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Appl Clin Inform 2023; 14(01): 153-163
DOI: 10.1055/a-2004-2304
Research Article

Evaluation of an Online Decision Aid for Selection of Contraceptive Methods

Molly Redman
1   College of Health Solutions, Arizona State University, Tempe, Arizona, United States
,
Jennifer Brian
2   Barrett, The Honors College, Arizona State University, Tempe, Arizona, United States
,
Dongwen Wang
1   College of Health Solutions, Arizona State University, Tempe, Arizona, United States
› Author Affiliations
Funding The ASU Barrett Honors College provided funding support for this honors thesis research by the first author.
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Abstract

Objectives Knowledge gaps in contraceptives led to their low adoption rates and misuse in young women. The existing online contraception decision aids missed certain decision factors deemed important to college-aged women and did not consistently provide clear and accurate recommendations. To address the needs of young women and the limitations in current tools, we developed a prototype contraception decision aid, My Contraceptive Choice (MCC). This article reports an evaluation study of the MCC tool.

Methods We conducted a mixed methods study: (1) to assess MCC's usefulness and usability through an online survey and a follow-up focus group, and (2) to provide a quantitative examination on the recommendations generated by MCC to match with individual user's needs and preferences through simulated test cases.

Results The survey of 150 college-aged women showed very positive responses (reflecting personal preferences, 75%; helping people learn more about birth control methods, 88%; easy to navigate, 91%). The follow-up focus group of 10 survey participants reconfirmed most findings from the survey and provided detailed feedback on certain system functions, such as the inclusion of an important decision factor of weight gain and the efficient hybrid design to integrate the customized recommendations with the side-by-side comparison of all contraceptive methods. Simulated test cases showed that the MCC tool achieved an accuracy of 72% in addressing user preferences and an accuracy of 72% in satisfying user needs, which were significantly better than the existing Planned Parenthood tool.

Conclusion The initial evaluations suggest that the MCC tool has achieved good levels of usefulness, usability, and appropriate recommendations to address user needs and preferences. Future research is required to assess the performance of the MCC tool in naturalistic settings and to examine the generalizability of the findings to other user populations.


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Keywords

contraception - decision making - weight gain - women - focus group - survey

Background and Significance

Birth control, also referred to as contraception, is any medication or device to prevent pregnancy.[1] Popular contraceptive methods include condoms, birth control pills, and intrauterine devices (IUDs). Certain methods are very effective in preventing pregnancy, but others are less so due to frequent user error. Beyond pregnancy prevention, some contraceptives provide additional health benefits,[2] including reducing hormonal acne, decreasing the symptoms from health conditions such as polycystic ovary syndrome and endometriosis,[3] [4] and managing the side effects of menstruation.[3] Yet other methods may come at an increased risk of depression, anxiety, and high blood pressure.[5] [6]

Previous studies have shown that lack of knowledge of highly efficient contraceptive methods results in their low adoption rates and misuse, especially in young women.[3] Selecting the right birth control method is a complex and challenging process due to the many factors to consider, such as: (1) cost—not all methods are easily accessible with health insurance plans[3] [7]; (2) the experiences of peers—many young women are more comfortable using a method if they have heard positive remarks from their close friends and family;[7] and (3) “forgettability”—the users do not wish to maintain the contraceptive method every day.[3]

To assist in selecting the appropriate contraceptive methods, online decision aids could be potentially useful tools. Online decision aids integrate various resources for patient education, provide support in complex decision making, and generate customized recommendations based on a specific user's needs and preferences.[3] [7] [8] These tools have been used in a wide variety of health problems to assist patients and health care consumers.[9] [10] [11] [12]

Existing Online Tools for Contraception Decision Aids and Their Limitations

There are two popular online contraceptive decision aids—the Planned Parenthood Birth Control Quiz[13] and the Bedsider Comparison Matrix.[14] The Planned Parenthood tool consists of a short quiz that evaluates a user's preferences, lifestyle, and opinions on certain methods. Based on a user's response, the tool recommends three birth control methods. Additional educational resources are provided for those interested in learning more about these recommendations. The Bedsider Comparison Matrix is a large grid that allows a user to compare and contrast many different contraceptive methods at the same time. The feature “Build Your Own” allows for comparison of up to three different methods selected by the user.

