Utilizing a Reproductive Mobile Clinic to Improve Health Outcomes of

Women and Infants:A Research Proposal

Khelyn Collado, Sylvie Delva, Connie Ngo, & Katie Olinger

Azusa Pacific UniversityJuly 2015

Background❖ Problem

➢ Low quality and substandard accessibility to reproductive health care for women results in negative health outcomes in women and their infants.

❖ Significance➢ Improving accessibility and quality of women’s

reproductive health care will empower women to make healthier choices in order to decrease negative health outcomes in women and their infants.

Research Question & Hypothesis❖ Question: Will improved quality and access to reproductive health care for

pregnant women from vulnerable populations (teens, homeless, low SES, minorities) decrease negative health outcomes for women and infants?

❖ Hypothesis: Improved quality and access to reproductive health care for pregnant women from vulnerable populations (teens, homeless, low SES, minorities) will decrease negative health outcomes for women and infants.

❖ Purpose: To evaluate the effectiveness of improved quality and access to reproductive health care for pregnant women from vulnerable populations (teens, homeless, low SES, minorities) on health outcomes of women and infants.

Conceptual Definitions of Variables

❖ Independent➢ Women’s reproductive health care

■ Accessibility: Ease of obtaining resources related to care given to a woman of childbearing age

■ Quality: Doing the right thing, at the right time, in the right way, for the right person—and having the best possible results

❖ Dependent➢ Negative health outcomes

■ Women: Poor health status that negatively affects fetus (gestational diabetes, preeclampsia)

■ Infants: Health indicators associated with infant mortality (low birth weight, early gestational age)

Operational Definitions of Variables

❖ Independent➢ Women’s reproductive health care

■ Accessibility:● Services provided by the Women’s Reproductive Health Mobile Clinic

■ Quality: ● Adequacy of prenatal care interventions

❖ Dependent➢ Negative health outcomes

■ Women● Preeclampsia: Blood pressure (mmHg)● Gestational Diabetes: Blood glucose (mg/dL)

■ Infants● Gestational age: Estimated from mother’s last menstrual period (weeks

and days)● Birth Weight: Measured in grams

Literature Review: Comparison and Analysis

❖ Studies on prenatal care for vulnerable populations showed that they are at risk for negative birth outcomes.2,3,5,10,12,16 Interventions such as a MOMmobile, Healthy Start program, or home visits showed improvements in birth outcomes.5,7,11 However, there was a gap--some vulnerable women still had poor birth outcomes.2,4,7

❖ The review of literature supported the necessity for enhanced accessibility to and quality of prenatal care. In addition, many studies supported the need for an extensive women's health care program to educate women of childbearing age, and to provide adequate care for the mother and child during and after pregnancy.2,5,7,12

Theoretical Framework

● Theory of interest and map

Research Design❖ Longitudinal Cohort Study with Post-test Only Design: We will

observe the participants in our study for a period of 9 months to see the effectiveness of our intervention.

Advantages Disadvantages

❖ It has the ability to show a consistent pattern over time.

❖ Gathers data concurrently rather than retrospectively.

❖ Sample remains the same; therefore, sampling error is reduced.

❖ Useful for establishing relationships between variables.

❖ Higher risk for losing participants in the study (mortality and attrition).

❖ Time consuming ❖ Expensive

Sampling

Target population: Pregnant women who are in a vulnerable state.

Accessible population: Pregnant women in the city of San Bernardino.

Sampling Technique Convenience, purposive sampling

High schools Homeless

Shelters and other Community Resource Centers

Bus Stops

Power AnalysisAnticipated effect size: 0.8Desired statistical power level: 0.8Probability level: 0.05

Minimum total sample size: 42Minimum sample size per group: 21

Intervention group: 50Control group: 50

Inclusion Criteria In order to be a participant, she must have the following characteristics:❖ Be between the ages of 12-35❖ Be in the first trimester of pregnancy❖ Must reside in the city of San Bernardino❖ Have one of the following:

➢ Teenage pregnancy ➢ Must be considered to be in poverty according to the 2015

Poverty Guidelines ➢ Ethnic minority: Asian American, African American,

Hispanic➢ Homeless

Exclusion Criteria Women who meet the following criteria are ineligible to be part of the study:

❖ Currently underweight, overweight, or obese according to BMI score.

❖ Diagnosed with an acute or chronic illness.❖ Have a drug or alcohol addiction. ❖ Prescribed a medication classified under

Category X.

MeasuresIndependent Variable❖ Mobile Clinic (and services

offered)➢ Nominal:

■ A checklist of prenatal care services provided to the pregnant women.

❖ Kotelchuck Index➢ Ordinal:

■ Measures adequacy of prenatal care as a ratio of expected visits to actual visits (inadequate, intermediate, adequate, adequate plus)

MeasuresDependent Variables

Ordinal

Ordinal

Ordinal

Ratio

Data Analysis❖ Paired t-test: To look at the differences

between data collections over time within the same group.

❖ Unpaired t-test: To assess differences in data between the intervention and control group.

❖ Pearson Correlation: To measure the association between the mobile clinic and women’s or infant’s health outcomes.

❖ Multiple Regression: To determine the relationship between the negative health outcomes of women while controlling the independent variable (mobile clinic).

Ethical Considerations❖ Ethical Principles

➢ Respect for Persons: Each woman that qualifies as a candidate has the right to choose whether or not to participate and may withdraw at any point in the study. ■ Voluntary consent for participation

➢ Beneficence: None of the interventions performed in the mobile clinic will cause harm to the mother or child and the benefits of the care delivered outweigh any possible risks.

➢ Justice: All women involved in the study will receive equal and fair treatment and will have protection of their identity. ■ HIPAA form and identification numbers.

Implications

❖ Facilitation➢ Increase access to care➢ Increase trust➢ Change of behavior➢ Accountability➢ Leading to decrease

negative pregnancy/birth outcomes

❖ Patient Advocacy❖ Increase education❖ Utilization of resources❖ Collaboration

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