Scalable, context-sensitive psychiatric assessment with large language models and brief diaries.

Contraceptive methods (CMs) vary widely in formulations and indications (ie, menstrual cycle regulation) beyond pregnancy prevention [-]. Adolescents and young adults (AYAs) seeking contraceptives face numerous considerations (eg, weight gain and pain with long-acting CM insertion) that are often overlooked by health care providers due to competing priorities and a lack of adequate contraceptive information, which can lead to CM misuse or nonuse and undesirable outcomes. AYAs also often rely on social media for contraceptive information [-]. AYAs from racial and ethnic minority groups are more likely to report mistrust in contraceptive use and to forego or discontinue a method []. Furthermore, AYAs with a nonconforming sexual orientation, gender identity or form of expression (SOGIE) are less likely to receive contraceptive counseling that meets their needs outside of a gender-affirming care clinic (eg, counseling regarding menstrual suppression) [,]. Therefore, developing a culturally and developmentally tailored intervention to support AYAs’ unique contraceptive indications and decisional needs is critical. The American Academy of Pediatrics recommends a patient-centered approach to contraceptive counseling to improve method uptake and prevent early discontinuation and adverse outcomes []. Shared decision-making (SDM)—the process of involving patients in health decisions about treatment options, benefits, and harms—enables patients to make evidence-informed choices that align with what matters most to them [,]. This approach reduces decisional conflict and enhances patients’ knowledge, treatment adherence, and health outcomes [-]. SDM is considered the pinnacle of patient-centered care and is standard practice for adult women’s contraceptive counseling [,,]. Although several contraceptive decision support tools have been shown to improve contraceptive knowledge among AYAs, their effectiveness in supporting AYA contraceptive choice, methods use, and treatment satisfaction remains unclear [,]. Furthermore, few of these tools meet the patient decision aid (DA) standards set by the International Patient Decision Aid Standards (IPDAS), and many have not been designed to address the unique needs of a diverse AYA population, including individuals who identify as nonbinary [,]. Finally, few have been rigorously evaluated, tested in diverse AYA populations, or successfully implemented in clinical practice following clinical trials (for a summary of existing contraceptive decision support tools, refer to ) [-]. To address these gaps, we aimed to develop a web-based DA that addresses the unique contraceptive decisional needs of AYAs from diverse backgrounds, following an evidence-based framework for web-based DA for patients and the IPDAS [,]. We drew upon the Elwyn et al [] framework for web-based patient DAs to develop our DA, which involved two main phases: (1) initial development and (2) user testing (). These phases were coordinated by the research team in collaboration with (1) an advisory group of stakeholder representatives, including a youth advisory group, clinicians, and community partners, to provide high-level guidance; (2) scientific experts with content knowledge in areas such as DAs and adolescent contraception; (3) a technical production team, including hospital health informatics experts and software consultants; and (4) clinicians and patient stakeholders, who tested the app as prospective users. Each group contributed its expertise and perspective to the research team at key points in the DA development process (). However, these groups did not have editing privileges for the DA content [].