P3.127: Using PRISM for pre-implementation planning of a Spanish language maternal contraceptive need screener in primary care pediatrics

Background: The right to plan or prevent a pregnancy is a social justice issue and uninsured immigrants face barriers to comprehensive contraceptive access. As 26% of US born children have at least one immigrant parent, the pediatric office is a trusted setting to support contraceptive access for immigrant parents.

In this study we used the implementation science framework PRISM (Practical Robust Implementation and Sustainability Model) to conduct user-centered, equity-focused pre-implementation planning for Conecta Familia, a pediatric-based maternal contraceptive need screener embedded in an existing resource program called Hopkins Community Connection (HCC). Conecta Familia’s core function is to identify unmet contraceptive needs among Latine new parents, refer individuals to resources, and confirm met need through follow up. Here we describe context considerations and implementation strategies emerging from our advisory groups which will inform implementation of Conecta Familia into the HCC workflow.

Methods: First, we created a process map of HCC's current workflow using SEIPS (Systems Engineering Initiative for Patient Safety) to guide observations. We hired the HCC supervisor as a project consultant and obtained process map feedback through separate one collaborator meeting with 4 HCC members and two meetings with the pediatric Latino Family Advisory Board (LFAB) at our implementation site. With both collaborator groups, we elicited feedback on the HCC process map and focused discussion questions around potential workflow ideas for Conecta Familia. Discussion questions stemmed from PRISM domains: 1) multi-sector perspectives; 2) user characteristics (i.e. HCC, LFAB, pediatric clinic); 3) external/structural drivers of equity; 4) implementation and sustainability infrastructure. We recorded meetings for internal review and compensated participants.

Results: Figure 1 illustrates the final process map of the current HCC workflow with possible points of intervention for the contraceptive screener. Table 1 describes the intervention implementation context, advisory group characteristics, and summarizes group discussion findings across advisory groups, by PRISM domain. HCC advisors suggested that HCC infrastructure can inform Conecta Familia implementation strategies. LFAB advisors highlighted HCC’s value in the context of community resource barriers, discrimination, and stigma. LFAB advisors also sought to expand the implementation of the screener throughout the medical appointment beyond the HCC workflow. Both advisory groups described that implementation planning should consider clarifying HCC service scope, address family planning related stigma, discrimination, and health insurance barriers.

Conclusion: The use of human-factors and equity frameworks in implementation science support equitable sexual health interventions from intervention strategy design to sustainability planning. Our findings allow us to anticipate contextual and cultural needs, address sustainability challenges early, and prepare for structural inequities in contraceptive access faced by the Latine community. Next steps include finalizing our contraceptive screening workflow and implementation outcomes development.