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Capstone Powerpoint Presentation

  1. 1. The Effect of an Educational Program for Nursing Students on HPV Disease and Vaccine<br />Colleen R. Barrett, MSN, CRNP, DNP (c)<br /> Principal Investigator<br />Mary Cothran, PhD, CRNP, FNP-BC<br />Capstone Advisor<br />
  2. 2. Purpose<br />To determine the effect of an educational program about human papillomavirus (HPV) on the knowledge base of baccalaureate nursing students<br />
  3. 3. Implications for Study<br />Limited research has shown a knowledge deficit about HPV among nursing students <br />Educational programs on HPV for this group may translate to improved personal and public health<br />
  4. 4. Background and Significance<br />HPV<br />Most common STI in the US (1,2)<br />Infects 6.2 million US residents annually (1)<br />
  5. 5. Background and Significance<br />HPV<br />Over 100 strains; at least 40 known to be oncogenic (3).<br />Types 6 and 11-low risk. Cause majority of genital warts (condyloma) (4).<br />Types 16 and 18 most oncogenic. Together cause over 80% of cervical cancers (4).<br />
  6. 6. Cervical Cancer<br />In the US in 2005 (7)<br />11,999 newly diagnosed<br />3,924 died of the disease<br />
  7. 7. Cervical Cancer<br />Worldwide (9)<br />HPV causes over 500,000 cases of genital cancers annually <br />370,000 of those are known cervical cancers <br />270,000 of those will lead to death <br />
  8. 8. HPV prevention<br />Primary prevention of the human papillomavirus is now possible. <br />
  9. 9. HPV PREVENTION<br />Vaccination<br />June 2006: prophylactic, quadrivalent HPV 6/11/16/18 VLP vaccine (Gardasil) was licensed for use<br />Indicated for males and females ages 9-26<br />Has been shown to prevent up to 70% of cervical cancers caused by HPV 16/18 (14). <br />
  10. 10. Knowledge Deficit<br />Numerous surveys on college campuses in US and Canada:<br />Low level of HPV knowledge among college students and nursing students<br />
  11. 11. Knowledge Deficit<br />Ingledue, et al.<br />College students<br />Denny-Smith, et al.<br />nursing students<br />Both studies revealed poor knowledge, low perception and high risk sexual behaviors<br />
  12. 12. Knowledge Deficit<br />Data support the need to educate adolescents and women about HPV<br />Studies reveal women desire more information about HPV (24)<br />
  13. 13. HPV Education<br />Few studies on effect of HPV-focused educational programs<br />Lambert (25) evaluated the effectiveness of a brief HPV focused educational program<br />Physician Assistant and Psychology students<br />Data revealed statistically significant improvement in HPV knowledge scores after the program<br />
  14. 14. STD and Pregnancy Prevention Programs<br />Have been shown in literature to be successful<br />Anderko and Uscian (22)<br />Studied decreasing risky sexual behavior<br />Kirby<br />Research review revealed success with educational programs on HIV prevention<br />
  15. 15. Study Design<br />Pre-test/Post-test<br />
  16. 16. Sample<br />Convenience sample of full time senior level undergraduate nursing students (n=18)<br />Demographic data analyzed using frequencies and averages<br />Mean age of students was 22.53 years (SD 1.13) –after removal of 3 outliers (ages 33, 37, 42)<br />
  17. 17. Sample<br />Participation was voluntary<br />Completion of study materials considered implied consent<br />No incentives offered for participation<br />Study approved by IRB at RMU and Human Subject’s Review Board at host university<br />
  18. 18. Instrument<br />The Awareness of HPV and Cervical Cancer Questionnaire (23)<br />40 item multiple choice questionnaire<br />Developed to assess knowledge, perceptions, and preventive behaviors regarding HPV and cervical cancer<br />
