By Aimee Chism Holland, DNP, WHNP-BC, FNP-BC, RD, NPWH Research Committee Chair
This issue of Women’s Healthcare: A Clinical Journal for NPs features abstracts presented at the NPWH Conference in San Diego, California, in September 2013. Please join us in congratulating our four podium presenters and the first- and second-place poster award winners, all of whom received cash scholarships supported through a grant from Teva Women’s Health.
We are proud of the high quality work done by our colleagues in women’s healthcare. We look forward to receiving abstracts on other important women’s health research and innovative clinical projects for consideration at future NPWH conferences.
Intimate partner violence’s effects on both individual-specific and partner-related sexual risk factors
By Holly Fontenot, PhD, RN, WHNP-BC; Melissa A. Sutherland, PhD, RN, FNP-BC; and Heidi Collins Fantasia, PhD, RN, WHNP-BC
Participants will be able to:
1. Understand the link between intimate partner violence (IPV) and sexually transmitted infection (STI)/HIV risks for women.
2. Develop knowledge of both individual-specific and partner-
related sexual risk factors.
3. Enhance awareness of screening questions related to violence, beyond initial IPV assessments.
Purpose: The purpose of this study was to explore the relationship between the duration of IPV experiences and both individual-specific and partner-related sexual risk factors that may increase women’s risk for STIs and HIV.
Methodology: The authors performed a secondary analysis using data collected from 2000 women’s health records. Four distinct categories defined the duration of IPV: (1) in the past year only, (2) in the past year and during the past 5 years, (3) in the past year plus extending for more than 5 years, and (4) no past-year violence but a history of IPV. Logistic regression models were used to examine the associations between duration of IPV and individual-specific sexual risk behaviors (e.g., number of sexual partners, drug/alcohol use, anal sex) and partner-related sexual risk factors (e.g., non-monogamy, STI risk, condom nonuse).
Results: Roughly 29% of the sample reported a history of IPV during their lifetime and 75.9% reported that they did not use condoms at their last intercourse. All of the individual-specific risk factors and partner-related risk factors were significantly (P = .05) associated with IPV and duration of IPV. For example, compared with no lifetime experience of IPV, violence during the past year or during the past 5 years increased the likelihood of an individual-specific sexual risk, namely that a woman used drugs/alcohol prior to sex (respective odds ratios, 5.12 and 7.75). As an example of a partner-related sexual risk, compared with no lifetime experience of IPV, a report of IPV during the past year or during the past 5 years increased the likelihood of the woman having a partner known to have had multiple other partners (respective ORs, 7.78 and 14.28).
Implications for women’s health: The study findings extend knowledge related to IPV as a risk factor for STIs/HIV, highlighting the effects of IPV duration on women’s health. Assessing for lifetime experiences of violence, in addition to current IPV, will improve outcomes for women and their families.
Me, myself, and my avatar: the feasibility of using Second Life for STI prevention education
By Versie Johnson-Mallard, PhD; Belinda R. James, MSPH; Kevin Kip, PhD; Cecile A. Lengacher, RN, PhD; Lissa Mangini, MBA; and Denise Passmore, PhD
Participants will be able to:
1. Identify risk assessment for sexually transmitted infection (STI) exposure.
2. Explore communication skills and their role in preventing STIs.
3. Use Second Life, a virtual environment, as an educational intervention to increase the knowledge of safer sex practices and viral STI risk reduction.
Purpose: This study aims to use Second Life, a virtual environment, as an educational intervention to increase the knowledge of safer sex practices and viral STI risk reduction.
Methodology: Female college students at two large universities were recruited to complete a cross-sectional questionnaire that assessed the dependent variables of sexual intercourse refusal; ability to question potential sexual partners; condom use; and level of worry concerning contracting various STIs. The participants’ information was correlated with the events collected from the exhibit and contained within Moodle’s primary MySQL Database.
Results: Demographic data were obtained from all of the research participants. The study sample was mostly female (60%) and composed of second-year college students (60%). All of the research participants were in school full-time and had never been married. Eighty percent lived off-campus in a house or apartment. Most research participants (60%) had no previous experience with Second Life. Almost half (40%) found the exhibit “very” useful. All participants reported that they learned something new and most (60%) indicated that what they learned would lead to a behavior change.
Implications for women’s health: This study enrolled students who had consistent access to computers with updated systems at their respective universities. Another advantage was the excitement associated with a new, stimulating adventure. This explosive tactile experience mentally captivated participants and drew them in. Last, the use of a virtual world exceeded current barriers by increasing the scope of people who could be reached.
Working women’s perceptions of cervical cancer screening
By Kelly Ackerson, PhD, RN, WHNP-BC; Lisa Stines Doane, PhD; Robert McNutt, MS; and Yuanyuan Shao, MS
1. Compare and contrast the background characteristics of women who do and do not obtain routine Pap tests.
2. Distinguish between findings which are and are not significant to seeking or avoiding routine gynecological care.
3. Evaluate one’s approach to the gynecological exam to determine needed change.
Purpose: To identify the personal characteristics and attitudes that predict cervical cancer screening in women, using the interaction model of client health behavior (IMCHB) as a theoretical framework.
Methodology: Study participants were female employees in professional and nonprofessional positions at a long-term healthcare facility. Data obtained were background variables (social influence, environmental resources, demographic characteristics, and sexual and physical abuse/assault history) and the Pap Smear Belief Questionnaire (PSBQ), which is a 31-item instrument with four subscales (benefits of the Pap test, barriers, vulnerability, and previous healthcare experience). Employees received the PSBQ in their mailboxes and returned the questionnaire via postal service. Descriptive statistics and univariate logistic regressions were used to analyze the data.
Results: The sample consisted of 53 women with a mean age of 43 years (standard deviation, 13.9 years). 81% of the sample reported having had a routine Pap test within the previous 3 years. Most participants reported earning less than $30,000 a year (53%), were Caucasian (79.2%), were well educated (91% had some college/college degree), and had insurance (89%). A trauma history was reported by 36.5% of the sample. The only significant background variable that predicted seeking a Pap test was social influence (P = .04); these women were encouraged to seek the exam by their mothers and healthcare providers. Among PSBQ subscales examined, only greater barriers to screening (P = .003) and previous negative gynecologic examination experiences (P = .04) were found to be significant predictors of avoiding Pap testing.
Implications for women’s health: Despite the evidence that routine Pap tests decrease cervical cancer risk, some women still avoid routine screening. Although most women who avoid screening have fewer years of education, this sample was predominantly college educated, which may be a weakness of the current study. This research should be replicated in a more socioeconomically and educationally diverse sample to better
understand the background characteristics and experiences that influence Pap test adherence in a wider range of women. Understanding women’s attitudes toward
cervical cancer screening will help WHNPs develop more effective screening programs and interventions, thereby facilitating a better experience for women and contributing
to an increase in routinescreening.
Sexually transmitted infections and pregnancy outcomes, Florida 2008-2010
By Karla Schmitt, PhD, MPH, ARNP and Daniel R. Thompson, MPH
By the end of the presentation, participants will be able to:
1. Describe significant associations between chlamydia infection and pregnancy outcomes.
2. Discuss regulatory policy strategies to improve timely screening and treatment for chlamydia infection during pregnancy.
3. Discuss implications for contributory factors to findings and areas for future research.
Purpose: A prior population-based study that controlled for 21 independent variables found the odds of giving birth to low-birth-weight (LBW) infants for women with inadequate weight gain and history of Chlamydia trachomatis (Ct) during the pregnancy was nearly twice that of women without Ct (adjusted odds ratio [AOR], 1.98; P
Methodology: Dependent/independent indicator variables were developed to support the calculation of crude odds ratios and AORs and logistic regression analysis for birth records (N = 548,407) linked to records for women who tested positive for Ct (n = 12,334), were treated, and gave birth from January 1, 2008 to December 13, 2010.
Results: Among women aged 18-35 years with singleton births, 2.7% were reported with Ct during pregnancy and 6.5% delivered LBW infants (37 weeks’ gestation) infants (AOR, 1.27; 95% CI, 1.03-1.57) among women who had Ct and treatment during the pregnancy.
