A Navigator Program to Overcome Barriers to Hormonal Contraception

克服激素避孕障碍的导航计划

• 批准号: 10685344
• 负责人: Tracey Wilkinson
• 金额: $ 15.89万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10685344
• 关键词: 19 year old; Address; Adolescent; Award; Awareness; Birth Rate; Clinical; Communication; Contraceptive Agents; Contraceptive methods; County; Developed Countries; Development; Ethics; Face; Faculty; Funding; Goals; Health behavior change; Human Resources; Improve Access; Indiana; Individual; Knowledge; Mass Media; Medical; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Modeling; Population; Positioning Attribute; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy in Adolescence; Public Health; Race; Research; Research Methodology; Research Proposals; Risk; Services; Teenagers; Training; Transportation; United States; Women' s Health; Work; abortion; birth control; career; clinical encounter; design; effectiveness study; health communication; help-seeking behavior; hormonal contraception; improved; multidisciplinary; outreach; patient oriented; pilot test; pregnancy prevention; programs; recruit; reproductive health of adolescents; school based health center; sexually active adolescent; skills; socioeconomics; success; support tools; unintended pregnancy; user centered design

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.

过去 10 年来，美国青少年怀孕率总体有所下降，主要原因是 增加使用激素避孕药。然而，它仍然是工业化国家中最高的。 研究表明，提高获得高效激素避孕药的机会会增加 利用率以及减少意外怀孕和堕胎。青少年在获取信息方面面临重大障碍 包括缺乏避孕选择和如何获得避孕方法的知识、交通问题以及 对保密性的担忧。虽然有一些策略可以预防意外怀孕，但没有一个 他们关注的是青少年在临床之外遇到的特定障碍以及如何克服 他们。我的长期职业目标是提高性行为获得高效激素避孕药的机会 活跃的青少年。对于这个 K23 应用程序，我建议开发一个避孕导航程序。这 该类型的模型已用于各种医疗环境，包括妇女健康。然而，我们的模型 其独特之处在于它关注青少年在临床之外获得激素避孕。这 该提案的具体目标是利用混合方法来：(1) 设计避孕导航器 帮助青少年选择避孕方法的计划，确定个人层面的避孕障碍 然后帮助消除这些障碍，以促进全面、及时地获得避孕服务； (2) 制定外展策略，有效激发青少年寻求帮助以获得荷尔蒙 通过导航程序避孕； （三）开展领航员计划及推广试点 在印第安纳州一个种族和社会经济多元化的县制定战略，以证明 程序模型。我们假设，通过以下方式促进激素避孕的获得： 避孕导航计划最终将导致激素避孕药的使用增加。我们将 研究我们的外展策略在激发青少年通过以下方式寻求帮助方面的有效性： 导航计划以及该计划在青少年人群中的可行性。拟议的研究 将为竞争额外资金提供必要的基础，包括申请 R03 资金 为陷入沉思前的青少年制定外展战略，以扩大导航计划的影响范围 R01 资金用于评估避孕导航计划对获得节育措施的影响， 随后使用节育措施，及其最终对青少年怀孕率的影响。拟议的研究 计划还将帮助我培养以患者为中心的研究方法、健康沟通/信息传递、 健康行为改变和青少年招募。我还将探讨相关的道德考虑 开展青少年生殖健康研究。 K23 奖项中提出的工作将进行 在多学科教师团队的指导下，他们拥有所需的专业知识，不仅可以帮助我 开发活动也是为了完成我的研究提案的具体目标。

项目成果

The Pediatrician in the Post-Roe Landscape.

• DOI: 10.1001/jamapediatrics.2022.2868
• 发表时间: 2022-10-01
• 期刊: JAMA PEDIATRICS
• 影响因子: 26.1
• 作者: Wilkinson, Tracey A.;Maslowsky, Julie;Berlan, Elise D.
• 通讯作者: Berlan, Elise D.

Providing Contraception for Young People During a Pandemic Is Essential Health Care.

• DOI: 10.1001/jamapediatrics.2020.1884
• 发表时间: 2020-09-01
• 期刊: JAMA pediatrics
• 影响因子: 26.1
• 作者: Wilkinson TA;Kottke MJ;Berlan ED
• 通讯作者: Berlan ED

Adolescents' and Young Adults' Ability to Self-Screen for Contraindications to Hormonal Contraception and the Role of Chronic Illness.

• DOI: 10.1016/j.jadohealth.2021.04.032
• 发表时间: 2021-10
• 期刊: JOURNAL OF ADOLESCENT HEALTH
• 影响因子: 7.6
• 作者: Wilkinson, Tracey A.;Meredith, Ashley H.;Rafie, Sally;Katz, Amy J.;Vielott, Thomas L.;Meagher, Carolyn G.;Ott, Mary A.
• 通讯作者: Ott, Mary A.

Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents.

青少年当日长效可逆避孕的成本最小化分析。

• DOI: 10.1001/jamanetworkopen.2019.11063
• 发表时间: 2019
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Wilkinson,TraceyA;Downs,StephenM;TuckerEdmonds,Brownsyne
• 通讯作者: TuckerEdmonds,Brownsyne

How can healthcare professionals provide guidance and support to parents of adolescents? Results from a primary care-based study.

• DOI: 10.1186/s12913-021-06200-1
• 发表时间: 2021-03-20
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Jones LD;Grout RW;Gilbert AL;Wilkinson TA;Garbuz T;Downs SM;Aalsma MC
• 通讯作者: Aalsma MC