Transcript 48x36 poster template - University of Michigan Health System

SEXUAL RISK HISTORY APPROACH THAT IMPROVES
ADOLESCENT-PROVIDER COMMUNICATION
Kristy K. Martyn, PhD, FNP-BC, CPNP-PCa, Cynthia Darling-Fisher, PhD, FNP-BCa, Michelle Pardee, MS, FNP-BCa, Katherine Kristofik, MSN, FNP-BCb,
David L. Ronis, PhDac, Irene L. Felicetti, MLS, BSa, and Melissa A. Saftner MS, CNM a
aSchool of Nursing, University of Michigan, Ann Arbor, Michigan
bOakwood Hospital, Detroit, Michigan
cDepartment of Veterans Affairs, Ann Arbor, Michigan
BACKGROUND AND SIGNIFICANCE
Sexual risk history using Event History Calendars
(EHCs) has been proposed as an efficient approach
to improve adolescent-provider communication and
potentially reduce risk behaviors. The EHC
approach addresses limitations of adolescent brain
development, such as not fully developed judgment
and self-awareness, by allowing the adolescent to
concretely see their patterns of risk behaviors over
time and discuss risks in context with providers.
Teens said, “We talked
about the other things…..
not just my sexual history..
like my life history and that
made me feel more open
and more able to talk to
the practitioner.”
Providers said they could
partner with teens to obtain
a “richer amount of information,
” “show [the teen] visually what
their behavior was,” and “intervene on a
different level” to promote sexual risk
reduction.
METHODS
RESULTS
This was a mixed methods exploratory Phase II pilot study. Adolescent
patients (n=30; 19 females; 11 males) in a school-linked clinic who
reported being sexually active in the past 3 months self-administered the
EHC and then discussed their EHC with a nurse practitioner (NP) (n=2)
during a clinic visit.
Adolescents reported sexual risk behaviors and perceptions about EHC
communication with providers on a questionnaire at pre- and post-clinic
visit, at 1and 3-months (retention was 95.5%), and during an interview at
post-visit. The NPs reported their perceptions about the use of EHCs by
questionnaire post-visit and in an interview.
CONCLUSIONS/IMPLICATIONS
• Descriptive statistics, paired t-tests, and Chi-square tests were used to
analyze questionnaire responses.
• The constant comparative method was used to identify common themes
related to clinical use of the EHC and communication.
What is your age?
What is your grade in school?
We gratefully acknowledge the following grant
support by the National Institutes of Health and
National Institute of Nursing Research, The Michigan
Center for Health Intervention, P30 NR009000.
The EHC approach improved adolescent-provider
communication and identification of risk behaviors, was
well received by adolescents, and can be efficiently used
in clinic settings. Next steps include an NIH randomized
clinical trial focused on reduction of adolescent sexual risk
behavior.
EVENT HISTORY CALENDAR
OBJECTIVES/AIMS
FUNDING MECHANISM
Adolescents also reported decreased sexual intercourse
at one month, p=.031. Adolescents and NPs reported the
EHC approach improved sexual risk communication, and
increased adolescent awareness of their risk behaviors.
Quantitative and qualitative analyses were performed.
Year
To explore the effects of clinical use of an event
history calendar (EHC) approach that encourages
conversation and disclosure of adolescent sexual
risk histories on: adolescent-provider communication
and avoidance of unprotected sexual intercourse
post-intervention.
Statistically significant results related to the EHC
approach included: Scores increased on Amount of
Communication, t(29)=8.174, p<.001; Satisfaction with
Communication, t(29)=3.112, p=.004; Client Involvement
in Decision Making, t(29)=3.901, p=.001, and Client
Satisfaction with Interpersonal Style, t(29)=3.763, p=.001.
What are your activities?
Where do you stay, and who
do you stay with?
“I never thought it was a big deal until I had to
write it down and see it for my own eyes.”
(female 17 yrs.)
Who are your family and
friends?
“It brought back a lot of stuff that I didn’t even
remember . . . people that I’ve had sexual
encounters with . . . made me think of a lot of
stuff.” (male 18 yrs.)
What negative events or losses
have you had?
“I think they enjoyed filling it out . . . allowed
them to look at their behavior in a way that they
haven’t in the past.” (provider)
What positive events have you
had?
What is your sexual activity?
Have you had any of these
behaviors: smoking, alcohol,
drugs, cutting?
2005
(2 years ago)
2006
(last year)
2007
(current year)
2008
(next year)