Incorporating motivational interviewing into virtual contraceptive counseling

Background: Innovative methods for overcoming ambivalence about contraceptive use to prevent unintended pregnancies in vulnerable populations are needed. Motivational interviewing (MI) has been found to be effective for resolving ambivalence about health behavior change, but implementation has been limited by the time, training and funding required for widespread use. “Virtual patient advocates” (VPAs) are computerized, animated characters that emulate the conversational behavior of an empathic clinician and are an ideal means of increasing access to culturally appropriate/individualized family planning counseling. Purpose: Incorporating the elements of MI into a computer-based intervention to resolve patients' ambivalence about using contraception has the potential to decrease the rate of unintended pregnancy within vulnerable populations, particularly young African American women. Methods: We designed a motivational interviewing-based pregnancy planning dialogue script for a VPA, as part of a larger effort to create a computer-based preconception care program to reduce disparities in adverse perinatal/reproductive health outcomes. The script was developed with input from experts in preconception care, motivational interviewing and health literacy, and presented to a small focus group of young African American women for additional feedback on its design. Results: The dialogue script was found to be an acceptable method of obtaining information about pregnancy planning and contraception; it can be utilized across multiple platforms and incorporated into a culturally sensitive virtual family planning counselor. Conclusion: The implementation of a VPA providing individualized contraceptive counseling based on MI has the potential to overcome ambivalence about contraceptive use and decrease rates of unintended pregnancy within vulnerable populations.