Development of a User-Informed Decision Aid for Contraceptive Decision-Making Among Adolescents and Young Adults: Qualitative Study

Clinical Snapshot

Key Findings

• Effect Size: Not applicable — qualitative design study; no quantitative effect size reported

• Primary Outcome: Successful iterative refinement of the 'MyPlanMyChoice' web-based contraceptive decision aid prototype based on stakeholder feedback across two user testing cycles (February 2023 – June 2024), resulting in a tool ready for pilot and feasibility evaluation

• Nnt Or Sensitivity: Not applicable — qualitative prototype development study; no diagnostic accuracy, therapeutic effect, or prognostic metrics reported. The decision algorithm applies a weighted scoring system (range: +1/-1 to +10/-10 per contraceptive method) based on indication, preferences, and health history, but clinical validation data are not yet available

Clinical Application

The tool is described as web-based and includes a clinician summary view, suggesting potential for integration into outpatient clinical workflows. However, feasibility in real clinical settings has not yet been evaluated — the authors explicitly position this as a prototype ready for pilot testing. Implementation would require assessment of electronic health record integration, health literacy accessibility, language availability, and digital equity considerations (device and internet access among adolescents). Australia has a significant adolescent sexual and reproductive health burden, with the RACGP and SHPA supporting shared decision-making in contraceptive counselling. The Australian Contraception and Abortion Primary Care Practitioner Support (CAPPS) network and Family Planning Australia provide relevant clinical frameworks. A tool of this nature would need TGA-independent assessment as a software-based clinical decision support tool under the TGA's Software as a Medical Device (SaMD) framework if it influences clinical decisions. PBS-listed contraceptive options (e.g., etonogestrel implant, levonorgestrel IUD, combined oral contraceptive pills) would need to be reflected in any Australian adaptation. The inclusion of diverse gender identities aligns with RACGP guidelines on inclusive care for LGBTQ+ young people. Adaptation for Aboriginal and Torres Strait Islander adolescents would require specific community consultation consistent with NHMRC guidelines on research with Indigenous communities. Adolescents and young adults (approximate age range 13–25 years) seeking contraceptive counselling in primary care, adolescent medicine, sexual health, and gynaecology settings, including those from diverse gender and sexual identity backgrounds

Abstract

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 nonadherence or nonuse as well as adverse health outcomes. OBJECTIVE: This study aimed to develop a digital decision aid 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-centered design framework and the International Patient Decision Aid Standards. The design and development process was informed by a literature review and 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 2 user testing cycles. Each focus group was recorded and transcribed, and the data were analyzed using a focus group guide to identify key attributes, patterns, and perspectives among users. Two qualitative researchers used rapid qualitative analysis to explore and summarize findings across 4 key domains, which contributed to the refinement of the decision aid content and the improvement of its 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 2 user testing cycles conducted 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 health care provider summary view. The decision algorithm applies a weighted scoring system ranging from +1 or -1 to +10 or -10 for each method, reflecting the user's primary indication for seeking contraception, contraceptive use preferences, and relevant health history. CONCLUSIONS: This approach allowed us to capture rich perspectives from a diverse group of stakeholders that accounted 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.

References

1. 1.Allende-Richter, S., Gonzalez, S., Sathi, S., Quinn, A., Pereira, M., Nava-Coulter, B., Revette, A., Landrigan, C., & Sepucha, K. (2026). Development of a user-informed decision aid for contraceptive decision-making among adolescents and young adults: Qualitative study. JMIR Formative Research. https://doi.org/10.2196/82306