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Table 3 Social-Ecological Model Levels and Potential Strategies to Address Congenital Syphilis

From: Congenital syphilis in East Baton Rouge parish, Louisiana: providers’ and women’s perspectives

SEM Level

Potential Strategy

Supporting comments

Individual-level

• Increase knowledge about risk from congenital syphilis

• Increase perceived effectiveness of screening and treatment of syphilis especially early in pregnancy

“About 30% of them initiate their care well into their second trimester. And I’d say another 30% in their third trimester or no care at all.”(provider)

“My last pregnancy ___ actually turned me away at 33 weeks. It was because of my insurance.”(community woman)

Social and sexual network

• Address barriers to partner testing and assist persuading male partners to prevent reinfection

• Track all sexual partners for syphilis case patients

“We can tell them … that their partner needs to be treated but we have almost no way to follow that up or have evidence that it actually happened.” (provider)

“A woman can be honest and don’t cheat, and the man can be out there cheating behind your back.” (community member)

Community

• Provide education and support to prenatal care providers

• Accept walk-ins for initial pregnancy diagnosis and screening tests

• Simplify STD testing

• Comprehensive case manager

• Confidential services to help women seeking services

• Transportation service

• Utilize text messages and apps to better inform pregnant women and assist their access to services

• Provide flyers after in-person consultation

• Host community events to educate and screen both men and women in the community

“We fax and we get nothing faxed [back]. … And there’s often questions of: Who’s obligated? Is the lab reporting?” (provider)

“If you call the doctor to make an appointment, they will ask you, “What type of Medicaid do you have?” … If they don’t accept it, they won’t even schedule your appointment.”(community woman)

• “We usually have to call them to come back in to get treated. And so some of them actually don’t return” (provider)

“Community perinatal clinics have been effective in the past of helping with these types of issues.” (provider)

“Trying to get people, for example to come here, with transportation issues is just not gonna work.” (provider)

I use two apps. I use the Pregnancy Plus app … I also use the Baby Center app … they answer many questions. (community woman)

“I think we should be given more information.” (community woman)

“So aside from social media and television, if there was a gatherin’— … where information is gonna be provided, testing can be done, and free stuff given.”(provider)

Policy/Enabling Environment

• Post billboards and ads to raise awareness in the community

• Correct administrative barriers in Medicaid that delay accessing prenatal care

• Offer in-class information sessions

• Providers suggested several community-based educational strategies, including billboards, social media, and television

“It sometimes takes forever for you to even sign up online.”(community woman)”

“Educational seminars, but.. it has to be done in the particular area where people live.” (provider)