  19. 19. Instrument<br />Permission to use granted by author, Ingledue (23)<br />Stability reliability established by test-retest procedures<br />Test-retest coefficients of 0.90 reported for knowledge; 0.95 for perceptions and 0.90 for behaviors<br />
  20. 20. Instrument<br />No data reported for internal consistency<br />Content validity established via consensual validity using a panel of health experts<br />Instrument was approved by a Human Subject’s committee<br />
  21. 21. Instrument<br />For present study, only the knowledge items of the instrument were used<br />Multiple choice questions<br />One correct answer<br />Correct answers assigned one point<br />Score range of 0 to 15<br />
  22. 22. Data Collection<br />Demographic questionnaire with cover letter describing study<br />Questionnaires numbered by author<br />Pre-test/post test-numbered by participants<br />All placed in privacy envelopes upon completion. <br />
  23. 23. Educational Intervention<br />Objectives<br />Increase general knowledge of HPV disease and its sequelae<br />Identify-<br />Risk factors for HPV and cervical cancer<br />Symptoms of HPV infection<br />Means to prevent HPV and cervical cancer<br />Means of detecting HPV and cervical cancer<br />
  24. 24. Educational Intervention<br />Content:<br />HPV types<br />HPV incidence, prevalence and pathogenesis<br />HPV risk factors and sequelae<br />Various stages of cervical dysplasia and cervical cancer<br />Cervical cancer statistics<br />Knowledge deficit<br />Quadrivalent HPV vaccine <br />
  25. 25. Educational Intervention<br />Concluded with open question and answer period<br />
  26. 26. Data Analysis<br />Data entered into Access Excel<br />Paired t-test<br />Analysis performed using SPSS 17.0<br />
  27. 27. Results<br />Mean of pre-test: 10.83 (SD 1.043)<br />Mean of post-test: 13.78 (SD 1.166)<br />t=7.517(7), p=.000 <br />
  28. 28. Discussion<br />Mean pre-test score: 72%<br />Mean post-test score: 91%<br />
  29. 29. Discussion<br />Undergraduate nursing students<br />Will be able to disseminate accurate information about HPV disease and vaccine to patients<br />May be of the age group recommended to receive the vaccine themselves<br />Improved knowledge in this group may contribute to public health both directly and indirectly<br />
  30. 30. Discussion<br />Study limitations<br />Small sample size<br />Homogeneity of sample<br />Vaccine knowledge not assessed<br />38.9% of students reported some previous education on HPV disease<br />Entire tool not utilized<br />
  31. 31. Future Research<br />Should include larger sample size<br />Nursing students in various pre-licensure programs<br />More heterogeneous sample<br />Assess knowledge retention over time<br />Vaccine knowledge (instrument development)<br />Vaccination status pre- and post-program<br />Include practicing nurses and their practice habits as they pertain to patient education<br />
  32. 32. Implications for Study<br />HPV incidence and subsequent cervical disease burden may be reduced through education of nurses<br />Nurses can have positive effect public health as they disseminate accurate information <br />
  33. 33. References<br /> 1. Fontenot HB, Collins Fantasia H, Allen JD. HPV in adolescents: Making the wake up call. Adv Nurse Pract. 2007;15(10): 73-76.<br /> 2. Denny-Smith T, Bairan A, Page M. C. A survey of female nursing students’ knowledge, health beliefs, perceptions of risk, and risk behaviors regarding human papillomavirus and cervical cancer. J AmAcad Nurse Pract. 2006;18:62-69. <br /> 3. O’Brien J. 11th annual conference on vaccine research. Expert RevVaccines. 2008;7(6):721-723. <br /> 4. Bosch, FX, & de Sanjose, S. (2003). Chapter 1: Human papillomavirus and cervical cancer burden and assessment of causality. J Natl CancerInst Monogr. 2003;31;3-13<br />
