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.

K23HD084753

2015-08-28

2019-10-31