JMIR Publications

ABSTRACT

Background:

Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and piloted an interactive web-based decision aid – Healthy Sex Choices – designed to support diverse young adults with their contraceptive decision making.

Objective:

The aim of this pilot study was to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians.

Methods:

We conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed the development of the decision aid. All panelists participated in semi-structured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot, five participants from ResearchMatch tested the tool and suggested improvements. We conducted a non-randomized pre/post study design in a Planned Parenthood clinic. We started with a purposive sample to obtain a minimum of 20% participants of color, then moved to a random recruitment method. Thirty-six participants who were aged 18-24 attending a contraceptive related visit filled out a pre-intervention survey and then used the decision aid before meeting with their clinician. Participants then filled out a post-intervention survey and optionally participated in a semi-structured interview (n=5) about their experience with the decision aid. Outcomes measured included acceptability, patient knowledge, and decisional conflict. We used paired t-tests to compare knowledge and decisional conflict pre- and post-intervention and used the standard deviations to assess differences within the decisional conflict subscales (i.e., uncertainty, informed, values clarity, support). An exploratory analysis on race/ethnicity differences was conducted for contraceptive knowledge and decisional conflict scores.

Results:

Participants were satisfied with the tool, rating the acceptability as “good”. Interviews revealed that participants found the tool made contraceptive decision making easier and would recommend the tool to a family member or friend. Participants had a non-significant change in knowledge scores (52.6% pre vs. 45.4% post, p=0.99). Decisional conflict scores significantly decreased (16.1 pre vs. 2.78 post, p < 0.001) with the informed subscale (patients feeling more informed) having the greatest decline after using the tool (23.1 vs. 4.7; SD=27.1). Most patients (81%) intended to use the same contraceptive method pre and post-intervention.

Conclusions:

Participants found Healthy Sex Choices to be acceptable and it reduced decisional conflict. The development and pilot phases of this study created a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations.