023]
Abstract
CONTEXT Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. METHODS A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. RESULTS Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. CONCLUSIONS Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy.
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Affiliation(s)
- Helen P Koo
- senior research demographer and consultant, RTI International, Research Triangle Park, NC
| | - Ellen K Wilson
- research health scientist, RTI International, Research Triangle Park, NC
| | - Alexandra M Minnis
- senior research epidemiologist with the Women's Global Health Imperative, RTI International, San Francisco
- associate professor, School of Public Health, University of California, Berkeley
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Marshall C, Nuru-Jeter A, Guendelman S, Mauldon J, Raine-Bennett T. Patient perceptions of a decision support tool to assist with young women's contraceptive choice. PATIENT EDUCATION AND COUNSELING 2017; 100:343-348. [PMID: 27578270 DOI: 10.1016/j.pec.2016.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/16/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
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.
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Affiliation(s)
- Cassondra Marshall
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Amani Nuru-Jeter
- School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA 94720, USA
| | - Sylvia Guendelman
- School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA 94720, USA
| | - Jane Mauldon
- Richard and Rhonda Goldman School of Public Policy, University of California, Berkeley, 2607 Hearst Avenue, Berkeley, CA 94720, USA
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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Patient-Centered Contraceptive Counseling: Evidence to Inform Practice. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0139-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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