Chlamydia is an important public health issue and, as a silent infection with serious sequelae for women, is an important issue for nurses promoting adolescent health and for those who encounter infertility and ectopic pregnancy in their practice (Stewart & Sparrow-Centre, 2005). Chlamydia trachomatis is the most common sexually transmitted bacteria in the United States. It is estimated that there are three million new infections each year (Adderley-Kelly & Stephens, 2005). From 1987 through 2002, the rates of reported chlamydia infection increased from 50.8 to 296.5 per 100,000 of the population (Adderley-Kelly, 2005).
Problem Statement
As nurses, it is imperative that we complete a full health assessment which would include a sexual history to identify early risk and detection of the disease. Appropriate screens have not being followed to assess individuals with potential risk factors. Screening at-risk individuals, who have been identified particularly females ages 13-25, would help in prevention and early detection of chlamydia infection. Due to the fact that the increase in chlamydia infection is among adolescents, and the fact that it is many times asymptomatic, failure to seek medical attention occurs and subsequently leads to long-term health concerns. (Reference)
According to Burns, Briggs, & Gaudet, (2007), establishing a chlamydia testing or screening program for adolescents has always been difficult. Barriers to screening include the inability to pay for health screening is due to a lack of health insurance, lack of transportation to the clinic site, discomfort with the clinic, and confidentiality. These barriers, in conjunction with a disease that exhibits minimal or no symptoms, generate a challenge for STD programs to screen a high-risk population.
The U.S. Preventive Service Task Force (USPSTF, 2001) strongly recommended that clinicians routinely screen all sexually active women aged 25 and younger, and other asymptomatic women at increased risk for infection. Since age is the most important risk factor, women and adolescents through age 20 years are at highest risk for chlamydia infection. Other risk factors associated with high prevalence included: being unmarried, African American race, having a prior history of sexually transmitted disease, having new, or multiple sexual partners, having cervical ectopy, and using barrier contraceptives inconsistently (Adderley-Kelly, 2005). Individual risk depends on the number of risk factors and local prevalence of the disease.
Studies have shown that inadequate screening, also result from three things: first, it takes time for any new recommendations to be implemented. Second, practitioner's adherence to screening recommendations varies widely. Third, adherence to screening recommendations varies by site of care. Therefore, it is important to be able to discuss and obtain a sexual health history with all patients, identify the signs and symptoms of chlamydia and recognize potential risk factors that are associated with chlamydia infection that would place individuals at higher risk. (References)
Purpose
The purpose of the study is to investigate whether yearly screening of sexually-active females ages 13-25 will increase prevention and early detection of chlamydia infection, as compared to females age 13-25 who are sexually active and are not screened at all.
Identification of Variables and Target Population
The independent variable related to this research is screening. The dependent variables are prevention and early detection. The target population is sexually active females ages 13-25.
Hypothesis or Research Question(s)
There is a decrease in the number of chlamydia infections in sexually active females ages 13-25, by increasing early screening, awareness of prevention, and early detection of chlamydia infection. Need to reword hypothesis to use the variables, target population and comparison group in the purpose.
Definition of Terms
Theoretical Definition: According to the CDC in 2010, chlamydia is defined as a common sexually transmitted disease (STD) caused by chlamydia trachomatis, a bacterium that can damage women's reproductive organs. Even though the symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman recognizes a problem.
Operational Definition: chlamydia can be identified through a health assessment history taking by nurses and varied by the number of risk factors identified.
Theoretical Definition: Screening is performed to identify the presence of the disease or of a risk factor for a disease, typically among asymptomatic persons (those who do not already manifest symptoms of disease). In this way, a disease or the risk factors for a disease can be detected early, allowing either treatment or prevention, including preventing the further spread of communicable or transmissible diseases (Robinson, 2002).
Operational Definition: screening involves a health history, which identifies the numbered risk factors that include assessing the individual sexual health practices.
Theoretical Definition: prevention is the keeping of something (such as an illness or injury) from happening (Miller-Keane, 1997).
Operational Definition: prevention is documentation via enumeration of resources for education and prevention resources.
Theoretical Definition: sexual active: involves participation in a sexual act, being involved, and an active participant.
Operational Definition: the number of stated behavior changes delineated in post sexual sexual health history.
Theoretical Framework
The appropriate framework selected for this proposal is Nola Pender's health promotion model (HPM). The HPM, originally developed in the early 1980's, is a framework that serves as "a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in health behaviors directed toward the enhancement of health" (Pender, 1996, p. 51). The HPM is widely represented in the nursing literature and is the framework that underpins over 100 research studies.
One of the major theoretical perspectives from which HPM is derived is the social cognitive theory (SCT) (Srof & Velsor-Friedrich, 2006). The SCT is a model that explains the nature of behavioral change within the context of larger social structures (Srof et al, 2006). The nature of human agency, or the ability to control life events, is explained as a triadic reciprocal relationship between behavior, interpersonal factors (cognitive, affective, biologic), and external factors (Bandura, 1997). The assumption that people have the power to shape their own destiny and to control outcomes is a common thread in both the SCT and the HPM (Srof & Velsor-Friedrich). For example, the adolescent population often represents unique challenges in healthcare as teens begin the transition process of parent-managed healthcare to personal responsibility for health behavior (Srof, 2006).
The understanding of health promoting behaviors in adolescents may not simply be an application of existing knowledge related to health promotion in adults (Srof, 2006). Rather the development of independence and the associated tasks of teen development contribute to unique body of knowledge of health promotion in teens (Srof, 2006). Appropriate theoretical models are necessary for the continued development of nursing knowledge related to adolescent health promotion (Srof, 2006). How does this relate to Pender?
The application of the health promotion theory by Nola Pender applies to my research proposal as it relates the individual's characteristics and experiences, which affects the outcome of an individual's health. In order to promote health, an individual's own actions and beliefs play a determining role. The health promotion model describes one's perception of environmental influences. Adolescents perceived benefits of action, barriers to action, self-efficacy, and activity-related effects are related to interpersonal influences, such as family, peers, situational influences, options, and demands. As I relate this model primarily to adolescents and their increased risk of chlamydia infection, the fact that adolescents do not take part in their own health promotion/disease prevention through the use of condoms to prevent the spread of STD infections demonstrates the need to address and identify each individual's perception of chlamydia infections which could affect his or her quality of life in all developmental stages of life.
Limited discussion of model(Pender)Seem to focus more on SCT model rather than Pender.
Significance of Study
This research proposal is necessary for attempting to decrease the risk of chlamydia infections among females ages 13-25. It is important to screen and educate this population about potential risk factors and preventive measures such as the use of education, supportive resources, condoms and abstinence. Because the disease is primarily asymptomatic in females, it is important for nurses and other healthcare providers to identify and follow recommended screening and assessment of these individuals. A problem identified in the literature review is that there is some inconsistency in screening females for STDs due to varies reasons. The CDC has recommended screening of all sexually active females ages 13-25 annually, but it is questionable whether such screening is actually taking place. It is also doubtful how many females of this age group routinely see healthcare providers unless a problem has been identified.
This study would make a difference in identifying if nurses are making assessment of the sexual health of individuals who present with potential risk factors in the age group of 13-25, multiple sex partners, STD history, or lack of use of protective barriers such as condom use. If healthcare provides who screen, educate, and recognize signs and symptoms of chlamydia infection would consistently perform sexual health history, assessment, and screenings, there will be a decrease in the incidence of this disease.
