A Navigator Program to Overcome Barriers to Hormonal Contraception

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The overall rate of teen pregnancy in the U.S. has decreased during the past 10 years, mainly due to increased use of hormonal contraceptives. However, it remains the highest amongst industrialized nations. Research has shown that improving access to highly effective hormonal contraception results in increased utilization and fewer unplanned pregnancies and abortions. Adolescents face significant barriers to access including lacking knowledge of contraceptive options and how to obtain them, transportation issues, and concerns over confidentiality. While there are strategies to address unplanned pregnancy prevention, none of them focus on adolescent-specific barriers encountered outside the clinical context and how to overcome them. My long-term career goal is to improve access to highly effective hormonal contraception for sexually active adolescents. For this K23 application, I propose to develop a Contraception Navigator Program. This type of model has been utilized in a variety of medical settings, including women’s health. However, our model is unique in its focus on adolescent access to hormonal contraception outside of the clinical context. The specific aims of this proposal are to utilize a mixed methods approach to: (1) Design a Contraception Navigator Program that assists adolescents in choosing a contraceptive method, ascertains individual-level barriers to access and then help mitigate these barriers to facilitate complete and timely access to contraceptive services; (2) Develop an outreach strategy that effectively activates adolescents to seek help in obtaining hormonal contraception through the navigator program; (3) Conduct a pilot test of the navigator program and outreach strategy in one racially and socioeconomically diverse county within Indiana to demonstrate the feasibility of the program model. We hypothesize that facilitating access to hormonal contraception through the Contraception Navigator Program will ultimately result in increased use of hormonal contraception. We will study the effectiveness of our outreach strategy at activating adolescents to seek out assistance via the navigator program and the feasibility of the program within the adolescent population. The proposed research will provide the necessary groundwork to compete for additional funding including applying for R03 funding to develop an outreach strategy for pre-contemplative adolescents to broaden the reach of the navigator program and R01 funding to assess the impact of the Contraception Navigator Program on access to birth control, subsequent use of birth control, and ultimately its impact on rates of teen pregnancy. The proposed research plan will also help me develop skills in patient-centered research methods, health communication/messaging, health behavior change, and adolescent recruitment. I will also explore ethical considerations related to conducting research on adolescent reproductive health. The work proposed in this K23 award will take place under the mentorship of a multidisciplinary team of faculty with the required expertise to assist with not only my development activities but also to accomplish the specific aims of my research proposal.