In a previous study, we assessed the accuracy and usability of the tools provided by Planned Parenthood and Bedsider.[15] We found a number of limitations: (1) missing certain decision factors deemed important to young women, such as weight gain and prior experience of using a specific contraceptive method,[15] from both tools; (2) usability issues, such as heavy reliance on recall when using symbols to denote contraceptives in the Bedsider matrix and no possibility to go back to correct a mistake in the Planned Parenthood quiz[15] [16] [17] [18] [19]; and (3) inaccurate recommendations by the Planned Parenthood quiz—not reflecting the needs or preferences of the user.[15]


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Development of My Contraception Choice Tool

We developed a new birth control decision aid, My Contraceptive Choice (MCC),[17] [18] aiming to fill the knowledge gaps among the young women in selecting appropriate contraceptive methods,[20] [21] to accommodate their unique needs in contraceptive decision making, and to address the issues identified in the two existing contraceptive patient decision aids. We designed the MCC tool based on the Centers for Disease Control and Prevention guidelines, additional medical literatures, the previous study on the two existing online tools, and the findings from a focus group.[2] [3] [5] [7] [17] [18] [21] [22] [23] [24] MCC focused on a list of contraceptive methods relevant to the target population, including condom,[25] copper IUD,[26] hormonal IUD,[26] ring,[27] mini pill,[28] combination pill,[28] implant,[29] patch,[30] shot,[31] and fertility awareness methods.[32] The functions of the MCC tool included three main sections: (1) a quiz to gather user preferences and prior experiences for specific contraceptive methods; (2) a side-by-side comparison of all contraceptive methods, with the customized recommendations highlighted; and (3) additional resources for educational purposes.

For the quiz in Section (1), we designed four distinct pages to solicit user needs and preferences. On the Personal Preferences page, a user can express priorities on cost effectiveness, preventing pregnancy, managing periods and their side effects, and (low) possibility of weight gain. On the User Experiences page, a user can indicate specific methods used before and prior experiences with them. On the Medical History page, a user can list health conditions that may interfere with use of specific contraceptive methods. On the Additional Factors page, a user can specify further preferences such as comfortableness with insertion of a foreign body in vagina, level of hormones, and frequency of maintenance.

We developed a numerical scoring system to rank the contraceptive methods based on a user's answers to the questions on the above topics. After completing data collection, the MCC tool recommends three contraceptive methods with the top scores.

Immediately following the quiz, a user is directed to Section (2) of the tool, which provides a matrix of all contraceptive methods for side-by-side comparison, with the top three recommendations customized to the user highlighted in blue color. The columns of this table include all the contraceptive methods, and the rows list the major factors considered by young women when selecting a birth control method.

In Section (3), detailed information pertaining to each of the top recommended contraceptive methods is presented. The last function of the MCC tool provides additional resources related to all the contraceptive methods, with links to external resources.

Screenshots of the three sections of the MCC tool are shown in [Fig. 1]. The system features of MCC when compared with the two other birth control decision aids are summarized in [Table 1]. Additional details can be found in our previous publication.[17] [18]

Zoom Image
Fig. 1 The three sections of the MCC tool: (1) a quiz to gather user preferences and prior experiences (only showing page 1 of 4), (2) a side-by-side comparison of all contraceptive methods, and (3) additional resources for patient education. MCC, My Contraceptive Choice.
Table 1

The system features of MCC when compared with the other birth control decision aids

MCC

Planned Parenthood

Bedsider

Decision factors

Cost effectiveness

Yes

Yes

Yes

Prevents pregnancy

Yes

Yes

Yes

Managing periods and side effects

Yes

Yes

Yes

(Low) possibility of weight gain

Yes

No

No

Previous experience with methods

Yes

No

No

Comfortable with insertion of a foreign body in the vagina?

