An Intervention to Improve Women’s Reproductive Health

 描述(申请人提供)：贫困妇女和有色人种妇女面临生殖健康差距，包括较高的意外怀孕和堕胎率。文献表明，由专门的医疗保健提供者提供的持续护理可以改善求医行为并改善结果，包括更好地使用预防性护理、更少的住院和更少的急诊室就诊。最近的医疗改革旨在增加获得持续医疗护理的机会，以减少健康差距和医疗成本。要求堕胎的妇女不成比例地来自医疗服务不足的人群，包括有色人种妇女和低收入妇女。这项拟议的研究以堕胎访问为契机，让可能缺乏持续医疗护理的妇女参与进来。将开发一种可复制的、基于理论的非专业卫生工作者(LHW)干预措施，以支持堕胎后的吸收和持续使用避孕和医疗保健。LHW是来自当地社区的个人，他们是社区成员与卫生保健提供者和系统之间的桥梁。LHW使用灵活的问题解决和指导来帮助个人改善健康结果。这项研究中提出的LHW干预将受到社会认知理论(SCT)的启发，该理论认为一个人施加行为控制或自我效能的能力是行为变化的核心，并调节个人对促进或阻碍健康行为的因素的反应。这项研究将开发和测试一种基于SCT的LHW干预措施，它通过简短的门诊咨询会议和后续电话，利用社会支持来帮助妇女培养技能，以改善避孕和生殖健康保健的使用。将与15-20名要求终止妊娠的妇女进行面谈，她们在堕胎访问之外不从事保健工作。将利用关于避孕和生殖保健使用的访谈答复来制定LHW干预的内容和培训材料。事前/事后测试将确定可行性并收集初步结果数据。我们假设参与者将体验到更高水平的避孕和生殖保健自我效能。这项工作有可能成为让其他难以获得护理的人群参与进来的模式，例如那些依赖紧急护理的人群。因此，制定、实施和评估将人口纳入常规护理的有效干预措施具有重要的公共卫生和政策意义。

 DESCRIPTION (provided by applicant): Poor women and women of color face reproductive health disparities, including higher rates of unintended pregnancy and abortion. Literature demonstrates that continuous care with a dedicated health care provider leads to improved health-seeking behaviors and better outcomes, including better use of preventive care, fewer hospitalizations, and fewer emergency room visits. Recent healthcare reform aims to increase access to continuous medical care to reduce health disparities and healthcare cost. Women presenting for abortion are disproportionately from medically underserved populations, including women of color and low- income women. The proposed research uses the abortion visit as an opportunity to engage women who may lack continuous medical care. A replicable, theory-based lay health worker (LHW) intervention will be developed to support post-abortion uptake and continuous use of contraception and health care. LHWs are individuals from a local community who serve as a bridge between community members and health care providers and systems. LHWs use flexible problem solving and coaching to help individuals improve health outcomes. The LHW intervention proposed in this study will be informed by Social Cognitive Theory (SCT), which posits that one's ability to exert behavioral control, or self-efficacy, is central to behavior change and moderates individuals' responses to factors that facilitate or impede health behavior. This study will develop and test a SCT-based LHW intervention that uses social support through a brief, in-clinic counseling session and follow-up phone calls to help women build skills to improve contraceptive and reproductive health care use. Interviews will be conducted with 15-20 women presenting for pregnancy termination who do not engage in health care outside of the abortion visit. Interview responses about contraception and reproductive health care use will be used to develop the content and training materials for the LHW intervention. Pre/post testing will determine feasibility and collect preliminary outcome data. We hypothesize that participants will experience improved levels of contraceptive and reproductive health care self-efficacy. This work has the potential to serve as a model for engaging other populations who have poor access to care, such as those who rely on emergency care. Therefore, development, implementation, and evaluation of an effective intervention to integrate populations into routine care have important public health and policy implications.