Pacific Institute for Research and Evaluation (PIRE) Southwest Center, 851 University Blvd SE, Suite 101, Albuquerque, NM, 87106, USA.
Department of Psychiatry, Child & Adolescent Services Research Center (CASRC), University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0812, USA.
BMC Health Serv Res. 2024 Nov 27;24(1):1485. doi: 10.1186/s12913-024-11785-4.
School-based health centers (SBHCs) provide vital behavioral, sexual, and reproductive healthcare services to school-aged youth across the United States. Adolescents who are sexual and gender diverse (SGD) are far more likely to suffer from adverse health outcomes than their cisgender and heterosexual peers. Emerging structural competency frameworks call for cultivating capacities in SBHCs to modify organizational service delivery environments, including provider and staff knowledge and behaviors, to influence SGD adolescent well-being. Nationally recognized guidelines for nurturing structural competency include (1) adopting, disseminating, and adhering to SGD supportive policies and procedures; (2) creating welcoming physical environments; (3) systematically documenting and using sexual orientation and gender identity information in clinical care; (4) training all employees in best practices for interacting with SGD patients; and (5) developing the clinical workforce to deliver high-quality services to SGD patients. This community-engaged study will test the effectiveness of the Dynamic Adaptation Process (DAP) in implementing these guidelines in SBHCs in culturally and geographically diverse areas of New Mexico.
We will conduct mixed-method readiness assessments to identify inner- and outer-context determinants affecting the implementation of structurally competent changes in SBHCs; employ a stepped-wedge trial to examine how the DAP-enabled implementation impacts adoption and changes in SBHC, student (patient), and implementation outcomes; and investigate inner- and outer-context determinants, bridging factors, and associated mediators and moderators influencing implementation processes and outcomes related to guideline adoption and SGD student care (e.g., reduced barriers, greater satisfaction and engagement).
This study addresses the long-term goal of high-quality care and decreased health disparities for SGD youth. As investments in SBHCs rise nationwide, opportunities to enhance services for SGD youth will also grow. This study will demonstrate the usefulness of a multifaceted implementation strategy, the DAP, in helping SBHCs build structural competency to serve a sizeable population of students affected by stigmatization, discrimination, and other social forces that create inequities in health. Accordingly, we will advance a model featuring a set of implementation strategies to reduce knowledge and practice gaps, create welcoming environments, and improve the quality of care for SGD youth.
ISRCTN13844475; 20 September 2024.
学校健康中心（SBHC）为美国各地的学龄青少年提供重要的行为、性和生殖健康保健服务。性和性别多样化（SGD）的青少年比顺性别和异性恋同龄人更有可能遭受不良健康后果。新兴的结构能力框架呼吁在 SBHC 中培养能力，以改变组织服务提供环境，包括提供者和工作人员的知识和行为，以影响 SGD 青少年的健康。全国公认的培养结构能力的准则包括：（1）采用、传播和遵守 SGD 支持政策和程序；（2）创造欢迎的物理环境；（3）在临床护理中系统地记录和使用性取向和性别认同信息；（4）对所有员工进行与 SGD 患者互动的最佳实践培训；（5）培养临床工作人员为 SGD 患者提供高质量的服务。这项社区参与研究将测试动态适应过程（DAP）在新墨西哥州文化和地理多样化地区的 SBHC 中实施这些准则的有效性。
我们将进行混合方法准备评估，以确定影响 SBHC 中结构性变革实施的内部和外部环境决定因素；采用逐步楔形试验来检查 DAP 启用的实施如何影响 SBHC、学生（患者）和实施结果的采用和变化；并研究内部和外部环境决定因素、桥梁因素以及与指南采用和 SGD 学生护理相关的中介和调节因素（例如，减少障碍、提高满意度和参与度）。
这项研究旨在实现为 SGD 青年提供高质量护理和减少健康差距的长期目标。随着全国对 SBHC 的投资增加，为 SGD 青年提供服务的机会也将增加。这项研究将展示一种多方面的实施策略（DAP）的有效性，该策略有助于 SBHC 建立结构性能力，为受污名化、歧视和其他造成健康不平等的社会力量影响的大量学生提供服务。因此，我们将提出一个模型，该模型具有一系列实施策略，以缩小知识和实践差距，创造欢迎的环境，并提高 SGD 青年的护理质量。
ISRCTN84166664; 2024 年 9 月 20 日。
