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

项目摘要/摘要 背景资料。种族和族裔差异在性健康和生殖健康结果中明显存在。 非裔美国人和西班牙裔女孩(有色人种年轻妇女)占所有青少年怀孕的57%1和79% 所有新的艾滋病毒感染2，尽管他们只占这一人群的26%2。医疗贫穷率高， 与有色人种青年妇女的贫困有关，限制获得高质量的性健康和生殖健康服务的机会3-4。 研究已经确定了在医疗保健方面保持健康差距的障碍，特别是提供者(例如，缺乏 培训和技能)和患者(例如，感知到的歧视)水平障碍以及患者-提供者 沟通障碍(例如性健康沟通不适)5.以患者为中心的医疗 家庭(PCMH)是一种初级保健模式，倡导以患者为中心的高质量护理， 连续的，全面的6-7。超过50%的年轻人有医疗院，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就医7，尽管鲜为人知 关于在这种情况下的性健康保健。这一模式旨在帮助服务不足的社区实现 通过响应文化的Care8实现健康公平。例如，PCMH模式具有内置的财务激励 对于减少种族和民族健康差距的提供者来说，例如参与学习协作， 包括电子学习课程8-9。PCMH模式在降低医疗成本方面已经很有效 和健康差异10。因此，PCMH模型是一种理想的工具，通过它可以减少性和 有色人种年轻女性的生殖健康差异。明确的目标。拟议项目的目的 是与PCMH提供者和有色人种年轻女性进行混合方法的需求评估 了解高质量的性健康和生殖健康的需求和障碍(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提纲，该提纲将告知下一步或 为有时间限制的医疗保健提供者开发电子学习课程，以提高文化能力和 在实现卫生公平方面取得进展。方法：研究方法。顺序的多层次混合方法需求评估将是 与服务提供者和有色人种年轻女性一起进行。量化阶段将包括调查方法，以 量化高质量的性和生殖保健的需求和障碍，并确定主要主题和主题 在定性阶段指导讨论。定性阶段将由深入的个人组成 与医生的访谈和与有色人种年轻女性的迭代焦点小组，以探索这些 主题以及如何处理这些主题。在集成阶段，定量和定性数据将 整合以创建电子学习课程的详细内容大纲。长期目标。我的长期任期 目标是开发一项卫生服务研究计划，重点是响应文化的医疗保健 针对青年的干预措施，以解决具有重大意义的健康差距。

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.