Understanding women's hesitancy to undergo less frequent cervical cancer screening.

Inappropriate cervical cancer screening (e.g., screening too often) can result in unnecessary medical procedures, treatment, and psychological distress. To balance the benefits and harms, cervical cancer screening guidelines were recently modified in favor of less frequent screening (i.e., every 3 to 5 years). This study investigated women's acceptance of less frequent cervical cancer screening and their primary concerns about extending the screening interval beyond one year. A national sample of 376 U.S. women ages 21-65 completed an online survey in 2014. Predictors of willingness to get a Pap test every 3 to 5 years were identified using logistic regression. We also examined perceived consequences of less frequent screening. Over two thirds were willing to undergo less frequent screening if it was recommended by their healthcare provider. Nevertheless, nearly 20% expressed discomfort with less frequent screening and 45% were either in opposition or unsure whether they would be comfortable replacing Pap testing with primary HPV testing. Women whose most recent Pap test was (vs. was not) within the past year and women who ever (vs. never) had an abnormal Pap test were less willing to extend the screening interval. Additionally, women who typically saw an obstetrician/gynecologist or nurse practitioner for their Pap test (vs. a family physician) were less accepting of the guidelines. Hesitancy about the longer screening interval appears to stem from concern about developing cancer between screenings. Findings contribute to the growing body of research on cancer overscreening and may inform interventions for improving adherence to cancer screening guidelines.

Predictors of provider recommendation for HPV vaccine among young adult men and women: findings from a cross-sectional survey.

BACKGROUND: Although physician recommendation is one of the strongest predictors of human papillomavirus (HPV) vaccination, it is unclear for whom physicians are recommending the vaccine. To help guide intervention efforts, this study investigated predictors of participant-reported physician recommendation for HPV vaccine among young adults in the USA. METHODS: Women and men (N=223) aged 18-26 years were recruited online through Craigslist, a popular classified advertisements website. Ads were posted in the 25 largest US cities from September 2013 to March 2014. Participants completed a survey that assessed demographic and sociopolitical characteristics, sexual history, HPV vaccination history, and whether they had ever received a recommendation for HPV vaccine from a physician or healthcare provider. RESULTS: Fifty-three per cent reported receiving a recommendation for HPV vaccine and 45% had received ≥1 dose of HPV vaccine. Participants who received a recommendation were over 35 times more likely to receive ≥1 dose of HPV vaccine relative to participants without a recommendation. Bivariable and multivariable correlates of provider recommendation were identified. Results from the multivariable model indicated that younger (aged 18-21 years), female, White participants with health insurance (ie, employer-sponsored or some other type such as military-sponsored) were more likely to report receiving a recommendation for HPV vaccine. CONCLUSIONS: Results suggest that physician recommendation practices for HPV vaccination vary by characteristics of the patient. Findings underscore the key role of the healthcare provider in promoting HPV vaccination and have important implications for future HPV vaccine interventions with young adults.

The multidimensional nature of perceived barriers: global versus practical barriers to HPV vaccination.

OBJECTIVE: Perceived barriers are one of the strongest determinants of health behavior. The current study presents a novel conceptualization of perceived barriers by testing the following hypotheses: (a) perceived barriers are multidimensional and thus should cluster into distinct factors; (b) practical barriers should be salient for individuals intending to engage in a particular health behavior, whereas global barriers should be salient for individuals not intending to enact the behavior; and (c) whereas global barriers should be negatively associated with behavioral intentions, practical barriers should be positively related to intentions. METHODS: The context for this investigation was young adult women's perceived barriers to human papillomavirus (HPV) vaccination. Two months after viewing an educational video about HPV vaccination, women (aged 18-26) who had not received any doses of the HPV vaccine (n = 703) reported their perceived barriers to HPV vaccination and intentions to receive the vaccine. RESULTS: Relative to the conventional single-factor approach, a five-factor model provided a better fit to the data and accounted for a larger proportion of variance in vaccination intentions. The relative salience of different perceived barriers varied as a function of women's intentions. Participants who were not intending to get vaccinated cited global concerns about vaccine safety and low perceived need for the vaccine. In contrast, participants intending to get vaccinated cited practical concerns (cost, logistical barriers) related to carrying out their intentions. Moreover, whereas global perceived barriers were associated with lower intentions, practical barriers were associated with higher intentions. CONCLUSIONS: Perceived barriers are multidimensional and vary systematically as a function of people's behavioral intentions.

