Reciprocal Innovation – Community-based provision of urine pregnancy tests as linkage to reproductive health services2020-08-12T13:54:26-04:00

Community-based provision of urine pregnancy tests as linkage to reproductive health services

Principal Investigator Dr. Caitlin Bernard
International Collaborator(s)
Project Title Community-based provision of urine pregnancy tests as linkage to reproductive health services
Priority Area Infant and maternal health
The Intervention Our proposal includes a multi-phase process to use a community-based participatory model, including collecting qualitative data through focus group discussions and stakeholder workshops, to perform a needs assessment and develop and implement a pilot study assessing the ability of community health volunteer-based provision of urine pregnancy tests with CHV-provided and phone-based post-test counseling to link women with reproductive health care, including prenatal care and family planning services. Similar to Kenya, the US and Indiana specifically faces high maternal and infant mortality. Data has shown a significant proportion of this could be prevented with earlier prevention and interventions. Our traditional health care setting-based interventions have not moved the needle on these statistics, and therefore the development of creative, community-based strategies are needed. Specifically, those with community input have the highest chance of success based on acceptability and sustainability within the communities at highest risk of poor outcomes. This creative strategy for development, implementation & improving reproductive health care linkages has been shown to be succesful in Kenya & therefore we are well-placed for an adaptation project in the US context.
Key Facilitators This pilot study was performed in Kenya with support of the public health system run by the Kenyan Ministry of Health as well Moi University, a tertiary academic referral center. The Indiana CTSI will provide fundng and other resources to adapt the intervention to the context of the state of Indiana with support from Indiana University School of Medicine academic center. Additionally, we will seek suppport from the Indiana State Department of Health as a creative way to reach their goals to decrease the state’s high rates of infant and maternal mortality. The Indiana Perinatal Quality Improvement Collaborative has identified early pregnancy care and pregnancy preventions strategies as key to meeting these goals, and we expect this project to integrate well within their overall strategies within this area.
Target Population Our study population includes community health volunteers (CHVs) and reproductive aged women in western Kenya. The target population of reproductive aged women includes those with significant barriers to traditional care-seeking, including distance from care settings, low socioeconomic and educational levels, and stigmatized populations, including women living with HIV and adolescents. Similarly, many communities in Indiana face significant barriers to access to reproductive health care, including lack of insurance coverage, language barriers, low socioeconomic and educational levels, distance from care settings, and stigma, including women with substance use disorders and adolescents. The CHVs are drawn from the same population, allowing for improved communication with and access to members of those communities to be able to provide them with community-based care, including pregnancy testing, counseling, and referrals.
Process to Implementation This intervention has not yet been implemented in Indiana but has been piloted in Kenya. We showed significantly positive outcomes, both from the qualitative data from community members and stakeholders, and in the number of women seeking reproductive health services. We are still performing data analysis to determine total number of women provided with testing, counseling, and referral services. The potential exists to apply this intervention to low-resource/high-risk community settings in Indiana. This intervention could build upon other projects in Indiana that are utilizing the community health volunteer model, such as the WeCare program. We would seek support from the Indiana CTSI and other health partners in Indiana, including ISDH, IU Health, Eskenazi, and other public health centers as sites for care referral.
Key Stakeholders Stakeholders include community members, patients, community health volunteers (existing ones and potential new ones), medical partners, and researchers. We anticipate in transferring to the US that there would need to be similar community-based participation and stakeholder engagement to develop a model that will be successful and sustainable within this context.
Scaled or Transferred? The aim is to work toward scaling this intervention in the US setting.
Type of Research We will perform a mixed-methods research study including qualitative phases for planning/needs assessment & evaluation, a community- based participatory phase for development of the intervention, and quantitative evaluation of key outcomes. Implementation strategies, including the RE-AIM framework could also be utilized to provide important outcomes to be used to assess for reach and likelihood of successful sustainability within the US context.
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