  34. 34. References<br />5. Walboomers JMM, Jacobs M, Manos N, Bosch F, Kummer A, Shah K. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12-19. <br /> 6. Oaknin A, Pilar-Barretina M. Human papillomavirus vaccine and cervical cancer prevention. Clin and Transl Oncology. 2008;10:804-811. <br /> 7. Cervical cancer statistics. Centers for Disease Control Website. Updated July 20, 2009. Accessed September 3, 2009.<br /> 8. Buttin B, Herzog T, Mutch D. Abnormal cytology and human papillomavirus. In: Curtis M, Overholt S, Hopkins M. Glass’ Office Gynecology. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2006:80-106<br />
  35. 35. References<br /> 9. Block S, Nolan T, Sattler C, Barr E, Giacoletti KED, Marchant CD, et al. Comparison of the immunogenicity and reactogenicity of a prophylactic quadrivalent human papillomavirus (types 6, 11, 16, 18) l1 virus-like particle vaccine in male and female adolescents and young adult women. Pediatrics. 2006;118(5);2135-2145.<br /> 10. Future I Study Investigators. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N England J Med. 2007;356(19):1928-1943.<br /> 11. Parkin D, Pisani P, Ferlay J. Estimates of the worldwide incidence of mortality from 25 cancers in 1990. Int J Cancer. 1999;80:827-841.<br />
  36. 36. References<br />15. Cancer Prevention & Early Detection Facts & Figures. American Cancer Society Website<br /> Reported as of November 30, 2007. Accessed September 3, 2009. <br /> 16. Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. 2000;132:810-819. <br /> 17. Adams M, Jasani B, Fiander, A. Human papillomavirus (HPV) prophylactic vaccination: challenges for public health and implications for screening. Vaccine. 2007;25:3007-3013.<br />
  37. 37. References<br />18. Future II study group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356(19):1915-1927.<br /> 19. Zimet GD, Liddon N, Rosenthal SL, Lazcano-Ponce E, Allen B. Psychosocial aspects of vaccine acceptability. Vaccine. 2006;24S3, S3/201-S3/209.<br /> 20. Ramirez J, Ramos D, Clayton L, Kanowitz S, Moscicki. Genital human papillomavirus infections: Knowledge, perception of risk, and actual risk in a nonclinic population of young women. J Womens Health. 1997;6:113-121.<br />
  38. 38. References<br />21. Pitts M, Clarke T. Human papillomavirus infections and risks of cervical cancer: what do women know? Health Educ Res. 2002;17(6):706-714.<br /> 22. Baer H, Allen S, Braun L. Knowledge of human papillomavirus infection among young adult men and women: implications for health education research. J Community Health. 2000;25:67-78.<br /> 23. Yacobi E, Tennant C, Ferrante J, Naazneen P, Roetzheim R. University students' knowledge and awareness of HPV. Prev Med. 1999; 28:535-541.<br />
  39. 39. References<br />24. Zimet GD. Improving adolescent health: focus on HPV vaccine acceptance. J Adolesc Health. 2005;37:19-23.<br /> 25. Anderko L, Uscian M. Academic-community partnerships as a strategy for positive change in the sexual behavior of rural college-age students. Nurs Clin North Am. 2002;37:341-349.<br /> 26. Ingledue K, Cottrell R, Bernard A. College women’s knowledge, perceptions, and preventive behaviors regarding human papillomavirus infection and cervical cancer. Am J of Health Stud. 2004;19(1):28-34. <br />
  40. 40. References<br />27. Holcomb B, Bailey J, Crawford K, Ruffin M. Adults' knowledge and behaviors related to human papillomavirus infection. J Am Board Fam Practice. 2004;17(1):26-31.<br /> 28. Lambert E. College students’ knowledge of human papillomavirus and effectiveness of a brief educational intervention. J Am Board Fam Pract. 2001;14(3):178-183. <br /> 29. Kirby D. Emerging answers: research findings on programs to reduceteen pregnancy (summary). Washington, DC: National Campaign to Prevent Teen Pregnancy. 2001.<br />