Nearly half (45%) of all pregnancies in the U.S. each year are unintended. Of all women at risk for unintended pregnancy, 32% use contraception either inconsistently or not at all (Guttmacher Institute, 2011). Lack of access to education, services, and counseling resources are large barriers to contraceptive use. The Reproductive Health Advocacy Program (RHA) seeks to address these gaps by training University of Miami medical students as Advocates who navigate reproductive healthcare via phone calls with patients. Role-playing phone counseling scenarios combined with training in using the Contraceptive Use CDC Phone Application provide Advocates the tools to integrate mHealth into patient care. This pilot compared Advocate knowledge with that of non-Advocate peers to gauge the efficacy of RHA training in preparing Advocates for real-world counseling scenarios.
Program Design and Methods:
Since 2015, RHA has trained 85 Advocates during 14 days of peer and resident-led lectures and interactive workshops. After trained and internally certified, RHA Advocates are paired with physician-referred patients in need of contraceptive counseling comprehensive of long-active reversible contraception (LARC) methods. Over the phone, advocates establish relationships with patients while counseling and navigating socioeconomic barriers to care.
Pre- and post-training surveys were administered to 71 Advocates to evaluate change in technical knowledge. The control group consisted of 29 medical students not involved in RHA. Surveys were administered before and after control subjects completed their clinical Ob/Gyn rotation to juxtapose RHA training with the general medical school curriculum.
Original Data and Results:
Pre and post-training surveys were completed by students who underwent RHA training. Mean age of the experimental cohort (n=71) was 24.2; 76% were first-year students. Median age of control subjects (n=29) was 26.5; 100% were third year students. The experimental group improved from a 60% to 82% average survey score (p <0.001). The control group showed a pre-test average of 56% and post-test average of 62% (p=0.360). Mean score comparison showed no significant difference between the groups (p=0.085).
Although experimental group subjects were on average both younger (p<0.001) and less advanced in their medical education (p<0.001) than control subjects, advocates had higher knowledge-based survey scores before and after undergoing training. Advocate scores significantly increased after training whereas control scores did not. Lack of comparison p value significance may be attributable to smaller control group sample size. These findings suggest that RHA training improved Advocate reproductive health knowledge, perhaps providing them increased confidence and skill in using mHealth to counsel women.