College students' preferences for health care providers when accessing sexual health resources

Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health

Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.

Re-envisioning the role of student health centers in offering LGBTQIA + friendly and sex-positive services

Objective: Offering comprehensive lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual (LGBTQIA+) friendly and sex-positive student health centers are central to institutions of higher education being able to retain and support students. Positive sexual experiences for LGBTQIA + students can have an impact on academic success but many LGBTQIA + students are discriminated against and are often victims of microaggressions. Participants: Twenty undergraduate students enrolled in a LGBTQIA+ health course. Methods: Students in an LGBTQIA + Health undergraduate course at a private Northeastern university assessed what mattered most to them when it came to creating a sex-positive healthcare environment that promotes LGBTQIA + inclusiveness and removes perceived barriers. Results: The themes included expanding mental health care, greater involvement of culturally-competent provider, establishing a stigma-free clinical environment, re-imagining the clinic waiting room, and facilitating sexual health advocacy. Conclusion: Re-envisioning the role of student health centers is critical for ensuring every student has a fair and just opportunity to achieve their full health potential.

A health risk assessment and early alcohol intervention program for non-mandated students

OBJECTIVE

We examined the effects of a two-part intervention including an online health risk assessment with personalized feedback and a brief in-person alcohol intervention for high-risk students.

PARTICIPANTS

Participants were 1,987 sophomore students, with 259 completing the alcohol intervention and 91 completing all follow-up surveys.

METHODS

Students were invited to take an initial online health assessment covering a range of health behaviors and subsequent 3-month follow-up survey. Students who reported high-risk alcohol behaviors on the assessment were invited to participate in two one-on-one sessions utilizing motivational interviewing. Follow-up surveys occurred 3, 6 and 12 months later.

RESULTS

Students who completed the health risk assessment reported knowledge and behavior changes. Students who completed the in-person alcohol intervention showed significant reductions in alcohol risk behavior 3-, 6- and 12-months post-intervention.

CONCLUSIONS

A two-part intervention for non-mandated students including a health risk assessment and one-on-one intervention shows promise in reducing alcohol risk.

Communication effectiveness: examining interactions between college health professionals and students on university campuses

ObjectiveTo examine how students would describe their communication exchanges with college health professionals on a university campus and also how students perceived those exchanges to be effective health communication. Participants: 48 participants completed the online survey. Methods: An open-ended questionnaire was utilized to collect data. Thematic analysis technique was used to analyze the data. Results: The analysis yielded six themes that emerged from participants' responses: clear communication, instruction, listening, friendliness, immediate feedback, and professionalism. Conclusions: The findings show that students' understanding of efffective health communication differs. Therefore, college health professionals should be cognizant of these differences when communicating with students who access health services on university campuses.

"Starting that Conversation Is Even Harder than Having It": Female Patients' Perceptions of Physicians' Communication Competence in Communication about Sexual Behavior

Female college students demonstrate a persistent lack of knowledge about safe sexual practices and engage in sexual behavior that puts them at risk for sexually transmitted infections and unplanned pregnancy. Physicians have an opportunity to provide accurate and timely information about safe sexual behavior to individuals in their care. However, many young people, and in particular young women, are reticent to talk to their physicians about sexual behavior because they typically consider the information to be private. Exacerbating this issue is the fact that many physicians are also uncomfortable discussing sexual topics with their patients. In this study, Communication Privacy Management (CPM) theory is used to investigate the criteria that female college students employ to negotiate the disclosure and concealment of information about sexual behavior in communication with physicians. Qualitative analysis of semi-structured interviews with female college students was used to explain their perceptions of disclosure of sexual behaviors to their physician. Specifically, the participants' perceptions of physicians' communication competence informed privacy management rules. These findings have the potential to improve communication interventions for both female college students and healthcare professionals.

University students' behaviours towards accessing sexual health information and treatment

Globally, it is widely recognised that young people (those under the age of 25 years) are at a higher risk of developing sexually transmitted infections (STIs). The majority of university students studying in the UK fall within this age bracket, and to help prevent such high incidence of STIs in this age group, it is essential that advice and treatment, if required, are obtained from reliable sources. This study sought to explore sources of sexual heath advice and treatment for students at Welsh universities (n = 3007). The main sources of advice were identified as the internet (49.1%) and GP/family doctors (38.9%), whilst local sexual health clinics (24.9%) and GP/family doctor services (20.2%) were the main sources for treatment in students. Males were more likely than females to report never needing advice (AOR 2.74; CI = 2.24-3.35) or requiring treatment (AOR 1.37; CI = 1.17-1.60). The apparent lack of engagement with these services by male students is a cause for concern, although one possible solution could be to further develop online methods to increase uptake of testing. Furthermore, the popularity of the internet for advice provides a timely reminder that regulation of online sexual health information is critical.

Emerging Adults' Discussion of Substance Use and Sexual Behavior with Providers

Emerging adulthood (ages 18-25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics - specifically substance use and sexual behavior - are not routinely brought up by providers.

