Forty-five percent of pregnancies in the State of Hawai'i are unintended. Vulnerable populations are disproportionately at risk, which poses economic and social implications for the state and its residents. Culturally appropriate programs can help to combat this adverse health outcome, and meet the goals of the 2010 Title V Maternal and Child Health Needs Assessment (State of Hawai'i DOH, 2010). The CDC recommends that all women of reproductive age (15-44 years) create a reproductive life plan (RLP) as a strategy to increase planned pregnancies (Johnson et al., 2006). However, only 23% of women receiving care from Title X clinics developed an RLP during their last visit (D. Hayes, personal communication). To ameliorate these disparities, the MCHB will implement and evaluate the Wonderful Journey… A Woman's Life and Wellness Planning Journal booklet in clinics receiving Title X federal funding.
This report describes a formative evaluation to be conducted by the MCHB during the first year of booklet implementation, in order to understand how the booklet is delivered in practice and demonstrate intervention effectiveness. Evaluation activities include: (1) pilot testing with the target population; (2) ongoing technical assistance and staff log; (3) booklet distribution tracking log in Title X clinics; (4) user testing; (5) linkage of the distribution log to the Title X Client Visit Record to evaluate associations between booklet use and RLP creation.
The formative evaluation will employ a quasi-experimental study design with a mixed-methods convergent parallel approach for data collection, management, and analysis. We recommend both consensual qualitative analysis, as well as univariate and bivariate approaches for quantitative assessment. Using findings from stakeholder interviews, we detail recommendations for booklet improvement, implementation, and evaluation. We describe our underlying assumptions and potential limitations to the proposed evaluation and opportunities for stakeholder engagement.