African American women suffer significant disparities in disease incidence and health outcomes in relation to reproductive health, including HIV/AIDS, STIs, breast and cervical cancer. When they live in small towns and cities, they encounter barriers in obtaining adequate reproductive healthcare that are specific to their social environments: limited numbers of reproductive healthcare providers, difficulty in traveling to and from providers'locations, and privacy concerns, in addition to lack of knowledge about preventive reproductive healthcare, and fear of discovering a health problem, which are faced by low income African American women more generally. Publicly funded providers are an important source of comprehensive reproductive healthcare services in both urban settings and smaller towns and cities. In the latter setting, however, these organizations face challenges in carrying out their mission that are directly linked to the social environment. These challenges include addressing patients'privacy concerns and problems with organizational image created by their association with stigmatized reproductive healthcare services, such as STI treatment and abortion. The goal of the proposed study is to identify successful strategies that can be applied in similar settings for overcoming barriers to reproductive healthcare seeking encounted by African American women in smaller towns and cities, and to improve African American women's reproductive health. The proposed study's location is Hudson, New York a small city in New York State with a 25 percent African American population, which served as the setting for a pilot project sponsored by the University at Albany's EXPORT Center. The study will be undertaken in collaboration with Upper Hudson Planned Parenthood (UHPP) and local community organizations, and will utilize an innovative multi-method design, informed by principles of community-based participatory research design and grounded theory methodology, to conduct and evaluate interventions providing community health education and transportation. UHPP will collect quantitative data on clinical participation and its relationship to the interventions;qualitative interview data will be collected to evaluate the interventions'impact on healthcare seeking behavior.
Reproductive healthcare seeking has implications for disparities in HIV/AIDs, STIs, and breast and cervical cancer. Small towns and cities, home to increasing numbers of African American women, present unique contextual challenges for reproductive health promotion. This study will evaluate the impact of communitybased education and transportation interventions on healthcare seeking, with the goal of identifying effective health promotion strategies that can be reproduced in similar settings and improving women's health.
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