A Navigator Program to Overcome Barriers to Hormonal Contraception

在过去的10年里，美国青少年怀孕的总体比例有所下降，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， 减少意外怀孕和堕胎。青少年在获得服务方面面临重大障碍 包括缺乏避孕选择和如何获得避孕选择的知识，交通问题， 对保密性的担忧。虽然有预防计划外怀孕的战略，但没有一项 他们专注于在临床环境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改善获得高效激素避孕的途径， 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 这种模式已被用于各种医疗环境，包括妇女健康。然而，我们的模型 它的独特之处在于它关注青少年在临床环境之外获得激素避孕的机会。的 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方案，消除个人层面的障碍， 获得，然后帮助减少这些障碍，以促进全面和及时地获得避孕服务; (2)制定一项推广战略，有效地激活青少年寻求帮助，以获得激素 通过导航员方案开展避孕;（3）对导航员方案和推广活动进行试点测试 在印第安纳州的一个种族和社会经济多样化的县的战略，以证明的可行性， 程序模型。我们假设，促进获得激素避孕，通过 避孕导航计划将最终导致更多的使用激素避孕。我们将 研究外展策略的成效，以鼓励青少年透过 导航员方案以及该方案在青少年人口中的可行性。拟议研究 将提供必要的基础，以争取额外的资金，包括申请R 03资金， 制定一项针对预防性青少年的外展战略，以扩大“领航员”方案的覆盖面 和R 01供资，以评估避孕导航方案对获得节育服务的影响， 随后使用避孕措施，并最终对青少年怀孕率的影响。拟议研究 计划还将帮助我发展以患者为中心的研究方法，健康沟通/消息传递， 健康行为改变和青少年招募。我还将探讨与以下方面有关的伦理考虑： 开展青少年生殖健康研究。K23奖项中提出的工作将在 在一个多学科团队的指导下，教师具有所需的专业知识，不仅可以帮助我 发展活动，也是为了实现我的研究计划的具体目标。

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.