Yes

Yes

No

Level of hormones

Yes

Yes

Yes

Frequency to maintain method

Yes

No

Yes

Presentation of results

Customized recommendations

Yes

Yes

No

Comparison matrix

Yes

No

Yes

Additional resources

Patient education

Yes

Yes

Yes

Link-out resources (clinic, pharmacy, online shop, etc.)

Yes

Yes

Yes

Abbreviation: MCC, My Contraceptive Choice.



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Objectives

We report an evaluative study in this article to assess the MCC tool in terms of: (1) generating appropriate recommendations that are customized to an individual user's needs and preferences and (2) usability and usefulness. This research serves as an important step in a series of work for development and evaluation of a patient decision aid to select appropriate contraceptive methods.


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Methods

We designed a mixed methods study with three components: (1) a qualitative assessment on usefulness and usability of the MCC tool via a survey; (2) an in-depth understanding of user experience and feedback through a focus group; and (3) a quantitative evaluation on the customized recommendations generated by the MCC tool through case simulations. The Arizona State University (ASU) Institutional Review Board (IRB) approved this study.

Survey

As the first step of the evaluation, we conducted a survey to assess the perceived usefulness and usability of the MCC tool. For this purpose, we solicited the potential participants from the female students at ASU who were between 18 and 24 years old. We obtained consent from 150 recruited participants. Five randomly selected participants received a $20 Amazon gift card as compensation for their time.

We performed the survey online through Google Forms. Participants were sent a link to the online survey, which included the MCC tool and the instruction to complete the quiz. After a participant used the MCC tool, she could proceed to answer the 17 survey questions. These questions focused on: (1) user background, such as demographics and experiences in using contraception methods and related online tools; (2) usefulness of the tool, including satisfaction of customized recommendations; (3) usability of the tool; (4) general impression and impact of the tool; and (5) an open question at the end to solicit additional comments. The questions in categories (2), (3), and (4) used a five-point Likert scale from strongly disagree to strongly agree. For data analysis, we profiled the users based on their background. For each question related to usefulness, usability, and general impression/impact, we analyzed the participant feedback by grouping them into positive (strongly agree and agree) versus nonpositive (neutral, disagree, and strongly disagree) responses. We conducted a co-variate analysis on race, ethnicity, age groups, prior use of a birth control method, and prior use of a contraception-related online tool to examine the potential differences. For the open question at the end, we analyzed the comments for overall connotation (good/bad) and categorized them into themes of accuracy and usability.


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Focus Group

To obtain in-depth understanding of user experience on MCC, we conducted an online focus group through Zoom. For this purpose, we randomly selected 10 participants from the survey who expressed interests in the follow-up focus group and obtained consent. Each participant received a $35 Amazon gift card as compensation for the 2-hour focus group session.

We organized the focus group as semi-structured interviews. To guide the discussion, we prepared a series of questions for the participants, including: (1) their opinions on specific aspects of the MCC tool in terms of usefulness and usability; (2) their satisfaction with the customized recommendations generated by the MCC tool; and (3) the comparison of the MCC tool to the resources provided by Planned Parenthood and Bedsider. The first author served as the moderator. The focus group session was recorded and transcribed. To start the conversation, a participant was selected to share her thoughts; others then joined the discussion. The participants could bring in topics other than the original questions. When there was a disagreement, the moderator made notes of how many participants landed on each side. For data analysis, we reviewed the transcripts and identified the points that were heavily agreed or disagreed upon. These findings were categorized by different themes, including satisfaction with their recommendation, overall usability, and suggestions for improvement. Statements that corroborated design choices were noted.


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Simulation of Test Cases

The survey and focus group provided qualitative assessment on usefulness and usability of the MCC tool. However, they were unlikely able to assess all scenarios in its use. To provide a quantitative measure to validate the customized recommendations generated by the MCC tool, we conducted a simulation study with a systematically generated dataset of test cases such as to assess the level of compliance with user needs and preferences. As a comparison, we applied the same dataset of test cases to the Planned Parenthood Birth Control Quiz.

The test cases were built by iterating through the decision factors that were present in both the MCC and the Planned Parenthood tools. These factors related to user preferences (high or low importance) such as cost effectiveness, preventing pregnancy, managing periods and their side effects, and (low) possibility of weight gain, as well as user needs such as past experiences (yes or no to certain methods) and the number of hormones (MCC: none, one, or two; Planned Parenthood quiz: yes [hormones] or no [hormones]). As the Planned Parenthood quiz did not include pre-existing medical conditions, this feature of the MCC tool was not included in the test cases.

A total of 300 simulated test cases were generated, representing all possible combinations of the decision factors; 180 were applied to MCC and 120 applied to the Planned Parenthood tool. The MCC tool had a larger number of test cases due to three available options for one of the decision factors, number of hormones, as opposed to two options in the Planned Parenthood quiz (see the previous paragraph). Each recommendation provided three methods to the user, which created 900 total individual recommendations (300 × 3). Using this logic, the MCC tool had 540 (180 × 3) individual method recommendations, and the Planned Parenthood quiz had 360 (120 × 3) individual method recommendations. These individual method recommendations were manually evaluated to determine if they accurately represented the input of a user, given the information obtained in the literature review. A one-way analysis of variance (ANOVA) test was used to examine the statistical significance of the difference between the two measures.


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Results

Survey

We have received a total of 150 responses from the survey, with no missing values. Most participants (123, 82%) were between the age of 18 and 21 years old. The majority were Caucasian (102, 68%) and Not Hispanic (125, 83%). A breakdown of the age and race/ethnicity distribution can be found in [Fig. 2]. Most participants (129, 86%) have used a form of birth control or condoms. More than half of the participants (82, 55%) have previously used an online tool to learn more about birth control methods. A breakdown of previous user experience can be found in [Fig. 3].

Zoom Image
Fig. 2 Distribution of survey participants by ethnicity, race, and age.
Zoom Image
Fig. 3 Distribution of survey participants by prior experience in birth control and online tools.

The participants' assessment of the MCC tool was very positive. In terms of usefulness, 112 (75%) responses agreed/strongly agreed that the recommended contraceptive methods were appropriate and reflected their personal preferences; 132 (88%) responses agreed/strongly agreed that this tool was beneficial in helping people learn more about birth control methods. In terms of usability, 136 (91%) responses agreed/strongly agreed that the layout of the MCC tool made it easy to navigate; 133 (89%) responses agreed/strongly agreed that it was easy to learn more about the contraceptive methods. Overall, 130 (87%) responses agreed/strongly agreed that the MCC tool enhanced the process of learning. A breakdown of the survey responses can be found in [Fig. 4].

Zoom Image
Fig. 4 The responses for the survey questions (n = 150). Strongly agree and agree responses are grouped together as “positive” and strongly disagree and disagree responses are grouped together as “negative.”

A covariate analysis of age, race, ethnic background, prior use of birth control, and prior use of online contraceptive tool for survey questions recorded <80% of positive responses indicated no significant differences (see [Table 2]).

Table 2

Summary of the results from the covariate analysis on survey questions recorded <80% of positive responses

Age

Ethnicity

Race

Birth control experience

Decision aid experience

Q1: Recommendations were appropriate and reflected preferences

0.589

0.919

0.947

0.561

0.802

Q2: Would recommend tool to a friend

0.629

0.278

0.187

0.849

0.328

Q3: More confident about knowledge of birth control methods

0.949

0.562

0.223

0.563

0.807

Note: The numbers in the table cells indicate the p-values when performing one-way analysis of variance analysis.


The survey participants provided 54 comments. Among them, 24 (40%) were compliments and generic comments such as “great job!”; 23 (38%) comments suggested improvements on some features of the MCC tool such as alterations to questions asked and usability issues; and the remaining 13 (22%) comments were a critique of the tool, which did not offer opportunities for improvement and generally surrounded dissatisfaction to the recommendations (see further discussions below in [Table 3] and the “Simulated Test Cases” section).

