Sexual Health Disparities in Young Women of Color: A PCMH Needs Assessment

项目摘要/摘要 背景在性健康和生殖健康结果方面，种族和族裔差异明显。 非裔美国人和西班牙裔女孩（有色人种的年轻女性）占所有青少年怀孕的57%，占所有青少年怀孕的79%。 所有新的艾滋病毒感染者2，尽管他们只占这一人群的26% 2。医疗贫困率高， 与有色人种年轻妇女的贫困有关，限制了获得优质性健康和生殖健康服务的机会3 -4。 研究已经确定了维持医疗保健中健康差异的障碍，特别是提供者（例如，缺乏 训练和技能）和患者（例如，感知歧视）水平的障碍以及患者-提供者 通信障碍（例如，性健康沟通的不适）5。以病人为中心的医疗 家庭（PCMH）是一种初级保健模式，倡导以患者为中心的优质护理， 连续性和全面性6 -7。超过50%的年轻人有医疗之家，这些年轻人不太可能 有未得到满足的需求，更有可能在初级保健中进行预防性医疗访问7，但知之甚少 在这种情况下的性保健。这种模式旨在帮助服务不足的社区实现 通过对文化有敏感认识的保健实现保健公平8.例如，PCMH模式具有内置的财务激励机制 对于提供者来说，减少种族和民族健康差异，例如参与学习合作， 包括电子学习课程8 -9。PCMH模式已经有效地降低了医疗成本 和卫生保健10.因此，PCMH模型是一种理想的车辆，以减少性和 有色人种年轻女性的生殖健康差异。具体目标。拟议项目的目的 是与PCMH提供者和有色人种的年轻女性进行混合方法的需求评估， 了解优质性保健和生殖保健的需求和障碍（在提供者和患者层面）。 所获得的知识将用于创建详细的内容大纲，这将为下一步或 为有时间限制的医疗保健提供者开发电子学习课程，以提高文化能力， 在卫生公平方面取得进展。方法.一个连续的多层次混合方法的需求评估将是 与供应商和有色人种的年轻女性进行。量化阶段将包括调查方法， 量化优质性保健和生殖保健的需求和障碍，并确定主要议题和主题 指导定性阶段的讨论。定性阶段将包括深入的个人 采访医生和迭代焦点小组与年轻女性的颜色，以探讨这些意义， 主题以及如何处理。在整合阶段，定量和定性数据将 整合这些信息，为电子学习课程创建详细的内容大纲。长期目标。我的长期 目标是制定一项卫生服务研究计划，重点关注文化敏感的卫生保健 为青年采取干预措施，解决健康方面的重大差距。

PROJECT SUMMARY/ABSTRACT BACKGROUND. Racial and ethnic disparities are pronounced in sexual and reproductive health outcomes. African American and Hispanic girls (young women of color), comprise 57% of all teen pregnancies1 and 79% of all new HIV infections2, although they represent only 26% of this population2. High rates of medical indigence, related to poverty in young women of color, limit access to quality sexual and reproductive health services3-4. Research has identified barriers that maintain health disparities in healthcare, in particular provider (e.g., lack of training and skills) and patient (e.g., perceived discrimination) level barriers as well as patient-provider communication barriers (e.g., discomfort with sexual health communication)5. The patient-centered medical home (PCMH) is a model of primary care that advocates for quality patient-centered care that is accessible, continuous, and comprehensive6-7. Over 50% of youth have medical homes, and those youth are less likely to have unmet needs and more likely to engage in preventative medical visits in primary care7, though little is known about sexual health care in this context. This model was designed to help underserved communities achieve health equity through culturally-responsive care8. For example, the PCMH model has built-in financial incentives for providers to decrease racial and ethnic health disparities, such as participation in learning collaboratives, including e-learning courses8-9. The PCMH model has already been effective at decreasing healthcare costs and health disparities10. Therefore, the PCMH model is an ideal vehicle by which to reduce the sexual and reproductive health disparities of young women of color. SPECIFIC AIMS. The purpose of the proposed project is to conduct a mixed-methods needs assessment with PCMH providers and young women of color to understand the needs and barriers to quality sexual and reproductive healthcare (on provider and patient levels). The knowledge gained will be used to create a detailed content outline, which will inform next-steps or the development of an e-learning course for time-limited healthcare providers to enhance cultural competency and progress towards health equity. METHODS. A sequential multilevel mixed-methods needs assessment will be conducted with providers and young women of color. The quantitative phase will include survey methods to quantify needs and barriers to quality sexual and reproductive healthcare and to identify major topics and themes to guide discussions during the qualitative phase. The qualitative phase will consist of in-depth individual interviews with physicians and iterative focus groups with young women of color to explore the meaning of these themes and how they may be addressed. During the integration phase, the quantitative and qualitative data will be integrated to create a detailed content outline for the e-learning course. LONG TERM GOAL. My long term goal is to develop a program of health services research focused on culturally-responsive healthcare interventions for youth to address health disparities of major significance.