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Health Care Providers

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Health Care Providers Interactions with Women who have Human Papillomavirus (HPV) Heather M. Brandt, PhD, CHES1 Patricia A. Sharpe, PhD, MPH1 – PowerPoint PPT presentation

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Title: Health Care Providers


1
Health 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
2
Study 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

3
Background 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)

4
Study 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
5
Methods
  • 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

6
Methods
  • 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

7
Methods
  • 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

8
Participant 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

9
Results
  • 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

10
Results
  • 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

11
Results
  • 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

12
Results
  • 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

13
Discussion
  • 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.

14
Recommendations
  • 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

15
Acknowledgment
  • 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.
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