PROJECT SUMMARY/ABSTRACT Candidate: Justine Wu, MD, MPH, is a family physician with clinical and educational expertise in family planning and primary care. Dr. Wu's long-term career goal is to become a successful clinical investiga- tor who leads efforts to develop practice-based interventions that improve contraceptive use and de- crease the rate of unintended pregnancy. She is particularly interested in understanding and address- ing the contraceptive needs of women with chronic medical conditions, including diabetes and hyper- tension. Upon completion of this 5-year career development award, Dr. Wu will have obtained the expe- rience and skills necessary to launch a career as an independent investigator. Public Health Context: The proposed project is relevant to the mission of NIH because it addresses the intersection of unintended pregnancy and chronic conditions, two significant public health issues that affect reproductive-aged women in the US. Adult women with chronic conditions have a higher rate of unintended pregnancy than adult women without chronic conditions. Chronic conditions and unin- tended pregnancy are both associated with pregnancy-related complications and adverse maternal and child health outcomes. Prior studies show that women with chronic conditions are not receiving ade- quate contraceptive counseling, particularly regarding highly effective contraceptive methods. There is an urgent need to improve contraceptive counseling and services for women with chronic conditions in order to decrease the rate of unintended pregnancy and improve reproductive health outcomes among this population. Proposed Research: The overarching goal of this proposal is to design and pilot test a theory-driven, interactive web-based contraceptive decision aid for women with chronic conditions and for use in pri- mary care. This decision aid will help women understand their contraceptive options within the context of their medical conditions, ongoing drug therapy, and personal preferences, and facilitate a shared- decision making process with their primary care providers (PCPs). The specific aims of this mixed methods, multi-phase study are: 1) to identify key factors on the patient-, provider-, and practice-level that are critical to the design of a contraceptive intervention for women with chronic conditions in primary care; 2) to develop an interactive, web-based contraceptive decision aid for women with chronic conditions, their PCPs, and implementation in primary care; 3) to conduct a pilot randomized controlled trial (RCT) decision aid versus usual care to assess the feasibility of the intervention and to determine the population size needed for a future R01 RCT. Project Innovation: The proposed contraceptive decision aid is innovative because it will: 1) be cus- tomized for women with chronic conditions and for use in community-based primary care sites; 2) be informed by a new conceptual model that draws upon elements of traditional behaviora...