Developing Brook’s Risk of Pregnancy Calculator

Helen Anderson, Senior Digital Innovation Manager at Brook, talks about the process of how Brook went about designing and developing the Risk of Pregnancy Calculator.

A core aim of Brook’s Digital Front Door is to empower young people to have more agency and control over their sexual health and wellbeing, helping them understand when they have the option to self-care and when they may need to seek support from clinical services. 

As an area of sexual health littered with misconceptions, emergency contraception presented a key opportunity in this respect.

For example, many people will have heard that the morning after pill is up to 98% effective at preventing pregnancy if it is used within five days of unprotected sex. What is not so well understood is that the morning after pill only works if taken before ovulation and shouldn’t be considered a fail-safe.  

Another common misconception is that emergency contraception can’t be used more than five days after unprotected sex. In fact, it is possible to have an IUD fitted up to five days after the earliest time you could have ovulated, meaning there are a few days where the morning after pill wouldn’t be effective but an IUD could be. The IUD is the most effective form of emergency contraception and, once fitted, can be used as an ongoing method of contraception for up to 10 years. 

Last year, Brook services carried out over 1,100 emergency contraception consultations.

When we asked our clinical teams how we could support with this area of delivery, they highlighted that it would be beneficial to develop a tool that people could use to assess their risk of pregnancy, make an informed decision about using emergency contraception, and understand their emergency contraception options. 

The tool would need to be easily accessible, guide users to seek further help if needed and, crucially, be designed for use by young people who may still be learning about the menstrual cycle and how pregnancy happens. 

Our approach 

Recognising that a tool to support emergency contraception choices would be an essential component of the Digital Front Door, the Brook Digital Team worked with our nursing teams across the country to better understand how decisions around emergency contraception are made and how the different options can be used. 

We also looked more closely at misinformation around emergency contraception, pregnancy, and the menstrual cycle to identify where we could incorporate important educational messaging within the tool. For example, explaining how withdrawal (“pulling out” before ejaculation) is not an effective way to prevent pregnancy. Essential to this was support from our education teams and participation forums, alongside incorporating findings from previous research and paying close attention to social media trends. 

Challenges 

The biggest challenge in the development of the Risk of Pregnancy Calculator was defining the algorithm required to determine both the chance of pregnancy and the emergency contraception options. 

The Brook Digital Team acted as a translator between clinical experts and our technical partner, Mindwave Ventures, working through lots of different scenarios with nurses and then mapping the potential outcomes. We also looked at recent guidance around emergency contraception use to make sure that the tool was up-to-date and clinically accurate. 

Every time we made an update to the tool in staging, it was tested by the Brook team and the team at Mindwave to make sure that the results presented were correct and matched what our nurses would advise in the same scenario. We then created a rigorous testing script that was completed before final sign-off.

By the time the tool was launched, we had run over 400 tests. 

The result 

The result is a new Risk of Pregnancy Calculator that is housed both within our interactive help and advice pages and in one of our chatbot journeys. It walks users through a series of questions that help them work out if they are at risk of getting pregnant, what their options are for emergency contraception and what steps they should take next to either access emergency contraception or get support around a possible pregnancy. 

The tool can be easily signposted to by our clinical services when they are booking people in for emergency contraception consultations with a nurse. It can also be used by anyone accessing the Brook website who thinks they might need emergency contraception; providing them with information to take to a consultation with another sexual health service or helping them understand if they can get emergency contraception from a pharmacy or online. 

Educational messaging has been included throughout to help users understand when emergency contraception might not be needed (e.g., because they’ve not had a type of sex that can cause pregnancy or they are at low risk of getting pregnant), when their emergency contraception options are limited, or when they may be outside the window of emergency contraception and should consider taking a pregnancy test. We have also included information about how their risk has been worked out, defined ovulation, and explained why not all methods are suitable for everyone. 

Key learnings and next steps 

By far the most important takeaway from this project was the importance of involving our clinical experts right at the start of the development of any new tools.

Combining the expertise and experience of our nurses and service managers with the skills and knowledge of the Digital Team enabled us to push beyond building a simple calculator to creating an online journey that offers clarity, support and encouraging calls to action with messaging and design appropriate for a youth audience.  

Since launching the Risk of Pregnancy calculator, in line with our commitment to continuous improvement, we have carried out further testing via our Participation Forum and have several updates to make to the tools and interactive webpages based off feedback from young people.  

We are also looking ahead and considering how we can integrate the calculator into appointment booking and pre-consultation journeys, as well as having started the development of a new tool to support choices around contraception.