Theses Doctoral

Expanding Access to Sexual and Reproductive Health Care in Alternative Primary Care Settings

Effron, Alayna Renee

The need to expand access to and availability of quality and comprehensive sexual and reproductive health care (SRH) to help close the gaps in existing health disparities and health inequities in the United States is a pressing public health concern. The emergence of alternative primary care settings (i.e., retail-based clinics [RBCs]) has recently proven to be an effective model for the delivery of acute care in lieu of more traditional medical services. Indeed, RBCs could be an agent for greater SRH care access with the integration of more services; however, barriers exist that inhibit this maximization of care. Providers play a central role in the utilization of SRH in RBCs, whether through their intent to recommend or biases about RBCs. Provider recommendation is a strong indicator for patient compliance. However, little is known about how providers’ attitudes and beliefs influence the uptake of SRH in RBCs. This cross-sectional study collected survey data from a large sample of 341 advanced practice clinicians (APC) to (1) understand the benefits and barriers of SRH integration in RBCs; and (2) identify the relationship between the attitudes of APCs regarding RBCs and their influence on barriers and benefits of SRH integration into RBCs. Items were adapted from existing valid and reliable measures. Survey data were analyzed primarily using descriptive statistics. Comparative analysis between demographic factors and identifier variables that led to several themes: a majority of APCs believe the integration of SRH into RBCs would expand access to and availability of quality and comprehensive SRH care for prevention and intervention; hesitancy to recommend SRH services is chiefly founded in lack of confidence in quality assurance, professional training and quality of services offered; overall APCs had a generally positive attitude towards the integration of SRH in RBCs but attitudes differed among the types of SRH services offered at RBCs.
These findings provide insight for the identification of barriers and benefits in the integration of SRH in RBCs. This may create opportunities to address barriers for the expansion of prevention and intervention services among women while capitalizing on benefits to advance awareness, education and access to care.


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More About This Work

Academic Units
Health and Behavior Studies
Thesis Advisors
Rajan, Sonali
Ed.D., Teachers College, Columbia University
Published Here
June 6, 2019