Development of a user-informed decision aid for adolescents and young adults' contraceptive care.

BACKGROUND: Adolescents and young adults seeking contraceptive care face many considerations related to differences in contraceptive indications and knowledge, which are often overlooked and can lead to contraceptive non-adherence or non-use and adverse health outcomes. OBJECTIVE: Develop a digital decision-aid tool that meets the contraceptive decisional needs of adolescents and young adults from diverse backgrounds. METHODS: We developed a web-based decision aid using a user-informed design framework by Elwyn et al. and the International Patient Decision Aid Standards. The design and development process was informed by a literature review, consultations with scientific experts, health informatics specialists, clinicians experienced in adolescent reproductive health, and a diverse group of adolescent and young adult advisors. We gathered feedback on the decision aid's content and functionality from clinicians, adolescents, and young adult stakeholders during focus group interviews conducted across two user testing cycles. Each focus group was recorded and transcribed, and analyses were conducted using a focus group guide to identify key attributes, patterns, and perspectives among users. Two qualitative researchers employed rapid qualitative analysis to explore and summarize findings across four key domains, contributing to the refinement of the decision aid content and improved functionality. RESULTS: Twenty-four clinicians, adolescents, and young adult participants from diverse backgrounds shared their perspectives on the decision aid's content, relevance, design, and usability across two user testing cycles from February 2023 to June 2024. The decision aid includes a survey, a decision algorithm that generates a summary of contraceptive method recommendations, infographics, and a provider summary view. The decision algorithm applies a weighted scoring system ranging from ±1 to ±10 for each method, reflecting the user's primary indication for seeking contraception, contraceptive usage preferences, and relevant health history. CONCLUSIONS: This approach allowed us to capture rich perspectives from a diverse group of stakeholders that account for the unique contraceptive decision-making needs of adolescents and young adults, resulting in a functional, youth-informed decision aid prototype, MyPlanMyChoice©, ready for pilot and feasibility evaluation in a clinical setting.