Maternal morbidity and mortality are increasing in the United States and there are large disparities for Black and Hispanic women. One of the ways to improve pregnancy outcomes is to prevent and/or carefully manage chronic conditions. Polycystic Ovarian Syndrome (PCOS) is a condition that impacts many reproductive age individuals and causes an increased risk of chronic conditions and poor pregnancy outcomes. Better management of PCOS may help people have improved pregnancy and long-term health outcomes, but there are very few programs that manage PCOS in a holistic way or in a way that is culturally relevant to the patients who need it most. Our team has a long history of engaging with diverse patient stakeholders especially Black, Native American and Hispanic women.
We plan to work with patient and clinical stakeholders to develop and test a Holistic PCOS Management Program within a Federally Qualified Health Center (FQHC) in the southern U.S where patients experience disparities in chronic conditions and in pregnancy outcomes.
Goal 1: Improve identification and diagnosis of PCOS by providers and clinical staff at the FQHC
Goal 2: Improve PCOS-related knowledge for patients with PCOS at PHS
Goal 3: Design and Implement a patient-centered, evidence-based Comprehensive, Multidisciplinary PCOS Management Program at the FQHC
Goal 4: Demonstrate improved physical, emotional and reproductive health for patients enrolled in the PCOS Management Program
Goal 5: Disseminate the PCOS Management Program more broadly
We will engage with 4 existing patient stakeholders who identify as Black and Hispanic, 6 clinical experts and 6-10 clinical stakeholders from the FQHC to design the educational tools and the PCOS Management Program. We anticipate enrolling about 50 patients, 25 of Hispanic ethnicity, 12 of Black/African American race and 13 other patients from the FQHC to participate in the PCOS management Program.
We will first work with our existing stakeholders to develop educational materials for providers to better diagnose PCOS and for patients to better understand PCOS. We will then develop a Comprehensive, Multidisciplinary PCOS Management Program for those individuals diagnosed with PCOS at the FQHC. This program will include evidence-based medical care that addresses both chronic conditions and reproductive health concerns, nutrition support, behavioral health support, and peer navigation. Peer navigators will also be trained to provide a year-long Diabetes Prevention Program for those patients with PCOS who are overweight and who are at high risk to develop Type 2 Diabetes. Peer navigators will also be trained to provide contraceptive information and, for those patients who are not on hormonal contraception, to teach them fertility awareness to track their cycles. Key informant interviews will be completed before the project launches and every 6 months to assess barriers and facilitators of implementation
Providers: PCOS knowledge; Provider PCOS referrals
PCOS Patients: PCOS quality of life at 6 and 12 months; Depression and Anxiety Symptoms at 6 and 12 months; Blood glucose (hemoglobin a1c), weight, blood pressure, and cholesterol at 6 and 12 months; Regularity of menstrual cycles and ovulation.
Implementation facilitators and barriers
Year 1: Design of program; Development of Provider and Patient Educational Tools
Year 2: Pilot PCOS Management Program at FQHC
Year 3: Evaluate Implementation and disseminate findings