Reproductive Health Clinics Improve Contraceptive Counseling via Decision Support Tool
Building a Custom Decision Support Tool for Person-Centered Contraceptive Care
Choosing the right birth control method is a very personal affair, and not always an easy decision.
The Person-Centered Reproductive Health Program (PCRHP), part of the Department of Family and Community Medicine at the University of California, San Francisco (UCSF), has been dedicated to understanding what patients really want regarding their contraception and contraceptive care, and finding creative ways to meet those needs for over 12 years.
Their mission: advance reproductive autonomy through rigorous research and carefully-designed programs that center people’s experiences and preferences for sexual and reproductive health and health care.
Studies show that patients want a birth control method that reflects their preferences, yet they are often dissatisfied with the counseling they receive from their doctors. Providers have limited time with patients, and are often hard-pressed to dispel common misconceptions about birth control. Too often, patients feel their concerns go unheard.
“People have such a need for compassionate, respectful, non-stigmatizing care, but often don’t have those needs met,” said Christine Dehlendorf, Director of the PCRHP and family physician at UCSF.
Dehlendorf saw an opportunity to bridge the gap between providers and patients. She envisioned an interactive decision support tool that would empower people to navigate their many birth control options with confidence and engage with their doctor through patient-centered contraceptive counseling - care that is respectful of their preferences, needs, and values.
Collaboration and User Testing Bear Fruit
When Dehlendorf met Jeremy Yun, founder of Nitid, she knew she had found a partner who could share in her vision and make the My Birth Control tool a reality.
“The Nitid team did an amazing job from the get-go of working with someone new to this particular use of technology,” said Dehlendorf. “Our roles were made transparent in a way that optimized our ability to achieve a high quality product.”
Nitid’s iterative Agile-based workflow let the researchers be part of the fun of the development process — without the pressure to define every requirement right off the bat. By testing new ideas quickly and often, they could identify and prioritize the most important features as the tool was being developed.
“Nitid really excels in their ability to bridge the content, design, and technical spheres and help us creatively think about solutions. They can step out of their tech roles and keep us focused on the big picture. I consider them an integral part of our team.” — Christine Dehlendorf, MD, MAS, Director
A custom-built content management system gave the researchers the flexibility to incorporate feedback autonomously and prepare the tool for its debut: a two-year academic study funded by the Patient-Centered Outcomes Research Institute with 758 patients and 28 providers participating from four San Francisco clinics.
Nitid also supported the translation of the tool into Spanish, enabling them to reach a wider patient pool.
Patients use My Birth Control on a computer, tablet, or mobile device immediately before seeing their doctor.
They can explore and compare birth control options based on what matters most to them, such as efficacy, how it’s used and side effects, without being directed toward any one method
Then, patients walk into their appointments prepared with a printout of their preferences and questions, facilitating a conversation with their provider that’s already off on the right foot.
IUD? Implant? What’s The Best Birth Control? It Depends!
The results of the study were thrilling: patients who used My Birth Control were significantly happier with the discussions they had with their providers, felt they knew all their contraceptive options, were more satisfied with information about side effects, and felt more confident in their final decisions.
My Birth Control also enabled providers to allocate time more efficiently and hone in on what really mattered to their patients.
“The tool allowed me to be more targeted in my counseling, as opposed to starting from scratch. I had a foundation to focus on folks’ preferences and what they wanted to talk about instead of what providers think clients should know,” shared one provider participating in the study.
“It’s really exciting to have produced something that improves the experience for women in the very intimate, complicated area of family planning. We have heard again and again how valuable this tool is. It makes people feel valued.” — Christine Dehlendorf, MD, MAS, Director
Conclusion - PCRHP’s Vision and Nitid’s App Development
The success of My Birth Control has increased the visibility of the PCRHP’s mission and has inspired new efforts to encourage a patient-centered approach to contraceptive counseling in different contexts. “The process of creating this tool helps me feel comfortable thinking about innovation in a practical way,” said Dehlendorf. Today, My Birth Control is being used in clinics across the country. Nitid continues to support adaptations of the tool, including a special version of My Birth Control for peripartum women, a mobile app for active military personnel and the integration of My Birth Control into a tool on HIV prevention in family planning settings.
“Nitid is deeply committed to our success because our projects make a huge impact on people’s lives and conscientiously address their needs. Nitid always goes above and beyond for us. I love working with their team.” — Whitney Wilson, MPH, Project Manager