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.
Young women of color are in need of high quality sexual and reproductive healthcare. The patient-centered medical home (PCMH) is a promising vehicle by which to reduce the sexual and reproductive health disparities of young women of color. A needs assessment with PCMH providers and young women of color will result in a comprehensive understanding of needs and barriers to quality healthcare services in this setting. This knowledge will also inform a grant application aimed at developing an e-learning course for time-limited healthcare providers to enhance cultural competence and progress towards health equity.