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2023 HSR&D/QUERI National Conference Abstract

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1132 — Empowering Women Veterans with Mental illness to Address their Reproductive Health Needs

Lead/Presenter: Amy Drapalski,  VISN 5 Mental Illness Research, Education, and Clinical Center
All Authors: Drapalski AL (VISN 5 Mental Illness Research, Education, and Clinical Center), Lucksted A (VISN 5 Mental Illness Research, Education and Clinical Center, University of Maryland School of Medicine) Kreyenbuhl J (VISN 5 Mental Illness Research, Education and Clinical Center, University of Maryland School of Medicine) Brown CB (VISN 5 Mental Illness Research, Education and Clinical Center, University of Maryland School of Medicine) Miles-McLean H (VISN 5 Mental Illness Research, Education and Clinical Center)

Objectives:
Many women Veterans are of reproductive age, a substantial number of whom experience mental health concerns. Yet provider discussions with women Veterans who have mental illness regarding their reproductive health needs and desires are rare. The current study examined the feasibility, acceptability, and potential efficacy of a mental health-informed facilitated reproductive health action plan specifically designed for women Veterans with mental illness.

Methods:
This study is a pilot randomized trial of 40 women Veterans with a diagnosis of mental illness, of reproductive age (18-40), and receiving outpatient mental health services at the VA Maryland Health Care System. Participants were randomly assigned to receive either: 1) the facilitated reproductive health action planning intervention (one session where an individual works with a facilitator to clarify reproductive health desires and develop action steps to address them plus a brief telephone call one month later) or 2) receipt of written reproductive health planning materials. All participants completed a baseline and 2-month assessment. Participants in the reproductive health action planning intervention condition also completed a brief assessment at immediate post-intervention.

Results:
Feasibility/Acceptability: The reproductive health action planning intervention was feasible and acceptable. Nineteen of the 20 participants randomized to the reproductive health action planning intervention completed it. All who completed that session identified at least one reproductive health action step (Mean = 2.42; Mode = 3). These participants reported significantly greater satisfaction with services received when compared to those who receive written materials (control), t(31,82) = 2.23, p = .033. Participants in the intervention said that they appreciated having time and space to reflect on and articulate their reproductive health goals with a neutral supportive person and felt doing this helped them to recognize and clarify their personal reproductive health issues/questions and increased awareness of the importance of and confidence in their ability to take ownership of their reproductive health. Preliminary Outcomes: Participants in the reproductive health action planning intervention were more likely to complete a summary of their current reproductive health needs/desires than those in the control group (95% vs 11.8%, respectively). Eighty-two percent of the intervention group reported taking steps to address their reproductive health needs (e.g., talking with their psychiatrist about medication, talking with their women’s health provider regarding contraception) at the 2-month follow-up, versus 59% in the control group. There were no differences between conditions from baseline to 2-month follow-up in decisional self-efficacy, intention to take steps to address reproductive health needs, or attitudes towards reproductive health action planning, though pilot study analyses lacked statistical power to detect such effects.

Implications:
Mental health-informed reproductive health goal setting and action planning was feasible and acceptable to Women Veterans with mental health concerns and may empower them to take steps to address their reproductive health needs. Women Veterans found the interactive process and tailored nature of the intervention valuable.

Impacts:
This mental health-informed reproductive health action planning intervention has the potential to improve health outcomes for women Veterans with mental illness. Further evaluation of the efficacy and implementation of this intervention via a large randomized trial is needed.