Methods
How was Q4T Developed?
Q4T (Quality for Teens): A Quality Improvement Package for Adolescent Sexual and Reproductive Health Care was developed using robust methods including an environmental scan, a national technical panel, expert review, feasibility testing, and pilot testing.
Summary
To develop Q4T, Cicatelli Associates Inc. (CAI), a contractor for the National Association of Community Health Centers (NACHC), in collaboration with NACHC and the Centers for Disease Control and Prevention (CDC), compiled change strategies and related resources drawing from several activities, including an environmental scan and obtaining individual input from experts. Using defined search terms, CAI identified quality improvement (QI) interventions from Google and Google Scholar searches, websites of government agencies, relevant organizations, foundations, and published reports from health centers. Potentially relevant materials were reviewed and for items that met specific inclusion criteria, standard information was extracted in an Excel spreadsheet. (See QARE for Teens Environmental Scan Report for additional details).
To complement the environmental scan, CAI facilitated a virtual technical panel on February 18, 2021, that brought together 26 leading experts from a diverse range of disciplines and institutions to provide individual input. Panelists included ASRH-focused academic researchers; physicians, nurses, and other care team members; training and technical assistance specialists; sexual and reproductive health equity experts; and national association representatives. Some panelists had specific expertise working with or within health centers to improve quality of care. In addition to the panelists, six individuals from CDC and the Office of Population Affairs joined the convening as listeners. NACHC and CAI held separate interviews with three panelists who were unable to attend the convening.
Panelists discussed effective change strategies and related tools and resources, considered how ASRH-related QI initiatives could advance principles of reproductive health equity, identified facilitators and barriers to implementation, suggested indicators to monitor progress, and made suggestions for format and dissemination of the package.
Drafts were developed based on feedback from the environmental scan and convening. Feedback on these drafts was collected from four individuals with expertise in implementing ASRH quality improvement initiatives in health center settings. Additionally, two individuals provided feedback about the feasibility of using the package in health centers.
The draft package was revised based on these reviews and then pilot tested from January to May 2022 with four health centers from diverse settings with varying experience in ASRH service delivery and QI. The pilot aimed to gather feedback on the extent to which the package helps health centers identify gaps in current ASRH service delivery, select ASRH improvement goals, and implement change strategies to reach those goals, as well as to gather additional implementation tips and tools. During monthly virtual meetings, collaborators gathered feedback on the utility of the package and suggestions for strengthening the content and format. Feedback and additional implementation tips were also collected from the four health centers via online surveys. Additionally, 22 subject matter experts from CDC, the Office of Population Affairs, and the Health Resources and Services Administration provided feedback on the package and provided suggestions for additional implementation tips and tools and resources. The package was revised based on feedback from the pilot and SME review.