Safeguarding children: the benefits of a peer-review process.

Nurses in hospitals and in the community are increasingly taking a leading role in safeguarding children. NHS London established a Safeguarding Improvement Team (SIT) in 2009. The SIT project was designed as a one-off activity to raise performance related to safeguarding children in London. This article presents a peer-review process that was established by NHS London and implemented across the 31 PCTs across London. This article presents the peer-review process methodology and a summary of the findings from the SIT visits. Feedback was requested from participants about participants' perceptions of the peer-review process immediately after the SIT visits and again, several months after the completion of all SIT visits. Findings show that the peer-review process was of value, both organisationally and professionally, and the process itself led to identification of good practice as well as gaps in existing practices. The non-threatening nature of the peer-review process was particularly valued, as was the feedback offered by the review teams.

Predicting human papillomavirus vaccine uptake in young adult women: comparing the health belief model and theory of planned behavior.

BACKGROUND: Although theories of health behavior have guided thousands of studies, relatively few studies have compared these theories against one another. PURPOSE: The purpose of the current study was to compare two classic theories of health behavior-the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB)-in their prediction of human papillomavirus (HPV) vaccination. METHODS: After watching a gain-framed, loss-framed, or control video, women (N = 739) ages 18-26 completed a survey assessing HBM and TPB constructs. HPV vaccine uptake was assessed 10 months later. RESULTS: Although the message framing intervention had no effect on vaccine uptake, support was observed for both the TPB and HBM. Nevertheless, the TPB consistently outperformed the HBM. Key predictors of uptake included subjective norms, self-efficacy, and vaccine cost. CONCLUSIONS: Despite the observed advantage of the TPB, findings revealed considerable overlap between the two theories and highlighted the importance of proximal versus distal predictors of health behavior.

Diversity, fulfilment and privilege: the image of nursing.

AIM: To explore the image that nurses have of nursing and the image of nursing held by the public to determine the difference between the two and the impact of this on nurse recruitment. BACKGROUND: Recruitment and retention nurses are important to the Strategic Health Authority for London (NHS London) who commissioned a study to explore the image of nursing. METHOD: Qualitative survey research was used. Data were collected from nurses and from the public. RESULTS: Three themes emerged related to the image of nursing held by nurses. These were diversity, fulfilment and privilege. However, the public image of nursing does not reflect these. The public appear ill-informed of what nurses do, purporting to respect nursing but would not recommend nursing as a career choice for themselves, their children or their pupils. This study could have been enhanced through the use of questionnaires to gain quantitative data about the image of nursing. CONCLUSIONS: The public image of nursing appears positive but also has negative aspects. The public image is different from nurse's image of nursing and is based on myth, misconception and stereotype. This may influence recruitment of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The results of this study offer a way forward to develop recruitment strategies that target changing the public's image of nursing.

Correlates of HPV knowledge in the era of HPV vaccination: a study of unvaccinated young adult women.

Until recently, awareness of the sexually transmitted infection human papillomavirus-the virus that causes cervical cancer-was relatively low. The purpose of this study was to identify factors associated with human papillomavirus knowledge now that human papillomavirus vaccines have become widely available. Young adult women (n = 739; aged 18-26 years) attending Florida State University who had not yet initiated human papillomavirus vaccination completed a survey between March-August 2009. The survey assessed human papillomavirus awareness, human papillomavirus knowledge, demographics, socio-political variables, sexual history, and health history variables. Over 97% of participants were aware of human papillomavirus prior to study enrollment; however, knowledge of human papillomavirus was only moderate. A multivariate regression analysis examining factors related to human papillomavirus knowledge revealed five independent correlates: Latina ethnicity, premarital sex values, number of lifetime sexual partners, history of cervical dysplasia, and HIV testing. These variables accounted for 14% of the variance in human papillomavirus knowledge. Less knowledge was observed for Latinas and women opposed to premarital sex. Greater knowledge was observed for women who had been tested for HIV and women with more sexual partners or a history of cervical dysplasia. These findings can inform future human papillomavirus vaccination campaigns and may be particularly useful in developing interventions for individuals with the largest deficits in human papillomavirus knowledge.

Behavioral frequency moderates the effects of message framing on HPV vaccine acceptability.

BACKGROUND: Research suggests that gain-framed messages are generally more effective than loss-framed messages at promoting preventive health behaviors. Virtually all previous studies, however, have examined prevention behaviors that require regular and repeated action to be effective. Little is known about the utility of message framing for promoting low-frequency prevention behaviors such as vaccination. Moreover, few studies have identified mediators of framing effects. PURPOSE: We investigated whether behavioral frequency (operationalized as the number of shots required) moderated the effect of framed health messages on women's intentions to receive the human papillomavirus (HPV) vaccine. We also sought to identify mediators of framing effects. METHOD: Undergraduate women (N = 237) were randomly assigned to read an HPV vaccination booklet that varied by message frame (gain vs. loss) and behavioral frequency (one shot vs. six shots). RESULTS: We observed a frame-by-frequency interaction such that the loss-framed message led to greater vaccination intentions than did the gain-framed message but only among participants in the one-shot condition. Perceived susceptibility to HPV infection mediated the observed framing effects. CONCLUSIONS: This study provides an important exception to the commonly observed gain-framed advantage for preventive health behaviors. Loss-framed appeals appear to be particularly effective in promoting interest in low-frequency prevention behaviors such as HPV vaccination.

Using message framing to promote acceptance of the human papillomavirus vaccine.

OBJECTIVE: Use of message framing for encouraging vaccination, an increasingly common preventive health behavior, has received little empirical investigation. The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer. DESIGN: Undergraduate women (N = 121) were randomly assigned to read a booklet describing the benefits of receiving (gain-framed message) or the costs of not receiving (loss-framed message) a prophylactic HPV vaccine. After reading the booklet, participants indicated their intent to obtain the HPV vaccine. MAIN OUTCOME MEASURE: A 5-item composite representing intentions to obtain the HPV vaccine. RESULTS: The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation. A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms. The loss-frame advantage was also observed among participants high in avoidance motivation. CONCLUSION: Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance. This study has practical implications for the development of health communications promoting vaccination.

Predictors of human papillomavirus vaccination acceptability among underserved women.

OBJECTIVES: The objectives of this study were to examine underserved women's acceptability of the forthcoming human papillomavirus (HPV) vaccines and to identify correlates of HPV vaccine acceptability. STUDY DESIGN: A sample of primarily low-income minority women (n = 58) recruited from community health clinics completed a semistructured interview assessing health beliefs, vaccination attitudes, health behavior, and HPV vaccination intentions. RESULTS: Personal acceptability of the HPV vaccines was generally high. Moreover, 100% of parents were interested in having their children vaccinated. Correlates of vaccination intentions included health beliefs and attitudes (perceived risk of HPV infection, perceived safety and effectiveness of HPV vaccines, perceived physician encouragement for vaccination) and previous health behavior (HIV testing). Independent predictors of vaccine acceptability were also identified. CONCLUSIONS: The current study highlights key correlates of vaccine acceptability that may inform HPV vaccination campaigns for underserved populations.

Proliferation of electronic health records among obstetrician-gynecologists.

OBJECTIVE: To examine the current use of electronic health records (EHRs) and their key subfunctions among obstetrician-gynecologists and compare this trend with other doctors. METHODS: In this study, we examined responses to a large statewide study of EHR use among Florida physicians practicing in the ambulatory setting. For assessment purposes, we compared obstetrician-gynecologists with other primary care physicians (PCPs) and surgeons with respect to EHR utilization, the availability of key EHR functions, and time since adoption. In addition, we examined adoption intentions among non-EHR users. To compare differences among groups, the chi-square test was utilized with significance level set at P < .05. RESULTS: A total of 2428 responses (28.4% response rate), of which 454 were from obstetrician-gynecologists, were available for the current study. EHR use among obstetrician-gynecologists (18.3%) was significantly less (P < .001) than among PCPs (25.7%) and surgeons (20.5%). Among EHR users, obstetrician-gynecologists were significantly less likely than PCPs to have the following desirable EHR functions: problem lists (P < .001), medication lists (P < .001), allergy information (P = .014), electronic prescribing of medications (P = .001), electronic order entry (P = .009), electronically available laboratory results (P = .002), electronic connection to pharmacy information (P = .008), preventative service reminders (P < .001), and patient education material (P = .004). Moreover, obstetrician-gynecologists were significantly more likely to have adopted their system within the last 2 years. However, among nonusers, they were not more likely to indicate the intention to adopt EHR. CONCLUSION: Compared with peers, obstetrician-gynecologists are less likely to be using EHR in their practice. In addition, their systems tend to have fewer medical error preventing functions and fewer basic functions.

