Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For women of reproductive age, what is the comparative effectiveness of counseling methods in primary care and community-based settings to prevent unintended pregnancy?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

• Primary care vs. community (including schools) counseling
• Individual vs. couples counseling vs. group
• Outreach and educational methods
• Information delivery type (pamphlet, video, web, in person; interactive vs. didactic)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Women of reproductive age

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Adolescents Women >35

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• improved family planning and decisionmaking
• decrease health risks to women
• improved resource utilization
• reducing unintended or mistimed pregnancy
• improvements in contraceptive adherence
• reduce late entry into prenatal care
• behavioral change

Describe any health-related risks, side effects, or harms that you are concerned about.

• Cost of counseling
• Risks of using counseling (e.g., increase in risky behaviors)
• Risk of outreach in schools (e.g., social stigma)

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth

AHRQ Priority Populations

• Women

Federal Health Care Program

• Medicaid

Importance

Describe why this topic is important.

• Unintended pregnancies account for nearly 50% of all pregnancies in the US including mistimed, unplanned, unintended and unwanted pregnancy (burden of disease)
• In 2011, the Institute of Medicine recommended: a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes
• Uncertainty regarding the most effective educational approach to reducing the number of unintended pregnancies
• To increase the proportion of pregnancies that are intended

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Clarifying the most effective approach to preventing unintended pregnancy in women

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

This report would help women in their decisionmaking as well as the clinicians and health organizations who care for them.

Describe the timeframe in which an answer to your question is needed.

Not aware of a specific timing issue

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Women, minorities, teens, low-income, populations disproportionately affected by poor birth outcomes

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

This report would help women in their decisionmaking as well as the clinicians and health organizations who care for them.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program