Browsing by Author "Kinard, Ashlyn"
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Item Demographic Factors Associated with Parents’ Knowledge About Sexually Transmitted Infections(2023) Johnson, Kaeli; Kinard, Ashlyn; Lemuz, Tiffany; Terrillion, Ryan; Griner, StaceyPurpose: Gender roles are usually discussed in the context of socialization, however, this can be extended to other facets of behavior, such as compliance with treatment of sexually transmitted infections (STI). Because of this, many times the burden of STI testing and relaying information to partners is left to women. Similarly, within traditional nuclear families, gender roles and norms create expectations for family members, but especially parents. For example, maternal roles often include tending to the children and home, while paternal roles usually include being a provider for the family. Though our current society continues to transform these gendered norms, some of these gender roles still linger. Because of this, it is expected to see these gender norms and roles reflected in knowledge about STIs. Other demographic factors such as race, age, and education level may have an impact on knowledge acquired about STIs. The purpose of this study was to explore the demographic factors, including gender, associated with parental knowledge of STIs. Methods: We recruited parents of children aged 10-17 (n=230) via Centiment, an online survey panel. We assessed STI knowledge using a 27-item validated knowledge scale that included true and false statements. The scale included questions about Chlamydia, Gonorrhea, Herpes Simplex Virus (HSV-2), Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), and Hepatitis B. An example of a question included was Genital herpes is caused by the same virus as HIV. Parents indicated their response (true/false/don’t know) and answers were coded (incorrect/correct). Incorrect answers were coded as 0, correct answers were coded as 1, and "don’t know” responses were automatically considered incorrect. There were 27 possible points based on the validated scale. Demographic questions included gender, age, race, parental STI history, and highest level of education. Descriptive statistics, univariate, and bivariate analyses were conducted in SPSS. A p-value of p < .05 was considered statistically significant. Results: The average knowledge score was 12.5 (SD=6.2, range 0-27). Knowledge score was not correlated with parent age (p=.62) or child age (p=.43). There were no significant associations between knowledge and parent gender (p=.06), parent race (p=.70), parent education level (p=.47), child gender (p=.08), or child race (p=.59). However, 28% of parents reported a history of an STI, and knowledge score was significantly different among those with an STI history (14.5) compared to those without (11.6; p=.001). Conclusions: We noted a significant difference in STI knowledge based on STI history. This is expected as those who have had experience with STIs and STI treatment would have increased knowledge about them. However, average knowledge scores were low overall, with no significant differences across several different demographic factors. This emphasizes a need for better sexual education across the life course. This also displays a need for targeted interventions to increase STI awareness and knowledge among parents, in general. Future studies should assess the specific gaps in STI knowledge among older adults and how sexual education information can be disseminated to this age group.Item Implementation of changing clinical practices: Prenatal syphilis screening in Texas(2023) Terrillion, Ryan; Lemuz, Tiffany; Kinard, Ashlyn; Johnson, Kaeli; Griner, StaceyPurpose: Congenital syphilis can cause negative health outcomes including stillbirths, miscarriages, birth defects, and infant death. From 2016-2020, national congenital syphilis rates have increased from 16.2 to 57.3 cases per 100,000 live births. Texas congenital syphilis rates are significantly higher than the national rates and have increased 835% from 2016-2020. Prenatal syphilis screening by providers can avert maternal and neonatal mortality and morbidity, although there are conflicts between national professional organization’s recommended guidelines and individual state screening mandates. State dissemination and clinical integration of updated screening mandates are imperative to reduce the rates of congenital syphilis in Texas. The purpose of this study is to understand the factors influencing implementation of prenatal syphilis screening guidelines into clinical practice. Methods: Prenatal providers including physicians (MD/DO) and mid-level providers (CNM/NP/PA) in Texas were recruited to participate in an in-depth interview. Recruitment strategies included social media advertising, newsletters of professional organizations, and direct email recruitment. The interview guide was based on constructs from the Consolidated Framework for Implementation Research, an implementation science theory focused on identifying determinants, or factors, that influence translation into practice. Interviews were approximately 45 minutes in length, were conducted via Zoom or phone, were audio recorded and then transcribed by a professional. Data were thematically analyzed with emergent and theory-based codes. Results: Respondents were certified nurse midwives and physicians (n=9) who discussed implementation of changing clinical practices in the context of the Texas Department of State Health Services (TDSHS) updated mandate for prenatal syphilis screening at delivery in 2019. Participants expressed difficulty with having clear communication and resources from TDSHS about changes, reliance on email updates from professional organizations for new screening recommendations, and both formal and informal colleague dialogues as sources of policy updates. Specific difficulties expressed were the confusing TDSHS website interface, ineffective email communications that are not practice-specific, and lack of data to understand the need for a change in practice for their populations. The interviewees discussed how population and professional ethics affect prenatal screening practices and the ease of changing orders once new policy changes were agreed upon by management stakeholders. Conclusion: Varied responses from participants regarding the source of TDSHS updated mandates for prenatal syphilis screening indicate that there are no universally effective methods of communication between TDSHS and clinicians to understand, be notified of, and/or implement new mandates in a timely and uniform manner. The clinicians also noted deference to national professional organizations as institutions that they could rely on for clear communication about policy recommendations that highlighted their practice needs while considering TDSHS communications as required for practice rather than a source of clinically relevant state and community health data. Understanding of how clinician perceptions of prenatal syphilis risk for their patient populations would change with relevant local statistics within TDSHS communications would further elucidate roadblocks to integration of state mandates into clinical practice. The development of context specific implementation strategies for providers in Texas can improve prenatal syphilis screening and ultimately reduce the adverse neonatal outcomes.Item LGBTQ+ Young Adults and Likelihood of Receiving Hypothetical Chlamydia and Gonorrhea Vaccines(2023) Lemuz, Tiffany; Johnson, Kaeli; Kinard, Ashlyn; Terrillion, Ryan; Kline, Nolan; Griner, StaceyBackground Sexual and gender minority (SGM) young adults (those identifying as lesbian, gay, bisexual, transexual, and/or non-binary; often known as LGBTQ+) face a number of health disparities and are among the most at risk of acquiring sexually transmitted infections (STIs) such as chlamydia and gonorrhea. Candidate vaccines against chlamydia and gonorrhea are under development, but an understanding of the likelihood of receiving future vaccines among SGM young adults is vital to promote uptake among these populations. Prior research of STI vaccine acceptability and likelihood, such as that of the human papillomavirus vaccine series, has shown healthcare provider recommendation to be a strong driver of uptake among the general population. The likelihood of the SGM young adult population receiving potential chlamydia and gonorrhea vaccines, however, has yet to be explored. The purpose of this pilot study was to examine the likelihood of SGM young adults receiving future chlamydia and gonorrhea vaccines. Methods Sexually active young adults between the ages of 18 to 24 were recruited to participate in an online survey. Here, we present a sub-analysis of the SGM young adults (n=14) who completed the survey. Items included likelihood of receiving a hypothetical: chlamydia vaccine, chlamydia vaccine if it was recommended by a physician, gonorrhea vaccine, and gonorrhea vaccine if it was recommended by a physician (response options: not very likely to extremely likely, five-point scale). Univariate analyses were conducted using SPSS. Results Participants included 12 individuals identifying as gender non-conforming and 2 identifying as transgender, with mean age of 20.9 years. Only 21% (n=3) of participants were extremely likely to be vaccinated for gonorrhea, and this increased to 36% (n=5) when the vaccine was recommended by a healthcare provider. Similarly, only 21% (n=3) of participants were extremely likely to be vaccinated for chlamydia, which also increased with a recommendation from a healthcare provider to 43% (n=6). Conclusion Results indicate low likelihood of receiving both chlamydia and gonorrhea vaccines among this small sample of SGM young adults. Likelihood of receiving both chlamydia and gonorrhea vaccines increased, however, with provider recommendation, indicating a reliance upon healthcare providers to aid in informed decision making regarding STI vaccines among this vulnerable population. Educating clinicians on the disparities as well as the tailored needs of SGM young adults surrounding chlamydia and gonorrhea infection rates and vaccination should facilitate provider recommendation and subsequently increase likelihood of chlamydia and gonorrhea vaccine uptake among SGM young adults. Additionally, to address overall low likelihood, further interventions, such as inclusive messaging targeted to SGM young adults may be necessary. Future studies would benefit from further exploration of this topic with larger samples, comparisons to cisgender and heterosexual young adults, and identification of additional potential barriers to STI vaccine acceptability among this population.Item Prenatal Providers Awareness of Information Sources Regarding Syphilis Screening Guidelines(2022) Johnson, Kaeli; Kinard, Ashlyn; Griner, StaceyPurpose: Syphilis infections during pregnancy are associated with miscarriage, stillbirth, birth defects, and infant death. Since 2012, rates of syphilis during pregnancy and congenital syphilis have been increasing, with many cases occurring among pregnant people who have accessed prenatal care but were not screened. State-level policies and national guidelines recommend the testing of all pregnant people for syphilis infections to prevent the numerous negative health outcomes, including stillbirth. However, providers receive screening guidelines from various sources, including their professional organizations, which culminates in varying recommendations. The purpose of this study was to evaluate provider awareness of and the information sources from which they receive prenatal syphilis screening guidelines. Methods: Prenatal providers (MD/DO; n=201) were recruited via Dynata, an online survey panel. We assessed awareness of professional organization screening guidelines (Does your professional organization have recommendations or guidelines about syphilis screening during pregnancy? Yes, no, I don't know), and where they received their screening guidelines (Where did you learn about the prenatal syphilis screening guidelines?). For those who reported their organizations did not currently have prenatal syphilis screening guidelines, we assessed where they would like to be notified of the guidelines if their organization did (If your professional organization did have policies or guidelines about prenatal syphilis screening, where would you want to learn about them?). Response options for the source of guideline information included twelve sources: colleagues within organization, colleagues outside of organization, conferences, continuing education, curriculum in training, practice bulletins, journal articles, professional organizations, residency programs, social media, websites, and another source, where providers were asked to list the source. Frequencies, descriptive statistics, and bivariate analyses were conducted in SPSS. Results: The majority of prenatal providers were Doctors of Medicine (MDs, 96%), and most (65%) worked in a private practice setting. A large proportion of prenatal providers were aware of prenatal syphilis screening guidelines (87%), with most of them learning these guidelines through practice bulletins (23%), their professional organization (21%), residency programs (14%), and continuing education (10%). The prenatal providers who were unaware (13%) wanted to learn about guidelines from their professional organization (20%), continuing education (18%), practice bulletins (18%), or conferences (15%). Overall, prenatal providers wanted to learn of any changes within prenatal syphilis screening guidelines through practice bulletins (28%), their professional organizations (23%), and continuing education (14%). Conclusions: Professional organizations, practice bulletins, and continuing education were the preferred sources of information for those who were both aware and unaware of screening guidelines. These sources were also favored by prenatal providers wanting to learn of any changes in syphilis screening guidelines, suggesting that these dissemination sources are important for provider awareness but are not reaching the entirety of their target audience. Targeted dissemination strategies utilizing these information sources could help increase provider awareness. Future studies should develop guideline and policy dissemination strategies to inform providers of recommended prenatal screening practices. Widespread dissemination of these recommendations could improve prenatal syphilis screening practices and by proxy reduce prenatal syphilis rates.Item Prenatal Providers’ Perceptions of Texas Policy Change and Reproductive Healthcare(2024-03-21) Johnson, Kaeli; Lemuz, Tiffany; Terrillion, Ryan; Kinard, Ashlyn; Kline, Nolan; Griner, StaceyBackground: Stringent healthcare policies and laws can exacerbate pre-existing disparities in access to healthcare. In Texas, there has been a rise in state-level mandates that restrict access to reproductive healthcare, criminally penalize healthcare providers, or limit the scope of practice among prenatal providers. These developments have created a unique environment for clinicians in Texas. Thus, this study aimed to investigate the impact of policy shifts within Texas on the provision of prenatal care by Texas prenatal providers to their pregnant patients. Methods: Texas prenatal providers(n=17;OB/GYNs,/CNMs,/ARNPs/PAs) were recruited from a range of practice settings such as outpatient hospitals, community clinics, and private practices. One-hour in-depth interviews guided by the Consolidated Framework for Implementation Research (CFIR)were conducted with participants. As part of the Outer Setting domain of CFIR, clinicians were asked how recent policy changes in Texas impacted the care of their patients. Interviews were audio-recorded, transcribed, and thematically coded using MAXQDA. Findings: In this analysis, two policy themes surfaced: prenatal COVID vaccines and access to abortion care. Clinicians noticed resistance among their prenatal patients in receiving the COVID vaccine, influenced by Texas’ COVID response and recommendations. They underscored how Texas laws hindered patient access to abortion care, especially within the six-week time frame. Clinicians detailed how these policies heightened the need for documentation and oversight regarding miscarriage and abortion care, including obtaining ethical approval from leadership before delivering care. Implications: The results suggest that prenatal providers perceived the implementation of new policies in Texas as introducing several challenges in their provision of reproductive healthcare. Subsequent research should explore how providers adjust their practices in response to these policy changes when caring for patients.Item Prenatal Screening for Sexually Transmitted Infections: Guideline Information Sources(2022) Kinard, Ashlyn; Johnson, Kaeli; Griner, StaceyPurpose: Sexually transmitted infections (STIs) during pregnancy can have adverse outcomes for women and neonates, including birth defects, preterm labor, and stillbirth. National guidelines from professional organizations, such as the American College of Obstetricians and Gynecologists, exist and provide detailed recommendations for STI screening among pregnant patients to help prevent negative health outcomes. These recommendations evolve with developing research, and little is understood about the dissemination of updated guidelines to prenatal providers. The purpose of this study was to assess provider awareness of screening guidelines and the source of guideline knowledge. Methods: Prenatal providers (MD/DO; n=201) were recruited by a survey panel to complete an online survey. Data was collected regarding guideline awareness (Does your professional organization have recommendations or guidelines about STI screening during pregnancy? Yes/no/don't know) and the most common sources used by providers to learn about recommendations and guidelines for STI screening in pregnancy. Twelve sources were listed, including conferences, professional organizations, continuing education, journal articles, practice bulletins, and residency programs. Providers then indicated the preferred sources for the dissemination of updated guidelines. Prenatal care provider demographic information, including degree and practice setting, was collected. Univariate analyses and frequencies were calculated in SPSS. Results: Out of the prenatal providers surveyed, 96% were a Doctor of Medicine (MD) and 65% worked in a private practice setting. Overall, 88% of prenatal providers were aware of STI screening guidelines during pregnancy. Of those aware, the primary sources used to learn about these guidelines included practice bulletins (20%), professional organizations (18%), continuing education (14%), and residency programs (14%). Of those unaware (12%), the sources they would use to learn about these guidelines included practice bulletins (28%), continuing education (22%), and professional organizations (15%). All respondents indicated practice bulletins (27%), professional organizations (23%), continuing education (14%), and journal articles (10%) as sources they would like used to be notified of changes in STI screening guidelines. Conclusion/Implications: Overall, practice bulletins, professional organizations, and continuing education were the preferred sources to obtain information regarding prenatal STI screening guidelines as well as future updates to those guidelines. Similar sources were selected by both providers that were aware and those that were unaware of screening guidelines to where they do gain or would like to gain their information, respectively. This indicates a complex issue with the dissemination of prenatal STI screening guidelines, suggesting that this information reaches some prenatal providers but not all. In regard to notifying providers of changes in guidelines, journal articles emerged as an indicated source, suggesting a possible new strategy for sharing screening recommendations. Future studies should analyze the dissemination of prenatal STI screening guidelines and any subsequent changes to help improve provider awareness and increase the rate of screening.Item Sexually Transmitted Infections: Does knowledge impact perceived susceptibility?(2023) Kinard, Ashlyn; Johnson, Kaeli; Lemuz, Tiffany; Terrillion, Ryan; Diener, Anelise; Griner, StaceyIntroduction: Young adults (18-24) have high rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia and gonorrhea. STI research commonly focuses on disease prevention through reducing the associated risk behaviors, such as condomless sexual activity, but limited research exists on risk perceptions related to STIs. Perceived susceptibility, a Health Belief Model construct, describes perceived risk of acquiring a disease. This study assessed perceived susceptibility to chlamydia and gonorrhea and the relationship with STI knowledge. Methods: An online survey panel was used to recruit sexually active young adults aged 18-24 (n=375). STI knowledge was assessed using the Sexually Transmitted Disease Knowledge Questionnaire, a 27-item validated scale. The participants responded to each statement with either true, false, or don’t know. Correct responses were given one point and the scores were averaged to calculate a knowledge score, with a perfect score being 27. Perceived susceptibility to chlamydia and gonorrhea infection was measured using three categories (strongly disagree/disagree, neutral, agree/strongly agree). Demographics including gender, race, sexual orientation, and education status were collected. Participants also reported on prior gonorrhea and/or chlamydia diagnoses as well as current sex practices and risk behaviors. Descriptive and bivariate analyses were conducted in SPSS. This study was approved by the university’s Institutional Review Board. Results: The average knowledge score among participants was 8.3 (standard deviation=5.4, range 0-22). Most respondents perceived that they were not at risk (strongly disagreed/disagreed) for acquiring chlamydia (54%) or gonorrhea (50%). The average knowledge score did not significantly differ by participants perceived susceptibility to chlamydia (p=.087). However, those who agreed/strongly agreed that they were at risk of contracting gonorrhea had a significantly higher knowledge score (mean of 9.9) than those who were neutral (mean knowledge score of 7.7; p=.016) or strongly disagreed/disagreed (mean knowledge score of 8.0; p=.021). Conclusion: The results from this study indicate a significant relationship between STI knowledge and perceived susceptibility to contracting gonorrhea, leading to the conclusion that individuals with more knowledge about STIs can more accurately assess their potential risk of infection. However, this relationship was not noted with perceived susceptibility of contracting chlamydia. Further exploring the difference in overall STI knowledge scores based on susceptibility of disease may provide insight into specific areas of STI knowledge to improve. Future aims should be broadly directed towards STI education among sexually active young adults to increase perceived susceptibility to these infections and improve preventative behaviors, such as increasing condom use.