Table 3

A summary of the findings from the focus group

Findings

Supporting quotes

Usefulness

The tool helps with the contraceptive selection process

•“It seems very useful if I was looking for a way to help my period or just overall birth control”

•“A good jumping off point”

•“Explicitly states what each [method] is and how they're used”

The results reflected user needs and preferences

•“[On the] last page I got educational information that dealt with things that were important to me”

•“Some of the results for me were helpful”

•“[My recommendation] made sense to me and, like the information section at the end definitely did”

The information presented is appropriate for the target population

•“[MCC] specifies like an effect in weight gain theirs doesn't and I know personally as a teenage girl that's like one of the big things that I'm worried about so I'm really glad that yours addresses that”

•“You were able to cram a good amount of information without me being like oh my god that's a lot to look at”

•“The information was…short and easy to understand, especially for some who might not be familiar with like different methods like implants or so”

The additional resources are helpful

•“Planned Parenthood is very reputable so I appreciated that”

•“You went through acne which for me has always been the biggest thing that would affect my self-esteem so I'm really glad you included those features”

Usability

The tool is easy to use

•“I was able to take it really quickly, mainly because, like it was so easy to understand.”

•“I didn't have to read the directions, or like click around a lot”

The tool is easy to navigate

•“I like that you can go back to the previous sections without like deleting all your results”

•“It was super easy to use and really clear like progress”

•“It was really easy to navigate”

It is easy to understand the results section

•“Once you get your recommendations, you can go back to the chart, so I really like that feature”

•“I don't read every single x or check, but I feel like it's very helpful to have it there and it gives you more information”

•“Having a few columns highlighted is definitely helpful just to make a couple of things stand out, instead of just looking at all of this together”

Comparison to existing tools

The tool is an efficient hybrid of the two tools

•“Best of both worlds”

•“[Bedsider] can be really overwhelming and like I wouldn't consider myself a beginner in terms of like knowing birth controls, but I could see why your tool would be especially good for beginners”

The language used is easy to understand

•“[The language] is accessible to college students because there's a good balance between like the overly medical jargon. I don't think the Planned Parenthood one was like that”

•“I liked that you used more like gender neutral [language] and didn't ask questions about people's partners”

•“I wasn't sure what party ready meant and I definitely think it's an inappropriate title”

This tool fits the target population better

•“The Planned Parenthood one is a little bit more complicated, so this is good for someone who may not have a lot of prior knowledge about birth control”

•“[Planned Parenthood] just doesn't seem like an accurate representation of what my primary concerns are”

Suggestions for improvement

The results need to elaborate on cost effectiveness more

•“You didn't put a price range, like the others, so I think if there's going to be a mention of cost effectiveness, I think, for each one, there should be a price range”

•“[People] have an idea in their head of what exactly is low budget it's not just like the experimenter's opinion on what's low budget”

•“I think a lot of people right now are having to have their parents pay for their medical treatment or things like that has to go through insurance which one's parents might know about. I think it's really cool to include that as well”

The methods presented can be altered to fit the target population better

•“I liked that [Bedsider] had an extra category for emergency contraception”

•“I think withdrawal, or the pullout method is important to list because I don't think people understand like how poor of a choice that is”

•“In order to not be pregnant, I think [FAM] is a very, very risky method and I don't really think it should be included in the list of methods”

•“If a method isn't particularly great for STI prevention, maybe explaining like 'Oh, when used in combination with something else it's okay'”

Other

•On indicating previous experiences: “I think, like, for it to be just kind of binary like yes, no or neutral like I'm not neutral, but I wouldn't say it was an entirely positive experience last time, but I wouldn't say it's always a negative experience so something that's you know.”

•“Might have been helpful if there was like an asterisk and it said, like we're noting this because…”

Abbreviations: MCC, My Contraceptive Choice; STI, sexually transmitted infection.



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Focus Group

From the individuals who responded to the survey, we recruited 10 participants to formulate a focus group to further evaluate the MCC tool. Among them, two participated in a previous focus group to develop the MCC tool.[17] [18] Although sampled at random, the background narrowly reflected the survey population—7 Caucasians, 2 Asians, and 1 African American; all had experience with birth control methods; and 6 had experience with contraception decision aids.

The focus group participants agreed that the MCC tool was a helpful resource for contraceptive method selection. One individual stated that it was “very useful if I was looking a way to help my period or just overall birth control.” Many participants thought that the customized recommendations fit their overall needs and “reflected things most important to me” such as concerns on weight gain.

