Promoting Decisional Readiness and Certainty about a Future Pregnancy: A Randomized Controlled Trial of a Digital Decision Support Tool Designed for Women with Physical Disabilities - PROJECT SUMMARY An estimated 8 million American women of childbearing age have some degree of physical disability. While they have a similar desire to have biological children, they also have more decisional ambivalence, uncertainty, and doubt. Physical disability, characterized by an impairment of physical function and mobility, amplifies common pregnancy concerns and adds unique obstacles to a healthy pregnancy and safe birth. Decision-making is complicated by negative societal attitudes about disability, limited expertise among healthcare providers, and a general lack of evidence-based information. Although many can and do have healthy pregnancies, pregnancy is not without elevated risks and significant tradeoffs in health, function, and independence. It is a decision that requires thoughtful deliberation and careful consideration of these risks. Unfortunately, the decision-making process is often done in a vacuum of information, role models, and informed guidance. Overcoming these obstacles requires information gathering, personal reflection, and thoughtful deliberation with healthcare providers, partners, family, and friends. A promising solution is the use of decision support tools, which are highly effective in increasing certainty and knowledge, evaluating risks, and fostering realistic expectations. Our team recently developed two pregnancy decision support tools designed specifically for women with physical disabilities and tailored for women with spinal cord injuries. Preliminary studies strongly supported efficacy for increasing decisional certainty and readiness to make a decision, with high levels of acceptability. Feedback highlighted the need to improve on the delivery of the content from paper-based and static web pages. In this application, we will refine a mobile web app of existing content, My Pregnancy Decision Compass, employing robust human-centered design principles and engaging participants in all stages of design and testing. We will then enroll a diverse sample of 248 women with physical disabilities who are actively planning, considering, or open to considering a future pregnancy in a 16-week randomized controlled trial. Participants will be randomly assigned the mobile web app or a one-page tip sheet. Outcomes will be assessed at 4, 8, 12, and 16 weeks with 6 and 12-month follow-up. We expect that My Pregnancy Decision Compass will be more effective than the tip sheet for increasing decisional certainty and readiness, health information seeking, and well-being. We will also explore the moderating effects of self-efficacy, disability identity, disability coping, and resilience. Finally, we will use a mixed methods approach to explore potential moderators and mechanisms of change associated with the decision support tool. Ultimately, better supporting women with physical disabilities to navigate this complex decision will promote healthcare access and inclusion and reduce barriers for individuals considering or planning pregnancy.
