Connecting Healthy Women: Examining the Effect of an Intervention From the Effect of Being Reachable
Condition: Contraception; Sexually Transmitted Infections; Cervical Cancer
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      The investigators propose to test a community-developed and targeted intervention that
      employs community health workers (CHWs) as aides to newly Medicaid-insured women. These women
      face the challenges of engaging with their healthcare and health and of making highly
      personal and socioculturally embedded decisions about reproductive health-related preventive
      services (e.g., contraception, STI and cancer screening).
    

Detailed description: 
      All newly enrolled women in one of Arizona's state-wide Medicaid health plans (University
      Family Care) who are ambulatory and community-dwelling, and between the ages of 18-39, will
      be identified by the health plan on a monthly basis as eligible for this study. For at least
      the first month, these new health plan members will be randomized 2 to 1 (intervention to
      usual care control). Each month the health plan will provide the study team with the number
      of new members. A study team member will then provide the health plan with a list of numbers
      (1's and 0's) generated using the biased coin design to apply to those new members. To avoid
      bias, health plan staff will not be aware of members study arm.

      All new health plan enrollees (as per current standard health plan practice) receive a series
      of welcome communications (by mail and electronically) from the health plan shortly after
      enrollment. These are designed to apprise new members of health plan policies and procedures
      related to covered benefits, facilitate the selection of a primary care provider, and provide
      general preventive health resources and information. This is followed by a second mailing at
      3-months post enrollment, as well as a nurse follow-up call. The latter is designed to answer
      questions about covered services, finding a primary care provider, and/or otherwise provide
      support. Both intervention and control group member will receive identical communications
      from the health plan up to this point. Potential participants will be contacted by the health
      plan's call center. A brief verbal overview of the intervention including time requirement
      and content to be covered will be provided. The potential participants who have been randomly
      assigned to the intervention group will then be offered the opportunity to set up an
      individual confidential appointment with a community health worker (CHW) at her earliest
      convenience.

      The call center will provide the research office a list of interested participants and their
      contact information. Once that list is received by the research office, a CHW will be
      assigned to each potential participant. The assigned CHW will call to introduce herself, to
      answer lingering questions about the intervention and proposed encounter and to confirm the
      participant's acceptance into the intervention. At that time, the CHW will confirm language
      and location preference, date/ time of proposed meeting, and the contact information for the
      research office for any questions. The CHW will meet with the subject and complete the
      informed consent process. Also, the baseline informed patient choice survey will be performed
      using a touch tablet device (to ascertain baseline knowledge, patient preferences, informed
      decision making, and health literacy). The CHW will tailor the individual education session
      to meet the unique needs of the participant (e.g., an individual who discloses a history of
      surgical sterilization will not receive information about contraception). The 45-minute
      intervention will be delivered as described above. The patient will be asked to personally
      assess her needs with regard to reproductive health-related issues. The CHW will work with
      the participant to develop a personalized plan to access the relevant targeted preventive
      services. This may involve assistance with contacting the Health Plan and assistance with
      identifying or making an appointment with a primary care provider. At the conclusion of the
      intervention, the patient will be encouraged to reach out to the CHW by telephone or
      electronically if she has any subsequent questions or concerns, and appointments for the two
      booster telephone calls will be scheduled. Finally, in consideration for her time and
      participation, the participant will be provided with a $40 gift card.

      Booster telephone support calls will occur at 2 and 4 months post intervention. A telephone
      call guide will be used to reinforce and clarify key concepts from the initial intervention
      encounter as well as to help clients formulate relevant questions related to specific women's
      preventive services and other health concerns in anticipation of their next primary care
      provider (PCP) visit. Participants will also be queried specifically about any issues related
      to interactions with the health plan and/or contacting her primary care provider. The patient
      will be assisted with connecting to the health plan or her PCP's office for those issues that
      cannot be easily addressed by the CHW. Whenever possible, every effort will be made by the
      CHW to connect the patient to the appropriate outreach staff at that PCP's office (if such
      staff is available). Again the availability of the CHW by telephone or electronically for
      interval questions will be emphasized. At month 6, the participant will receive a call from
      the telephone interviewer to administer the 6-month informed patient choice survey identical
      to the survey that was completed at baseline. A $40 gift card incentive will be offered to
      complete this survey.

      The call center will administer a similar 6-month survey by phone to a sample of the group
      randomized to invitation, but who did not accept the invitation (IG2) and the group not
      invited (CG). A $30 gift card incentive will be offered to complete this survey.
    

Intervention name(s): Community health worker
Intervention type(s): Behavioral
Intervention description(s): Community health workers (CHWs) in Hispanic communities, often referred to as "promotoras," are members of the community who use "resource sharing, partnership development, education, outreach, health promotion, and disease prevention strategies to improve the health" of their communities.
IG1: The intervention itself consists of a 45-minute one-on-one presentation and tailored planning session delivered by a CHW in a community setting of the new member's choosing. Presentations (in English or Spanish) will be delivered using a tablet computer or a hand held flipchart. Two booster telephone interactions will be performed at 2 and 4 months. At month 6, the participant will receive a call from the telephone interviewer to administer the informed patient choice survey.
Other intervention name(s): Promotoras
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Affordable Care Act; Medically underserved minorities; Community health workers; Health disparities among Mexican origin