Project Abstract Short interpregnancy intervals (IPIs) pose risks for mothers and newborns alike, including preterm birth, low birth weight, small for gestational age, and placental abruption. IPIs of less than 12 months increase risk of neonatal death. Short IPIs are a source of major health disparities, and disproportionately affect African American adolescents. Postpartum contraception significantly, and perhaps uniquely, lengthens IPIs. Increasingly, policy barriers have been removed to make highly effective methods such as the intrauterine device and implants available. Yet, tremendous caution is needed given a history of contraceptive coercion: the concern is not to underuse or overuse these methods. In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm, highlighting the potential for a patient-centered care model to improve quality of care. Within this model, care is respectful and responsive to individual patient preferences, needs, and values. Patients are actively engaged in making decisions about their health care and continuously informed and educated on all the care options. Patient-centered care has been demonstrated to improve health care utilization, decrease costs, and improve outcomes for a wide range of clinical outcomes, including family planning. Yet, low income, minority populations often demonstrate low levels of patient activation. Tailored, multisystem interventions addressing the patients and providers are needed to support immediate postpartum contraceptive initiation that reflects the needs and values of each patient. The proposed STTR project will directly address the need for innovative solutions to reproductive health disparities in IPIs among adolescents. The Patient Centered Postpartum Contraception Toolkit-- ?PC2? will be a novel toolkit for patients, providers, and administrators designed with pregnant and postpartum adolescents using the Information, Motivation, and Behavioral Skills Model and novel methodologies such as human-centered design and lean startup techniques. For this Phase I prototype, the introductory module on ?activating? patients to prevent short IPIs will be developed and tested with African American adolescents. ACCESS, the largest FQHC network in the Midwest, will be the implementation partner. .

R41HD090825

2017-09-13

2018-03-31