A systems thinking approach to implementation of a novel chlamydia testing and treatment program
Elliott, Patricia Akins
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Background: Rising rates of chlamydia among Boston adolescents have made this sexually transmitted infection (STI) a priority focus for the Boston Public Health Commission (BPHC). Due to its asymptomatic nature, screenings are necessary to identify and treat chlamydia. In an effort to enhance screening opportunities for Boston youth, BPHC collaborated with Boston Public Schools to pilot a new STI testing and treatment service. The goal of this dissertation is to determine how a chlamydia testing and treatment program can be implemented and managed within a non-clinic school setting to maximize the efficient use of resources and increase access to STI screening and treatment. Methods: This project used the WHO Health System framework to understand barriers, facilitators, and unintended consequences of the program. Information collected from two site visits, eight key informant and thirteen stakeholder meetings was compiled and categorized to assess common themes and develop strategies to inform a sustainability plan. Results: Key informant meetings, which yielded information regarding financing, outreach, partnership, and staffing, resulted in a new understanding of the unintended effects of the program. Stakeholder meetings generated feedback in 8 main domains: program enhancements, financing, outreach, partnership, process, pushback, space, and staffing. Further analysis assessed potential collaborations among local stakeholders and produced recommendations for BPHC stakeholder management. Translation: This work informed five products to advance public health practice. Two documents for BPHC include a memorandum regarding legal issues associated with parental consent for adolescent participation in STI services, and a summary brief with recommendations for program redesign and future implementation. Two abstracts, accepted at national conferences for oral presentations, will review the challenges of interagency collaboration and identify strategies applicable to programs in other cities. A manuscript for submission to a peer-reviewed journal will examine aspects of adolescent privacy and confidentiality for STI programs involving health department and school system partnerships. Conclusion: The systems thinking approach provided a useful frame for exploring challenges and opportunities that can inform the redesign and implementation of a STI testing and treatment program and thereby generate knowledge to advance public health practice.
Thesis (Dr.P.H.)--Boston University