Improving student knowledge and perceptions of primary care providers at campus health centers

OBJECTIVE

To examine current knowledge and perceptions toward primary care providers commonly staffed at student health centers (PAs and NPs), and also assess the effectiveness of information-rich provider biographies to improve knowledge and perceptions.

PARTICIPANTS

One thousand six hundred forty six students from 2 universities in 2 states participated in this study from February to November, 2016.

METHODS

An online survey. Students were exposed to an improved biography of an NP discussing how she can perform many of the same duties as primary care physicians. Changes in knowledge and perceptions were assessed pre- and post-biography exposure.

RESULTS

More than half of students are unaware NPs and PAs can prescribe medications and diagnose illnesses. Students exposed to the biography increased their knowledge of NPs, and perceptions of their expertise.

CONCLUSIONS

Results suggest improved provider biographies on student health centers' websites can help reduce the knowledge deficit that exists among students regarding common primary care providers.

A Qualitative Investigation of Healthcare Engagement Among Young Adult Gay Men in New York City: A P18 Cohort Substudy

PURPOSE

We used in-depth interviews with a cohort of young adult gay men (YAGM) to provide a more detailed understanding of their current healthcare engagement, including experiences with the healthcare system, provider knowledge of healthcare needs, and desired provider characteristics.

METHODS

Qualitative interviews were conducted with a sample of 40 YAGM in New York City. The interview guide examined healthcare engagement across key developmental stages: childhood (birth-12), adolescence (13-18), young adulthood (19-22), and the present (23-26). All transcripts were coded using a consensual qualitative research approach to identify crosscutting topics. The interviews were conducted between September and October 2015.

RESULTS

The following topics were identified: experiences with the healthcare system, provider knowledge of healthcare needs, and desired provider characteristics. Common barriers to healthcare access were financial concerns, lack of insurance, and dissatisfaction with the care provided. Reasons for dissatisfaction with care were based on perceptions of providers' anti-gay attitudes, judgment of same-sex sexual behavior, and lack of provider knowledge about YAGM's health needs. This often led men in this study to seek sexual healthcare from providers other than their primary care provider. When asked about desired provider characteristics, participants noted that basic demographics were of less importance than skills-based characteristics such as rapport, comfort discussing sexual health issues, and knowledge of YAGM's health.

CONCLUSION

YAGM have unique challenges to engaging in healthcare, including provider stigma and lack of provider knowledge of YAGM's health needs, which are not faced by other young adult populations. The results from this study highlight the need for more extensive and standardized training in medical school and as part of continuing medical education for healthcare providers.

Campus Health Centers' Lack of Information Regarding Providers: A Content Analysis of Division-I Campus Health Centers' Provider Websites

Campus health centers are a convenient, and usually affordable, location for college students to obtain health care. Staffed by licensed and trained professionals, these providers can generally offer similar levels of care that providers at off-campus clinics can deliver. Yet, previous research finds students may forgo this convenient, on-campus option partially because of a lack of knowledge regarding the quality of providers at these campus clinics. This study sought to examine where this information deficit may come from by analyzing campus health centers' online provider information. All Division-I colleges or universities with an on-campus health center, which had information on their websites about their providers (n = 294), had their providers' online information analyzed (n = 2,127 providers). Results revealed that schools commonly offer professional information (e.g., provider specialties, education), but very little about their providers outside of the medical context (e.g., hobbies) that would allow a prospective student patient to more easily relate. While 181 different kinds of credentials were provided next to providers' names (e.g., MD, PA-C, FNP-BC), only nine schools offered information to help students understand what these different credentials meant. Most schools had information about their providers within one-click of the homepage. Recommendations for improving online information about campus health center providers are offered.

The application of a feminist poststructural framework in nursing practice for addressing young women's sexual health

AIMS AND OBJECTIVES

Using a feminist poststructuralist framework, this paper examines the conflicting discourses of young women who experience power struggles with regard to their sexuality and sexual health practices. It aims to provide nurses with a pragmatic framework for exploring, interrogating and potentially transforming health care situations when caring for young women in a sexual health setting.

BACKGROUND

Sexuality and sexual health are important components of health and well-being. Young men and women are continually perpetuated with societal ideals of sexuality and sexual health practices. Young women specifically, receive societal and peer pressure to conform to certain sexual health practices that can lead to both positive and negative health outcomes. Nurses and other health care providers may care for young women in a public or acute care setting that are living with these conflicting sexual health discourses.

DESIGN

A review of the literature on young women's sexuality and sexual health was conducted and analysed using a feminist poststructuralist framework.

METHODS

A review of the sexual health literature on young women was conducted. Issues identified from the review, as they relate to sexual discourse were power, language, subjectivity and agency. Nursing strategies to address these issues in practice were identified using a feminist poststructuralist framework.

DISCUSSION

The feminist poststructural framework highlights the conflicting discourses related to young women's sexuality and sexual health practices. This paper provides a pragmatic example of how to incorporate theory to improve nurses' understanding of an individual or group's health.

RELEVANCE TO CLINICAL PRACTICE

Examples of how a feminist poststructural framework can be used to enhance sexual health nursing practice are discussed, such as helping nurses to challenge the status quo and question the sexual health norms among young women.