PROJECT SUMMARY The objective of the proposed project is to develop and evaluate an online contraception decision aid, ContraceptionForAll, for transgender or gender-nonconforming (TGNC) persons assigned female at birth (AFAB). The specific aims are: (1) build the ContraceptionForAll tool by engaging the TGNC AFAB individuals in participatory design to enhance the platform, system function, and usability of an existing prototype developed by our group; (2) assess the usefulness and usability of ContraceptionForAll in a series of mixed- methods studies with cognitive walkthrough, usability testing, simulated test cases, a user survey, and follow- up interviews; and (3) conduct a randomized controlled trial to use ContraceptionForAll as a digital intervention to improve contraceptive decision-making, sexual health knowledge, and mental health for TGNC AFAB people. The proposed research fills the current knowledge gap in characterizing the structure and process of contraceptive decision-making among the TGNC AFAB individuals. It directly addresses the unmet health needs of the TGNC AFAB population and advocates for health and healthcare equity for this gender-minority group. It has the potential to advance culturally appropriate healthcare as well as to fight against potential biases, stigma, and discriminations. From the technology perspective, it will develop guiding principles for engaging gender-minority groups in participatory design of digital health tools as part of the efforts to build cultural competence for the biomedical informatics and health IT workforce. It builds on: (1) our team’s expertise and experiences in health information dissemination research, clinical decision support systems and patient decision aids, design and evaluation of information systems, gender-minority health, reproductive health, behavioral and mental health, clinical trials, and biostatistics; and (2) our preliminary work in development and evaluation of online contraceptive decision aids for both cisgender women and TGNC AFAB individuals. The digital intervention developed from this project will directly serve the TGNC AFAB population and has the potentials to enhance their sexual health education, to facilitate contraception decision-making, and to improve their sexual and mental health. The proposed research is highly responsive to AHRQ’s priorities in: (1) study of decision making tailored to the needs of disadvantaged populations; and (2) advancing health and healthcare equity. The success of the proposed research will lay out a foundation for dissemination of the digital intervention to the TGNC AFAB population in the next stage.

PROJECT NARRATIVE The proposed project will develop and evaluate an online contraceptive decision aid for the transgender and gender-nonconforming (TGNC) individuals assigned female at birth (AFAB). It will generate evidence to use digital health interventions to improve gender-minority groups’ health. The project has long-term potential impacts to advance health and healthcare equity.