An Intervention to Improve Women’s Reproductive Health

 描述（由申请人提供）：贫困妇女和有色人种妇女面临生殖健康差异，包括意外怀孕和堕胎率较高。文献表明，由专门的医疗保健提供者进行持续护理可改善寻求健康的行为和更好的结果，包括更好地使用预防性护理，减少住院和急诊室就诊。最近的医疗保健改革旨在增加获得持续医疗保健的机会，以减少健康差距和医疗保健成本。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。拟议的研究利用堕胎访问作为一个机会，让可能缺乏持续医疗保健的妇女参与进来。将制定一项可复制的、基于理论的非专业保健工作者干预措施，以支持堕胎后采取和继续使用避孕药具和保健。LHW是来自当地社区的个人，他们是社区成员与医疗保健提供者和系统之间的桥梁。LHWs使用灵活的问题解决和辅导，以帮助个人改善健康结果。本研究中提出的LHW干预将由社会认知理论（SCT）提供信息，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改变的核心，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基于SCT的LHW干预，通过简短的诊所咨询会议和后续电话，利用社会支持，帮助妇女建立技能，以改善避孕和生殖保健的使用。将对15-20名要求终止妊娠的妇女进行访谈，这些妇女在堕胎访视之外不从事保健工作。关于避孕和生殖保健使用的访谈答复将用于制定LHW干预的内容和培训材料。前/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避孕和生殖保健自我效能的提高。这项工作有可能成为一个模式，让其他难以获得护理的人群，如那些依赖紧急护理的人群参与进来。因此，制定、实施和评估一项有效的干预措施，将人群纳入常规护理，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.