The participants enjoyed the usability of the tool, as the information was “short and easy to understand, especially for someone who might not be familiar with like different methods like implants.” Participants stated that the Results section was especially useful, and many highlighted the ability to go back and forth between the detailed text information and the side-by-side comparison matrix.

When comparing to the existing tools, the participants indicated that the MCC tool was an efficient hybrid of the Planned Parenthood and Bedsider resources, citing it as the “best of both worlds.” They believed that highlighting the columns of the recommended methods made it easy to compare to other methods. The language was also more professional compared to the other resources.

A summary of the focus group findings can be found in [Table 3].


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Simulated Test Cases

To assess the accuracy of the MCC tool, we developed 300 simulated test cases, with 180 applied to the MCC tool to generate 540 recommendations and 120 applied to the Planned Parenthood quiz to generate 360 recommendations.

The first set of evaluation criteria focused on accommodating user preferences in terms of cost effectiveness, preventing pregnancy, managing periods and their side effects, and (low) possibility of weight gain. The original version of the MCC tool reflected user preferences in 216 of the 540 (40%) recommendations, while the Planned Parenthood quiz reflected user preferences in 108 of the 360 (30%) recommendations.

The second set of evaluation criteria focused on addressing user needs in terms of past experiences and number of hormones in a contraceptive method. The original version of the MCC tool reflected user needs in 348 of the 540 (64%) recommendations. The Planned Parenthood quiz, in contrast, reflected user needs for 111 of the 360 (31%) recommendations.

The test cases revealed three issues that led to the relatively low accuracy rate of the original version of the MCC tool: (1) a bug in the code that inhibited adding preference values in the scoring system; (2) a lack of case management for contraceptive methods with scores tied for the third-place recommendation slot; and (3) some combinations of preferences could not be fulfilled by any methods present in the MCC tool.

After fixing the bug in the code associated with (1), the MCC tool reflected user preferences in 252 of the 540 (47%) recommendations and addressed user needs in 351 of the 540 (65%) recommendations.

To address the issue in (2), we further reviewed the test cases by including all contraceptives methods tied for the third place. The accumulated performance after addressing both issues in (1) and (2) indicated that the MCC tool adhered to user preferences in 261 of the 540 (48%) recommendations and reflected user needs in 389 of the 540 (72%) recommendations.

To counteract the issue in (3), we added a new system feature to highlight the recommendation in yellow color, rather than blue, indicating that the recommended method may not fully adhere to user preferences but is still the best fit based on their inputs. The accumulated performance after addressing all the issues in (1), (2), and (3) indicated that the MCC tool reflected user preferences in 387 of the 540 (72%) recommendations. The adherence to user needs remained to be 72%. Compared to the Planned Parenthood tool, MCC recorded a statistically significant better performance for user preferences (p < 0.001) and needs (p < 0.001). A summary of the results is shown in [Table 4].

Table 4

The performance of the MCC and Planned Parenthood tools

Systems and recommendations for test cases

User preferences

User needs

Planned Parenthood tool (out of 360)

108 (30%)

111 (31%)

MCC—original (out of 540)

216 (40%)

348 (64%)

MCC—fixed bug (out of 540)

252 (47%)

351 (65%)

MCC—addressed tied methods (out of 540)

261 (48%)

389 (72%)

MCC—fixed unsatisfiable preferences (out of 540)

387 (72%)

389 (72%)

Abbreviation: MCC, My Contraceptive Choice.



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Discussion

This study leveraged a mixed methods design with the three components of survey, focus group, and simulated test cases. Each study component provided unique perspectives in evaluation of the MCC tool, and meanwhile the findings from the different components complemented each other, as shown by the data reported in [Fig. 4], [Table 3] and [4].