Gonadal steroids, selective serotonin reuptake inhibitors, and mood disorders in women.

That gonadal steroids influence the limbic system and that they affect neurotransmitter activity is undisputed. Because of these known actions, and because ET and HT alleviate hot flushes and resultant sleep disturbances, they may improve mood and sense of well-being in healthy climacteric women. However, estrogen plus progestin did not decrease depressive symptoms in the WHI, the largest double-blind, placebo-controlled trial of hormone replacement yet performed. In addition, although several studies have suggested efficacy in this regard, neither ET nor HT has been proved to be therapeutic for major depression in perimenopausal and menopausal women. Certainly, further studies are needed on the potential of estrogen as an antidepressant. Based on current evidence, however, one cannot prescribe ET or HT as primary treatment for major depression in good conscience. When treating patients far this serious problem, one cannot rely on theory and the desire that it be borne out. As Sigmund Freud wrote: "Thus we call a belief an illusion when a wish-fulfillment is a prominent factor in its motivation, and in doing so we disregard its relation to reality, just as the illusion itself set, no store by verification". Since the initial publication of the results of the WHI, clinicians have learned to be cautious when making decisions about therapy that has not been proved in randomized controlled trials. In addition, attention has shifted away from potential global effects of ET and HT toward more specific management of each specific clinical sequela of menopause. If major depression is to be addressed in this way, SSRIs become first-line therapy, with TCAs considered second-line because of reduced tolerability. ET and HT may be added separately as appropriate, and may be helpful on an individual basis. Indeed, treatment for major depression in any person, male or female, at any age, is best chosen based on life situation and the neuropsychology of the condition, and not based on gender alone.

Pharmacy-based care for perimenopausal and postmenopausal women.

Perimenopause and menopause represent a major physiologic and, often, psychosocial transition in the lives of women. During this time, women often experience disturbing new symptoms and develop an increased awareness of their risks for major chronic illnesses. Women in this stage of life are often highly motivated to improve their health and can benefit greatly from pharmacy-based preventive health care services. Although perimenopausal and menopausal women represent an important target market, some pharmacists may wish to offer more focused services within the broader arena of women's health. For example, a number of community pharmacies have developed niche services for these patients, such as osteoporosis screening, (46) breast cancer risk assessment, (50) or bioidentical HRT consulting and compounding. (59) Other pharmacy care services that may be targeted to women in midlife include smoking cessation, weight management, and dietary supplement consulting. Based on the experiences of the Mar-Main Pharmacy staff, a practical approach is to implement new services gradually, while focusing on providing high-quality, individualized service to a small number of patients. Using this strategy, Mar-Main Pharmacy has experienced tremendous growth in its bioidentical HRT services. This increase in demand for pharmacy services has arisen from word-of-mouth referrals from patients and physicians rather than formal marketing. Perimenopausal and menopausal women represent a growing and increasingly knowledgeable group of patients. Many of these women are seeking care that is individualized, responsive to their health beliefs, and designed to help them maintain a high quality of life. Providing pharmacy-based consulting services for these patients can be extremely rewarding, both professionally and personally.

Therapeutic options in female sexual dysfunction.

OBJECTIVE: To review the psychology and physiology of female sexual dysfunction (FSD) and explore current strategies for prevention and treatment. DATA SOURCES: Articles identified through a MEDLINE search using the term female sexual dysfunction. Additional references were identified from the bibliographies of retrieved articles. STUDY SELECTION: Investigational studies, clinical trials, and review articles examining female sexual dysfunction. DATA SYNTHESIS: FSD is a widespread problem that can arise from disorders of any component of female sexual response. These disorders are classified as problems with sexual desire, arousal, orgasm, and sexual pain. The dysfunction that characterizes these disorders may stem from a variety of factors, including psychologic issues surrounding sex and the effects of medications on female sexual response. Although pharmacists are unlikely to be involved in counseling patients about the psychologic aspects of sexual dysfunction, they can play a vital role in screening for and managing sexual adverse effects of medications. A variety of nonprescription, prescription, and investigational products may be of benefit for addressing the various types of disorders. CONCLUSION: Pharmacists who have a thorough understanding of female sexual response, potential causes of dysfunction, and accepted treatment strategies can help detect FSD and advise women about their options for managing this common problem.