Oral

This session presents results from initiatives designed to improve the quality of reproductive healthcare by targeting the structure and process of service delivery. For nearly 3 decades, health services research has employed Donabedian’s structure, process, outcomes framework to examine the quality of health services and identify key relationships between service delivery and health outcomes. Donabedian hypothesized that the structure of care influences the process of care which in turn influences health outcomes. The structure of care includes equipment, personnel, and in an expanded definition, structural components of access to care; process of care is what is happens during service delivery—what is done to the patient. The first speaker presents findings on the process of reproductive health care for patients with limited English proficiency in California. The study examines the relationship of quality process indicators and the use of a language concordant interpreter, a structural element. The next paper addresses the quality of reproductive health services targeted at California youth, using quality indicators that cover both structural—for example, walk-in hours—and process—for example, advance provision of EC—elements of care. The next two presentations focus on assessing the impact of removing structural barriers to access to evidence-based reproductive health services. Theft is cited by pharmacies as the primary reason for keeping condoms behind counters or in locked cases, but the third presentation, from the “Unlocking the condoms” initiative, suggests that this fear may be unwarranted, and that accessible condom displays may be associated with increased purchase of condoms. The final presentation, an assessment of HPV vaccine uptake among a group of college women, reminds us that although cost is a major structural barrier to access to evidence-based health services, free is not always enough to increase utilization. Together, these papers have implications for measuring quality, especially when targeting reproductive health services at subpopulations such as youth or those with limited English proficiency, and for interventions designed to increase utilization by removing structural barriers to access, such as locked cases or cost.

Session Objectives: 1) Describe the relationship between interpreter services and processes of reproductive health service delivery for limited English proficiency patients 2) Identify key “youth friendly” reproductive health service quality indicators 3) Compare and contrast the role of structural barriers to access to reproductive health services in the “Unlocking the condoms” and HPV uptake studies

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH)