Title: Health Care Providers
1Health Care Providers Interactions with Women
who have Human Papillomavirus (HPV)Heather M.
Brandt, PhD, CHES1Patricia A. Sharpe, PhD,
MPH1Jill M. Abbott, DrPH2Donna H. McCree, PhD,
MPH, RPh3 1University of South Carolina,
Prevention Research Center2University of South
Carolina, Department of Health Promotion,
Education, and Behavior3Centers for Disease
Control and Prevention, National Center for HIV,
STD, and TB Prevention
2Study Objective
- To explore health care providers (HCPs)
attitudes and perceptions about women who have
high-risk HPV and perceived needs of high-risk
HPV positive women - Provided the researchers with information from
the perspective of HCPs - Findings informed development of quantitative
instrument to be administered to women tested for
HPV in second phase of study
3Background and Setting
- South Carolina ranks 8th in USA in cervical
cancer mortality - Four federally-funded, primary health care
clinics - All women with Pap test result of ASCUS or higher
are tested for HPV (HCII) (reflexive testing) - HCPs are predominantly nurse practitioners and
family medicine practitioners - Pee Dee region of South Carolina
- Predominantly rural (60)
- Large minority population (42)
- Low income ( families w/children in poverty23)
- Low education level (lt9th grade 19)
- High cervical cancer incidence rate (15.27 per
100,000)
4Study Population
Pee Dee Region 15.27 per 100,000 cervical ca
incidence
South Carolina 8th in USA in cervical ca
mortality 10.25 per 100,000 cervical ca incidence
5Methods
- Background Information Questionnaire
- Perception of prevalence of HR-HPV
- Perception of vaccine acceptability
- Patient counseling topics for HPV women
- Sociodemographic variables
- Discussion Group Questions
- HPV testing protocol
- Counseling messages
- Treatment recommendations
- Womens responses to HPV positivity
- Patient education challenges
6Methods
- Data Collection
- Four, one-hour discussion groups (one at each of
four clinics) conducted in May and June 2002 - Facilitated by public health researcher
- Audiotaped and field notes recorded
- Informed consent completed
7Methods
- Data Management
- Audiotaped groups were transcribed verbatim and
reviewed for quality control purposes - Data Analysis
- Paper and pen, note-based analysis to identify
overarching themes and to conduct more detailed
analyses - Key concepts and themes specific to knowledge
emerged from the data - Descriptive statistics analyzed in SPSS 10.1
8Participant Characteristics
- 35 total participants
- 6-11 health care providers in each group
- 34 women, 1 man
- 18 White, 17 African American
- Most between ages 30-39
- MDs (n5), FNPs (n4), CNMs (n2), Others (n23)
including CMAs, CNAs, social workers, lab techs,
radiologic techs
9Results
- Background Information
- Estimate of high-risk HPV prevalence among their
women patients 5-70 majority 30 or less - 91 would recommend HR-HPV vaccine to women
patients - HCPs perceive that women patients would be
somewhat to very receptive of vaccine - Reported most commonly counseling HPV women
about sexual health issues, cervical cancer and
HPV, transmission of HPV, reproductive health,
disclosure to sexual partners, and viral nature
of HPV
10Results
- HCPs were receptive to vaccine for HR-HPV
- Low awareness of recent vaccine trials
- Mixed level of awareness of the corporate policy
on reflexive HPV testing - Mentioned other criteria for testing womans
previous STI history, promiscuous behavior, age - Varied responses to womans request for HPV test
when Pap test is normal - HCPs had concerns about over-treating younger
women patients
11Results
- HCPs preferred in-person discussion of HPV
results, when possible - Giving results over phone is not ideal
- HCPs reported discussing range of HPV-relevant
topics with women patients - HCPs perceptions of womens responses to HR-HPV
diagnosis - Consistent with current literature angry, mad,
scared, blaming - Testing men???
- Providers alluded to testing men for HPV
12Results
- HCPs were frustrated with repeat offenders
- Past history of STIs
- History of noncompliance with recommended
medical care - HCPs need simple educational materials, free of
medical jargon, for patients - Encouraging, friendly materials
- Color print
- Pictures, diagrams
- Referral to free resources outside of clinic
13Discussion
- HCPs want clear messages about HPV to share with
patients - HCPs want training and current information to
assist them in counseling patients about HPV - HCPs recognize absence of appropriate materials
for their population of rural, low-income women
and - HCPs perceive that their patients want more
information on HPV.
14Recommendations
- Continuing education opportunities for HCPs that
address current issues related to cervical health - Available and appropriate educational materials
for patients are needed to supplement
patient-provider communication
15Acknowledgment
- This project was supported under a cooperative
agreement from the Centers for Disease Control
and Prevention (CDC) through the Association of
Schools of Public Health (ASPH). Grant Number
U36/CCU300430-22. The contents of this article
are solely the responsibility of the authors and
do not necessarily represent the official views
of CDC or ASPH. - Special thanks to Dr. April Winningham for
facilitating the focus groups and to the health
care providers for participating in the focus
groups.