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  1. 1. The Effect of an Educational Program for Nursing Students on HPV Disease and Vaccine
    Colleen R. Barrett, MSN, CRNP, DNP (c)
    Principal Investigator
    Mary Cothran, PhD, CRNP, FNP-BC
    Capstone Advisor
  2. 2.Purpose
    To determine the effect of an educational program about human papillomavirus (HPV) on the knowledge base of baccalaureate nursing students
  3. 3.Implications for Study
    Limited research has shown a knowledge deficit about HPV among nursing students
    Educational programs on HPV for this group may translate to improved personal and public health
  4. 4.Background and Significance
    Most common STI in the US (1,2)
    Infects 6.2 million US residents annually (1)
  5. 5.Background and Significance
    Over 100 strains; at least 40 known to be oncogenic (3).
    Types 6 and 11-low risk. Cause majority of genital warts (condyloma) (4).
    Types 16 and 18 most oncogenic. Together cause over 80% of cervical cancers (4).
  6. 6.Cervical Cancer
    In the US in 2005 (7)
    11,999 newly diagnosed
    3,924 died of the disease
  7. 7.Cervical Cancer
    Worldwide (9)
    HPV causes over 500,000 cases of genital cancers annually
    370,000 of those are known cervical cancers
    270,000 of those will lead to death
  8. 8.HPV prevention
    Primary prevention of the human papillomavirus is now possible.
    June 2006: prophylactic, quadrivalent HPV 6/11/16/18 VLP vaccine (Gardasil) was licensed for use
    Indicated for males and females ages 9-26
    Has been shown to prevent up to 70% of cervical cancers caused by HPV 16/18 (14).
  10. 10.Knowledge Deficit
    Numerous surveys on college campuses in US and Canada:
    Low level of HPV knowledge among college students and nursing students
  11. 11.Knowledge Deficit
    Ingledue, et al.
    College students
    Denny-Smith, et al.
    nursing students
    Both studies revealed poor knowledge, low perception and high risk sexual behaviors
  12. 12.Knowledge Deficit
    Data support the need to educate adolescents and women about HPV
    Studies reveal women desire more information about HPV (24)
  13. 13.HPV Education
    Few studies on effect of HPV-focused educational programs
    Lambert (25) evaluated the effectiveness of a brief HPV focused educational program
    Physician Assistant and Psychology students
    Data revealed statistically significant improvement in HPV knowledge scores after the program
  14. 14.STD and Pregnancy Prevention Programs
    Have been shown in literature to be successful
    Anderko and Uscian (22)
    Studied decreasing risky sexual behavior
    Research review revealed success with educational

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    programs on HIV prevention

  15. 15.Study Design
  16. 16.Sample
    Convenience sample of full time senior level undergraduate nursing students (n=18)
    Demographic data analyzed using frequencies and averages
    Mean age of students was 22.53 years (SD 1.13) –after removal of 3 outliers (ages 33, 37, 42)
  17. 17.Sample
    Participation was voluntary
    Completion of study materials considered implied consent
    No incentives offered for participation
    Study approved by IRB at RMU and Human Subject’s Review Board at host university
  18. 18.Instrument
    The Awareness of HPV and Cervical Cancer Questionnaire (23)
    40 item multiple choice questionnaire
    Developed to assess knowledge, perceptions, and preventive behaviors regarding HPV and cervical cancer
  19. 19.Instrument
    Permission to use granted by author, Ingledue (23)
    Stability reliability established by test-retest procedures
    Test-retest coefficients of 0.90 reported for knowledge; 0.95 for perceptions and 0.90 for behaviors
  20. 20.Instrument
    No data reported for internal consistency
    Content validity established via consensual validity using a panel of health experts
    Instrument was approved by a Human Subject’s committee
  21. 21.Instrument
    For present study, only the knowledge items of the instrument were used
    Multiple choice questions
    One correct answer
    Correct answers assigned one point
    Score range of 0 to 15
  22. 22.Data Collection
    Demographic questionnaire with cover letter describing study
    Questionnaires numbered by author
    Pre-test/post test-numbered by participants
    All placed in privacy envelopes upon completion.
  23. 23.Educational Intervention
    Increase general knowledge of HPV disease and its sequelae
    Risk factors for HPV and cervical cancer
    Symptoms of HPV infection
    Means to prevent HPV and cervical cancer
    Means of detecting HPV and cervical cancer
  24. 24.Educational Intervention
    HPV types
    HPV incidence, prevalence and pathogenesis
    HPV risk factors and sequelae
    Various stages of cervical dysplasia and cervical cancer
    Cervical cancer statistics
    Knowledge deficit
    Quadrivalent HPV vaccine
  25. 25.Educational Intervention
    Concluded with open question and answer period
  26. 26.Data Analysis
    Data entered into Access Excel
    Paired t-test
    Analysis performed using SPSS 17.0
  27. 27.Results
    Mean of pre-test: 10.83 (SD 1.043)
    Mean of post-test: 13.78 (SD 1.166)
    t=7.517(7), p=.000
  28. 28.Discussion
    Mean pre-test score: 72%
    Mean post-test score: 91%
  29. 29.Discussion
    Undergraduate nursing students
    Will be able to disseminate accurate information about HPV disease and vaccine to patients
    May be of the age group recommended to receive the vaccine themselves
    Improved knowledge in this group may contribute to public health both directly and indirectly
  30. 30.Discussion
    Study limitations
    Small sample size
    Homogeneity of sample
    Vaccine knowledge not assessed
    38.9% of students reported some previous education on HPV disease
    Entire tool not utilized
  31. 31.Future Research
    Should include larger sample size
    Nursing students in various pre-licensure programs
    More heterogeneous sample
    Assess knowledge retention over time
    Vaccine knowledge (instrument development)
    Vaccination status pre- and post-program
    Include practicing nurses and their practice habits as they pertain to patient education
  32. 32.Implications for Study
    HPV incidence and subsequent cervical disease burden may be reduced through education of nurses
    Nurses can have positive effect public health as they disseminate accurate information
  33. 33.References
    1. Fontenot HB, Collins Fantasia H, Allen JD. HPV in adolescents: Making the wake up call. Adv Nurse Pract. 2007;15(10): 73-76.
    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.
    3. O’Brien J. 11th annual conference on vaccine research. Expert RevVaccines. 2008;7(6):721-723.
    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
  34. 34.References
    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.
    6. Oaknin A, Pilar-Barretina M. Human papillomavirus vaccine and cervical cancer prevention. Clin and Transl Oncology. 2008;10:804-811.
    7. Cervical cancer statistics. Centers for Disease Control Website. Updated July 20, 2009. Accessed September 3, 2009.
    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
  35. 35.References
    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.
    10. Future I Study Investigators. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N England J Med. 2007;356(19):1928-1943.
    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.
  36. 36.References
    15. Cancer Prevention & Early Detection Facts & Figures. American Cancer Society Website Reported as of November 30, 2007. Accessed September 3, 2009.
    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.
    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.
  37. 37.References
    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.
    19. Zimet GD, Liddon N, Rosenthal SL, Lazcano-Ponce E, Allen B. Psychosocial aspects of vaccine acceptability. Vaccine. 2006;24S3, S3/201-S3/209.
    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.
  38. 38.References
    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.
    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.
    23. Yacobi E, Tennant C, Ferrante J, Naazneen P, Roetzheim R. University students' knowledge and awareness of HPV. Prev Med. 1999; 28:535-541.
  39. 39.References
    24. Zimet GD. Improving adolescent health: focus on HPV vaccine acceptance. J Adolesc Health. 2005;37:19-23.
    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.
    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.
  40. 40.References
    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.
    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.
    29. Kirby D. Emerging answers: research findings on programs to reduceteen pregnancy (summary). Washington, DC: National Campaign to Prevent Teen Pregnancy. 2001.

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