Development and Pilot Testing of a Patient-Centered Web-Based Reproductive Decision Support Tool for Primary Care

Abstract

BACKGROUND: Patient-centered counseling to help women achieve their reproductive goals is an essential yet often absent component of primary care. OBJECTIVE: We developed and piloted MyPath, a novel web-based decision support tool integrating reproductive goals assessment, information about optimizing health before pregnancy, and contraceptive decision support, for use prior to primary care visits in the Veterans Administration (VA). DESIGN: We created MyPath using best practices for decision tool development, including a conceptual framework informed by theory and user-centered design with input from patients, providers, and scientific experts. We conducted a non-randomized pilot in two VA Women's Health primary care clinics. A control group (n = 28) was recruited prior to and intervention group (n = 30) recruited after introduction of MyPath into clinics. PARTICIPANTS: Women Veterans ages 18-44 with an upcoming visit scheduled with one of eight providers. INTERVENTIONS: After recruitment of controls, providers and staff received a brief introduction to MyPath. Patients scheduled to see providers in the intervention phase used MyPath on an iPad in the waiting room prior to their visit. MAIN MEASURES: Acceptability, feasibility, discussions about pregnancy and/or contraceptive needs, and contraceptive decision quality by a survey of participants and providers. KEY RESULTS: Nearly all participants who used MyPath reported they learned new information (97%) and would recommend it to other Veterans (93%). No providers reported that MyPath significantly increased workload. A greater proportion of intervention participants reported having discussions about reproductive needs in their visit compared to controls (93% vs 68%; p = 0.02). Intervention participants also experienced greater increases in pre-/ post-visit knowledge and communication self-efficacy and a trend towards greater reduction in contraceptive decision conflict compared to controls. CONCLUSIONS: MyPath was highly acceptable to women, increased the proportion of primary care visits addressing reproductive needs, and improved decision quality without increasing providers' perceived workload. A larger randomized evaluation of effectiveness is warranted.

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States

“…In a nonrandomized pilot of the final prototype (control group, n=28; intervention group, n=30), we found that a greater proportion of intervention participants reported having discussions about their reproductive needs in the visit compared to controls (93% vs 68%; P=.02) [34]. A multisite hybrid effectiveness-implementation randomized controlled trial is currently ongoing to evaluate the impact of the text message-delivered MyPath on various person-centered and clinical outcomes, with the goal of ultimately scaling the intervention nationally within VA if found to be effective.…”

“…Veterans capable of pregnancy who use VA Health Care services are a highly diverse population, with nearly half identifying as racial or ethnic minoritized groups [32], and face elevated risks of adverse pregnancy and birth outcomes compared to their civilian counterparts due to a higher prevalence of medical, mental health, and psychosocial factors [33]. Drawing on our first principle (Principle 1: Interdisciplinary stakeholder-inclusive teams), MyPath development was informed by formative qualitative work to understand veterans' preferences and needs [25] and followed user-centered design principles, guided by patient, provider, and scientific expert input [34]. Designed to be used prior to primary care visits, MyPath empowers patients by helping them clarify and share their reproductive goals with their primary care providers, augmenting their knowledge, and building self-efficacy in communicating about their reproductive needs (Principle 2: Facilitating a patient-centered approach).…”

Reproductive Life Planning in Adolescents

“…Depending on the woman's responses, Gabby works with them over time to meet her reproductive and general health goals. Building on the PATH tool, 25 26 the online MyPath reproductive goals assessment 32 was designed to be used prior to primary care visits. Tested in women Veterans in the United States, MyPath also included information about reproductive health and contraception.…”

Women’s Health Provider Perspectives on Reproductive Services Provision in the Veterans Health Administration

“…Another consideration is the use of patient-facing reproductive decision-support tools that can be deployed ahead of an appointment to educate and identify issues to address in a comprehensive primary care visit. 27…”