Salcedo, Jennifer MD, MPH, MPP

Research Overview

2015-2016 & 2016-2017 RMATRIX Collaboration Pilot Projects Program Awards

Project Description

Abstract

STI and unintended pregnancy rates disproportionately impact teens and Pacific Islander men and women in Hawai’i. According to the most recent data from the Pregnancy Risk Assessment Monitoring System (PRAMS, unpublished data), Native Hawaiian and Pacific Islander women have significantly higher rates of unintended pregnancy than white women in Hawai’i. The teen pregnancy rate is higher than the national average across racial and ethnic groups in Hawaii, but disproportionally so for Pacific Islander teens. Hawai’i also has the 15th highest rate of chlamydia infection in the country and distinct disparities across age and racial/ethnic groups in disease prevalence, with Native Hawaiian patients accounting for 28% of all new cases and young women ages 15-24 representing 78% of new cases. Nationally, rates of STI testing in adolescent populations is troublingly low, with one study reporting that only 34% of adolescents who had been seen for “routine check-up” in the prior year had received any STI counseling or screening during their visit. The cost-effectiveness and acceptability of STI testing and treatment and high effective contraception are high. However, implementing evidence-based contraceptive and STI counseling and service provision requires significant clinician time at the expense of overall practice efficiency, which is costly and unsustainable. Health educators have been successfully used in a variety of settings as clinician-extenders, providing comprehensive counseling and working as part of the healthcare team to facilitate efficient, evidence-based patient care. However, the use of volunteer RHEs has not been systematically evaluated in a busy outpatient ob-gyn clinic serving as a highly diverse population, and guidelines for implementation of such programs are not established.

This study aims to assess the impact of volunteer reproductive health educators on adherence to STI testing and contraceptive standards of care, to compare rates of STI testing and contraceptive uptake between the RHE intervention and a historical cohort, and to assess the feasibility of instituting a volunteer RHE program into a hospital-based outpatient obstetrics and gynecology clinic.