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Examining the Provision of Sexual and Reproductive Health Services at School-Based Health Centers: Structural, Organizational, and Community Factors
- Lopez, Brenda Maria
- Advisor(s): Franck, Linda
Abstract
Background: Adolescents face increased rates of poor sexual and reproductive health (SRH) outcomes, including sexually transmitted infections and teen births. School-based health centers (SBHCs) are recognized as a public health strategy and evidence-based model to improve access to SRH services for adolescent populations. The provision of SRH and contraceptive services at SBHCs in the United States (U.S.) vary and remain inequitable yet it is unclear what current factors have the greatest influence on the provision of these services.Method: This dissertation includes an integrative literature review that searched 5 databases (PubMed, Embase, ERIC, CINAHL, Web of Science) for relevant research published from January 2011 through December 2023. Eight studies were critically appraised, and findings were summarized and synthesized. This dissertation also analyzed secondary cross-sectional data from the 2021-2022 National School-Based Health Care Census survey along with public data from the National Center for Education Statistics on characteristics of schools where the study SBHCs were located during the 2021-2022 school year. The analyses include bivariate analyses with chi-square tests and a forward stepwise logistic regression model with omnibus Wald tests for covariates with more than two groups. Results: The literature review findings in Chapter 2 demonstrated that SRH services vary from contraceptive counseling to long-acting reversible contraceptives and 46% of SBHCs dispensed contraceptives on-site, according to the latest published data available from the 2016-2017 school year. The federally funded Title X Family Planning Program and school/district level policies drove the provision of SRH services at SBHCs in the U.S. Chapter 3 demonstrated that based on recent data from the 2021-2022 school year, 84% of adolescent-serving SBHCs offered SRH services. The SBHCs that had greater odds of providing any SRH services were those that received state and local government funding, were located at a middle, high or combined grade schools, had ten years or more of operation, and had physician assistants employed on their primary care staff. SBHCs in the southern region of the U.S. or those located in an elementary school had lower odds of providing any SRH services. Chapter 4 showed that 70% of adolescent-serving SBHCs that offered SRH services dispensed contraceptives on-site. SBHCs with the greatest odds of dispensing contraceptives on site were those that received federal and local funding, were located at high schools or combined grade/non-traditional schools, and were located at schools that had 75% or more Black, Indigenous, and other people of color (BIPOC) identifying student population. Conclusion: This dissertation provides a contemporary description of the provision of SRH and contraceptive services at adolescent-serving SBHCs in the U.S. The provision of SRH and contraceptive services at SBHCs have increased however remain inequitable. This dissertation identified characteristics that impacted the odds of SRH and contraceptive services being provided at SBHCs. Findings can inform future program and policy development to help ensure equitable access to SRH for adolescents.
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