September 2022

In This Issue: Women's Health Research

MyPath: A Patient-Centered, Web-Based Intervention to Improve Reproductive Planning for Women Veterans

Feature Article

Takeaway: "MyPath" is a novel online decision support tool designed to help users consider their reproductive goals, increase their knowledge about preconception health and contraception, and engage in shared decision-making with providers. Use of MyPath prior to VA primary care visits has the potential to enhance access to high-quality reproductive services in VA and improve reproductive health outcomes among women Veterans.

Compared to their civilian counterparts, women Veterans have higher rates of medical and mental health comorbidities that elevate their risk of poor pregnancy and birth outcomes. Proactive planning and optimization of physical and mental health prior to pregnancy can mitigate these risks, but nearly 40% of pregnancies among Veterans are unintended. Further, only 38% of women Veterans at risk of pregnancy report having contraceptive or preconception health discussions with their primary care provider in the past year. There is an urgent need for patient-centered, scalable interventions that can enhance delivery of VA reproductive planning services without creating burden on primary care providers.

This ongoing study (October 2020–September 2024) developed “MyPath,” a novel patient-facing, web-based decision support tool, to address gaps in reproductive planning services in VA primary care. MyPath’s objectives are to help women Veterans consider their reproductive goals, increase their reproductive knowledge, align contraceptive and pregnancy-timing decisions with their goals and health needs, and engage in shared decision-making with providers. In pilot testing, use of MyPath prior to clinic visits was highly acceptable to Veterans, and it increased the proportion of primary care visits addressing reproductive needs compared to usual care without increasing providers’ perceived workload. MyPath use was also associated with enhanced decision quality and effective contraception use. Specific aims of this study include:

• Compare the effect of using MyPath before primary care visits with traditional primary care visits to assess reproductive planning discussions with shared decision-making, patient-provider communication self-efficacy, and contraceptive decision quality.
• Test the longer-term effect of MyPath on contraceptive use, unintended pregnancy, and preconception health behaviors, comparing it to traditional care.
• Use quantitative and qualitative data collection to evaluate the MyPath implementation process, identifying implementation barriers and facilitators and intervention costs.

Methods

This study is a multi-site, randomized, controlled trial clustered at the provider level among women’s health primary care providers and their reproductive-aged Veteran patients. Researchers will assess the outcomes of a minimum of 456 women Veterans through telephone surveys post-visit and at three- and six-month follow-up and will collect information on barriers and facilitators to implementation using quantitative and qualitative methods, including interviews with Veterans, providers, and clinic leaders.

Findings

None yet available.

Anticipated Impact

MyPath addresses the urgent need for patient-centered, scalable interventions that can enhance delivery of VA reproductive services without creating additional burden on primary care providers, a need that has only become more pressing in the wake of recent abortion restrictions across much of the US. By empowering Veterans to make high-quality, informed decisions and engage with providers about their reproductive needs, MyPath has the potential to increase access to critical reproductive services including preconception and contraceptive care as well as reproductive health outcomes.

Principal Investigator: Lisa S. Callegari, MD, is an investigator with HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle and Denver, and an obstetrician-gynecologist at VA Puget Sound Health Care System in Seattle, WA.

Publications

Callegari L, Nelson K, Arterburn D, et al. Development and Pilot Testing of a Patient-Centered Web-Based Reproductive Decision Support Tool for Primary Care. Journal of General Internal Medicine. October 2021;36(10):2989–2999.

View study abstract