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
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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

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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)

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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
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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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.