Developing and testing the mobile sexual and reproductive health care (SRHC): A new model for delivering sexual and reproductive health care to adolescents

Awarded 2014
Complex Family Planning Fellowship Research
Lilja Stefansson, MD, MS
University of Chicago

Adolescents face many barriers to accessing reproductive health care including lack of transportation, finances, privacy, and autonomy. Improving access to sexual health care may stem high rates of sexually transmitted infections and pregnancy.  “Mobile Sexual and Reproductive Health Care (Mobile SRHC)” is a new model of adolescent sexual and reproductive health care delivery. This model uses a Mobile Health Unit (MHU) to address barriers to sexual health care access for adolescents. Prior to project initiation, the MHU provided routine health care services to adolescents in under-resourced neighborhoods in Chicago, however, sexual health services were limited. We wanted to: 1) develop adolescent sexual and reproductive health care services to be delivered via a Mobile Health Unit (the Mobile SRHC model), and 2) to assess if MHU providers were amenable to providing Mobile SRHC and whether adolescents would use Mobile SRHC.
Development of the model was informed by Standards-Based Management and Recognition: A Practical Approach for Improving Performance and Quality of Health Services (SBM-R), a model design and implementation process to create high quality health care. The SBM-R uses four steps, “standardize, do, study, and reward,” in health care model development. Formative research to develop Mobile SRHC included key informant interviews and an adolescent needs assessment survey. The key informant interviews with health care providers sought to understand their attitudes and identify potential barriers to providing sexual health care on the MHU. An adolescent needs assessment survey was administered to youth aged 14-19 years who entered the MHU for routine care.  Through an iterative process, the MHU staff and adolescents assisted in the development, implementation, and evaluation of reproductive health care service integration into the MHU. Various forms of contraception (emergency contraception, oral contraceptive pills, and injectable contraception) were introduced onto the MHU and evaluated to understand whether the based on desirability, feasibility, and sustainability.
On review of the data, the key informants perceived a need for SRHC and that they would like to provide this care. The adolescent needs assessment survey revealed that the majority of the students were likely to want to learn about and obtain sexual health care on the MHU. Overall, adolescents thought the MHU would be a safe and private location to learn about sexual health information and birth control. Once Mobile SRHC was implemented, MHU staff provided contraceptives to MHU adolescents who requested it.
The MHU providers were pleased with their ability to provide Mobile SRHC services to adolescent MHU users who requested it, and the adolescents reported that they felt safe were amenable to obtaining Mobile SRHC. The long term goal of this research is to reduce gaps in access to health care through provision of mobile services that can meet youth where they are located.