Becoming Part of the Environment of the Underserved: An Ecologically Informed Intervention to Increase Reproductive Healthcare Seeking Among Low Income African American Women

Theoretical Background and research questions/hypothesis: African American women suffer significant disparities in relation to reproductive/sexual health (HIV/AIDS, STIs, breast and cervical cancer). Community-based interventions have been identified by the 2004 National Healthcare Disparities Report as holding the most promise for achieving improvements. The purpose of the project reported on here is to identify effective community-based strategies for encouraging low income, “hard to reach” African American women in a racially diverse town in the northeastern U.S., to seek reproductive/sexual healthcare services. The project is informed by social ecological and community partnering approaches to health promotion, which emphasize, respectively, the interrelationships among individuals and their physical and social environments, and interagency collaboration.

Methods: A field office was established for the project in the town’s public housing complex, where the greatest concentration of low income African American women resided. The field office was staffed by a community outreach associate (an African American woman with ties to the area) and served as a base for her interactions with residents, as well as a location from which local health and human service organizations offered on-site services to neighborhood residents (such as HIV/STI screening, health information resources, and over-the-counter contraception). In addition, bi-monthly community health education events/resource fairs and a transportation program were conducted on site over 18 months in partnership with local organizations. Impact of the interventions was assessed through ethnographic observations, qualitative interview accounts (n=69) from health education event participants, and pre- and post-event questionnaires to assess knowledge and behavioral intentions with respect to reproductive healthcare seeking.

Results: Areas in which success in promoting health equity occurred include: (1) gains in reproductive health knowledge; (2) heightened intentions to seek healthcare services; (3) increasing health awareness; (4) intention to communicate information to others within the participants’ social network; (5) renewal of ties with local providers; (6) signing up to receive reproductive health services from the local publicly funded provider; (7) receiving health screenings.

Conclusions: The project’s successes are attributable to its sociophysical presence within the community of focus and its interagency collaborations. The field office gave the project an organizational identity (“The Women’s Health Project”) with a physical location in the community. The choice to locate the office within the public housing complex demonstrated – to both the residents and local organizations – the project’s commitment to serving a marginalized subgroup population. In addition, working to develop relationships with local organizations and bringing them on site influenced residents’ decision making about healthcare seeking because of the immediacy and accessibility of the services. By developing relationships with local residents and organizations, and establishing a physical presence in the community, the project was able to serve as a bridge between local health and human service organizations and a “hard to reach” population.

Implications for research and/or practice: Becoming part of the environment of the underserved and building interagency partnerships requires a significant investment of time and social interaction on the part of project staff. However, the project’s primary features could be sustained beyond the life of the project with commitment by community agencies and support of community members.