The data from the survey and focus group indicated that the MCC tool achieved good performance in terms of the usefulness and usability. Specifically, the survey respondents expressed high satisfaction with the educational information (81%), the assistance in learning more about contraceptive methods (88%), as well as user control in navigation and correction of data entry mistakes (91%). The focus group re-confirmed most findings from the survey and provided detailed user feedback on certain system functions, such as: (1) the efficient hybrid design that highlighted the customized recommendations (brought from the Planned Parenthood quiz) within the side-by-side comparisons of all contraceptive methods (borrowed from the Bedsider matrix); and (2) providing additional information and actionable items (clinic, pharmacy, and online shopping) for the recommended contraceptive methods. In particular, the MCC tool included a unique decision factor of potential weight gain, which was deemed very important to the target population of college-aged women in selection of contraceptive methods.[33] [34]

Regarding the recommendations generated by the MCC tool, 75% of survey respondents had positive feedback about their appropriateness and reflection of personal preferences. Further quantitative assessment through simulated test cases indicated that the MCC tool achieved a similar level of accuracy in addressing user preferences (72%) and needs (72%) after the issues identified were fixed. In contrast, the performance of the Planned Parenthood tool was at the level of 30% (user preferences) and 31% (user needs). Obviously, there is room for further improvement of the MCC tool's performance, for example, by including additional hard rules to remove a contraceptive method from the recommendation if a user has indicated no more use.

There were two limitations in this study. First, the survey and focus group participants were recruited from ASU's College of Health Solutions and Barrett Honors College. The students in these two colleges were likely more knowledgeable on contraceptive methods when compared to the general public. Generalization of certain findings, for example, the structure and format of the resources provided, from this group to other populations, including those with more diversified racial and ethnic backgrounds as well as other age groups, should be further studied. Second, the overall design of this evaluation study was in a lab setting and used simulated test cases. While these were reasonable approaches for initial assessment, a more robust evaluation should be conducted with direct use of the MCC tool in naturalistic settings.[35] This is a direction for our future work.


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Conclusion

An initial evaluation of the MCC tool through a survey and a focus group has demonstrated its good performance in usefulness and usability. Simulated test cases have shown that the MCC tool can generate appropriate recommendations that reasonably address users' needs and preferences better than the existing Planned Parenthood tool. Future research is required to assess the performance of the MCC tool in naturalistic settings and to examine the generalizability of the findings to other user populations.


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Clinical Relevance Statement

This research provided a new patient decision aid, MCC, for college-aged women to select appropriate contraceptive methods based their individual needs and preferences. The study indicated good performance of the MCC tool in terms of usefulness and usability, as well as more appropriate recommendations when compared to the existing Planned Parenthood tool.


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Multiple-Choice Questions

  1. What is a potential function of a patient decision aid?

    • Focus groups

    • Patient education

    • Quality improvement

    • User satisfaction

    Correct Answer: The correct answer is option b. Patient education. A decision aid can help the user to make a more informed decision by providing educational resources.

  2. What is a measure when evaluating a patient decision aid?

    • Usability

    • Color palette

    • IQ of users

    • Test cases

    Correct Answer: The correct answer is option a. Usability. Usability evaluation focuses on how well users can learn and use a patient decision aid.


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Conflict of Interest

None declared.

Acknowledgements

We would like to thank the students who participated in the survey and focus group for their contributions to this study.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration on Ethical Principles for Medical Research Involving Human Subjects and was approved by the ASU IRB.



Address for correspondence

Molly Redman, BS
College of Health Solutions, Arizona State University
2323 E Apache Blvd, Apt 3061, Tempe, AZ, 85281
United States   

Publication History

Received: 24 August 2022

Accepted: 21 December 2022

Accepted Manuscript online:
28 December 2022

Article published online:
22 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


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Zoom Image
Fig. 1 The three sections of the MCC tool: (1) a quiz to gather user preferences and prior experiences (only showing page 1 of 4), (2) a side-by-side comparison of all contraceptive methods, and (3) additional resources for patient education. MCC, My Contraceptive Choice.
Zoom Image
Fig. 2 Distribution of survey participants by ethnicity, race, and age.
Zoom Image
Fig. 3 Distribution of survey participants by prior experience in birth control and online tools.
Zoom Image
Fig. 4 The responses for the survey questions (n = 150). Strongly agree and agree responses are grouped together as “positive” and strongly disagree and disagree responses are grouped together as “negative.”