title: Development and testing of an iOS waiting room "app" for contraceptive counseling in a Title X family planning clinic.
abstract: OBJECTIVE
  Long-acting reversible contraceptive (LARC) methods, such as the intrauterine device and implant, are highly effective but used by less than 10% of US women. The objective of our study was to improve LARC interest by enhancing clinic counseling.
  
  
  METHODS
  A quality improvement methodology was used to evaluate intrauterine device service delivery in 3 Chicago Title X clinics. To address identified barriers, we developed a theory-based iOS application (app) for patients to use in the clinic waiting room using human-centered design. The final prototype was tested in a randomized controlled trial in a Title X clinic with sexually active females (79% African American) under age 30 years. Our sample of 60 was chosen to detect an increase from 10% (baseline) to 45% (app intervention) in the proportion of patients expressing interest in discussing a LARC method during their clinic visit with 80% power and two-sided α = 0.05. After completing demographic and baseline knowledge questionnaires, participants were randomized 1:1 to intervention (app) or standard care arms. App users also completed a posttest. Our primary outcome was expressed interest in discussing a LARC method during the clinic visit. Secondary outcomes were contraceptive knowledge and LARC selection.
  
  
  RESULTS
  App testers (n = 17) preferred interactive, visually appealing design and video testimonials. In the pilot randomized controlled trial (n = 52), app users had a significantly higher knowledge of contraceptive effectiveness (P = .0001) and increased interest in the implant (7.1-32.1%, P = .02) after the intervention. Users were highly satisfied with the app. Staff reported no problems using the app in the clinic.
  
  
  CONCLUSIONS
  Use of a theory-based counseling app offers a novel method to optimize wait time while minimizing clinic flow disruption. Preliminary data demonstrate that app use was associated with improvements in patients' contraceptive knowledge and interest in the implant.
authors.affiliation: Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL. Electronic address: mgilliam@babies.bsd.uchicago.edu.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Gilliam
authors.affiliation: Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Summer L
authors.initials: SL
authors.lastname: Martins
authors.affiliation: Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Emily
authors.initials: E
authors.lastname: Bartlett
authors.affiliation: Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Stephanie Q
authors.initials: SQ
authors.lastname: Mistretta
authors.affiliation: Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D003267:Contraception; D003271:Contraceptive Agents, Female; D003376:Counseling / Q000379:methods*; D004343:Drug Implants; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007434:Intrauterine Devices; D063731:Mobile Applications; D010353:Patient Education as Topic / Q000379:methods*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants
keywords: African American; contraception; counseling; intrauterine device; technology