Reproductive Planning for Women Veterans

女性退伍军人的生殖计划

• 批准号: 10172949
• 负责人: Lisa Susanne Callegari
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10172949
• 关键词: Address; Adherence; Age; Area; Benefits and Risks; Centers for Disease Control and Prevention (U.S.); Chronic; Conflict (Psychology); Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Data; Decision Aid; Decision Making; Development; Development Plans; Discipline of obstetrics; Doctor of Philosophy; Effectiveness; Evidence based intervention; Fellowship; Female; Foundations; Goals; Gynecologist; Gynecology; Health; Health Policy; Health Services; Health Services Research; Healthcare; Intervention; Interview; K-Series Research Career Programs; Knowledge; Life; Medical; Mental Depression; Mental Health; Mentorship; Methods; Obesity; Outcome; Pamphlets; Patients; Pilot Projects; Planned Pregnancy; Post-Traumatic Stress Disorders; Pregnancy; Pregnancy Outcome; Prevention Research; Primary Care Physician; Primary Health Care; Provider; Publishing; Qualitative Methods; Randomized Controlled Trials; Reproductive Health; Reproductive Health Services; Research; Research Methodology; Research Personnel; Risk; Science; Self Efficacy; Site; Structure; Supervision; Testing; Training; Uncertainty; Universities; Veterans; Washington; Woman; Women' s Health; Women' s Health Services; Work; adverse pregnancy outcome; arm; base; care providers; career; career development; child bearing; clinical practice; comorbidity; computerized; design; evidence base; evidence based guidelines; experience; fetal; genetic testing; health administration; health care service; implementation science; improved; innovation; interest; novel; novel strategies; patient oriented; preference; prenatal; prevent; primary care setting; primary outcome; professor; public health relevance; reproductive; satisfaction; service intervention; shared decision making; skills; sound; trial design; unintended pregnancy

 DESCRIPTION (provided by applicant): BACKGROUND. Lisa Callegari, MD, MPH is a postdoctoral HSR&D fellow at VA Puget Sound, a VA Staff Gynecologist, and an Assistant Professor of Obstetrics & Gynecology at the University of Washington. Since beginning her fellowship in 2012, Dr. Callegari's research has reflected her commitment to addressing the reproductive health care needs of women Veterans. The proposed Career Development Award (CDA-2) will provide Dr. Callegari with the in-depth training and skills she needs to succeed as an independent health services researcher designing and testing interventions to improve reproductive health care for women Veterans. CAREER DEVELOPMENT PLAN. Dr. Callegari's proposed CDA-2 will employ innovative strategies, including reproductive planning and shared decision making, to address gaps in reproductive health services for women Veterans. Compared to civilians, women Veterans have higher rates of chronic medical and mental health illness. These comorbidities, in combination with low rates of documented contraception among women Veterans, result in increased risks of unplanned pregnancy and poor pregnancy outcomes. Reproductive planning discussions promote proactive planning for pregnancy and contraceptive use, yet rarely occur in practice. One novel approach to guide reproductive planning discussions is use of a decision aid based on shared decision making principles. Decision aids improve decision quality by aligning patients' health care decisions with their values and preferences. While decision aids have been used effectively for other reproductive health decisions, no decision aid has been developed for reproductive planning. This CDA-2 proposes to design and test a reproductive planning decision aid intervention in VA primary care to improve reproductive planning decision quality and use of contraception. Specifically, this CDA-2 aims to: 1) determine reproductive planning decision needs among women Veterans and VA primary care physicians using qualitative methods; 2) develop, refine, and pilot test a reproductive planning decision aid; and 3) conduct a two-site randomized controlled trial (RCT) to test the effect of the decision aid on decision quality (decisional conflict, knowledge, decision self-efficacy and decision satisfaction) and contraceptive outcomes, compared to reproductive planning information only. Barriers and facilitators to implementation will also be investigated to facilitate downstream implementation if the intervention is found to be effective. The experience Dr. Callegari will gain in conducting the proposed research will be supplemented with structured training in qualitative methods, decision science and decision aid development, RCT design, and implementation science. Dr. Callegari will conduct her research under the guidance and supervision of her mentorship and consultant team, which includes experts in health services interventions (Karin Nelson, MD, MSHS), shared decision making and decision aides (David Arterburn, MD, MPH and Suzanne Brodney, PhD), reproductive health and qualitative methods (Sonya Borrero, MD, MS and Alison Hamilton, PhD, MPH), RCT designs (Gayle Reiber, PhD and Eleanor Bimla Schwarz, MD, MS), implementation science (Alison Hamilton, PhD, MPH), and reproductive health policy (Laurie Zephyrin, MD, MPH, MBA). IMPACT. This CDA-2 will enable Dr. Callegari to collaborate with leaders in VA women's health research and shared decision making to design and test a patient centered intervention that improves reproductive decisions and the quality of reproductive health care services. The research proposed, in combination with the mentorship and training plan, will facilitate Dr. Callegari's successful transition to an independent VA health services researcher with a career dedicated to advancing the health of women Veterans.

 描述（由申请人提供）： 背景 Lisa Callegari，医学博士、公共卫生硕士，是 VA Puget Sound 的 HSR&D 博士后研究员，也是 VA 妇科医生，也是华盛顿大学妇产科助理教授，自 2012 年开始担任研究员以来，Callegari 博士的研究已经反映出来。她致力于解决女性退伍军人的生殖保健需求，拟议的职业发展奖 (CDA-2) 将为 Callegari 博士提供深入的帮助。卡勒加里博士提出的 CDA-2 将采用创新策略，包括生殖规划和共同决策，与平民相比，女性退伍军人患有慢性医疗和精神健康疾病的比例较高，加上女性退伍军人中记录的避孕率较低，导致女性退伍军人的生殖健康服务差距增加。生殖计划讨论促进积极规划怀孕和避孕药具的使用，但在实践中很少出现一种指导生殖计划讨论的新方法是使用基于共同决策原则的决策辅助。通过使患者的医疗保健决策与其价值观和偏好保持一致来提高决策质量虽然决策辅助工具已有效用于其他生殖健康决策，但尚未开发用于生殖计划的决​​策辅助工具。退伍军人事务部初级保健中的生殖计划决策辅助干预具体而言，本 CDA-2 旨在：1) 使用定性方法确定女性退伍军人和退伍军人事务部初级保健医生的生殖计划决策需求；2) 开发、完善和试点测试生殖计划。规划决策援助；3) 进行两中心随机对照试验 (RCT)，以测试与生殖相比，决策援助对决策质量（决策冲突、知识、决策自我效能和决策满意度）和避孕结果的影响仅规划信息。如果存在以下情况，还将调查实施的障碍和促进因素，以促进下游实施： Callegari 博士在进行干预时将获得的经验是有效的。 拟议的研究将辅以定性方法、决策科学和决策辅助开发、RCT 设计和实施科学方面的结构化培训。Callegari 博士将在包括健康专家在内的导师和顾问团队的指导和监督下进行研究。服务干预（Karin Nelson，医学博士、MSHS）、共享决策和决策辅助（David Arterburn，医学博士、公共卫生硕士和 Suzanne Brodney 博士）、生殖健康和定性方法（Sonya Borrero，医学博士、MS 和 Alison Hamilton， CDA-2 将使 Callegari 博士能够与 VA 妇女健康研究和共同决策的领导者合作，设计和测试以患者为中心的干预措施，以改善生殖决策和生殖保健质量。拟议的研究与指导和培训计划相结合，将有助于卡莱加里博士成功过渡为独立的退伍军人事务部卫生服务研究员，其职业致力于促进女性退伍军人的健康。