Implications for women’s health: Proactive public health policies for chlamydia screening during pregnancy and intensified treatment timeliness may have contributed to improved pregnancy outcomes, but Ct infection continues to be associated with increased odds of delivering moderately LBW infants. Findings have implication for targeted regulatory change to enhance practice guidelines and expand electronic laboratory reporting to improve sexually transmitted infection case management in pregnancy. Prospective examination of treatment dosage and timeliness may be informative. =
Poster Presentation – First-Place Winner
Empowering women: Use of a Pap test record/cervical cancer prevention card
By Mary Prendergast, RN, PHN, MSN and Lauren P. Hunter, PhD, CNM, WHNP, FACNM
1. Improve client education regarding the Pap test, cervical cancer, and follow-up care.
2. Increase client understanding of and compliance with use of a Pap test record.
3. Improve continuity of clients’ cervical healthcare among providers.
Purpose: To empower women in improving their preventive healthcare regarding Pap testing and improve continuity of care in a community adult care center.
Summary of the innovative project: An educational deficit was identified in a community health clinic in San Diego County, California, involving the newest Pap testing guidelines. A literature search regarding Pap testing and problems with compliance with screening indicated multiple barriers to care. Education, focused on the Pap test and health promotion, and the use of a hand-held Pap test/treatment record were identified as methods to educate women in pursuing care for cervical cancer prevention. The Pap Card was developed to resemble the immunization record card, an easy-to-use hand-held card that has been shown to improve compliance with immunizations. The two-sided Pap Card was designed to fulfill the needs of both clients and practitioners. Educational information, the current recommended schedule for Pap testing, and resources were included along with client identification and contact information on the “patient” side. The “provider” side has an area to record HPV vaccine history and Pap/HPV co-testing results, provider/clinic information, dates, treatment given, and recommendations for the next steps of care.
Outcomes: Use of the Pap Card was initiated at a community health clinic, which has a population mix similar to that of many clinics in San Diego County, California.
Implications for women’s health: The Pap Card will be used to improve rates of Pap testing and outcomes with regard to cervical cancer prevention. The easy-to-use format and information on the Pap Card enable it to be a tool that will empower women in terms of managing their cervical health and in setting an example for their younger female relatives.
Poster Presentation – Second-Place Winner
One Key Question: Better integration of preventive reproductive health into primary care
By Susan Cooksey, PhD, MSEd, WHCNP, RN; Helen Bellanca, MD, MPH; and Michele Stranger-Hunter, MS
1. Discuss the prevalence of unintended pregnancy and the need for more effective delivery of preventive reproductive services.
2. Describe the One Key Question (OKQ) initiative and its potential to serve as a model for integrating preventive reproductive health into primary care.
3. Explore ways to implement OKQ into various clinical and community settings.
Purpose: The OKQ initiative proposes that the question “Would you like to be pregnant in the next year?” become a routine preventive screening question in all primary care settings that serve reproductive-aged women.
Summary of the innovative project: Most women spend at least 30 years trying to avoid unintended pregnancy. Rates of unintended pregnancy nationally and in Oregon are near 50%. Because it is clear that the current method of delivery of reproductive health services is inadequate in this area, this initiative offers an alternative way to deliver specific reproductive support to women in preventing unintended pregnancy. The initiative also provides preconception counseling to help support a healthy-baby-and-mother outcome.
This program supports and assists primary care providers in addressing contraception and pre-conception care through prompts, access to information, and assistance with referrals. As a part of routine health screening in the primary care setting, women of reproductive age will be asked, “Would you like to be pregnant in the next year?” Supportive services in counseling, information, and referral will be offered depending on the women’s answer of “yes,” “no,” or “maybe.”
Outcomes: Many outcomes of OKQ are currently being developed. Outcome measures will be compared between sites where OKQ is initiated and others where it is not integrated into primary care. Some of the measures include women’s satisfaction with their contraceptive choice, actual use of contraception, number of unintended pregnancies, and use of folic acid supplementation in pregnancy. Cost measures such as expenditures for preterm births, maternity services for unintended pregnancies, and social services/supports needed by families pushed into poverty by unintended pregnancy will be evaluated and will provide evidence-based support for this intervention. OKQ has been endorsed by more than 18 health organizations in Oregon.
Implications for women’s health: Contraceptive counseling and pre-conception counseling are proactive interventions to support planned and healthy pregnancies. The climate of healthcare reform and renewed focus on prevention provide key opportunities for this reintegration of reproductive health services into primary care. OKQ offers an innovative approach to support healthy planned pregnancies.