Study Objective

1. Health Care Providers’ Interactions with Women who have Human Papillomavirus (HPV)Heather M. Brandt, PhD, CHES1Patricia A. Sharpe, PhD, MPH1Jill M. Abbott, DrPH2Donna H. McCree, PhD, MPH, RPh31University of South Carolina, Prevention Research Center2University of South Carolina, Department of Health Promotion, Education, and Behavior3Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention

2. Study Objective • To explore health care providers’ (HCPs) attitudes and perceptions about women who have high-risk HPV and perceived needs of high-risk HPV positive women • Provided the researchers with information from the perspective of HCPs • Findings informed development of quantitative instrument to be administered to women tested for HPV in second phase of study

3. Background and Setting • South Carolina ranks 8th in USA in cervical cancer mortality • Four federally-funded, primary health care clinics • All women with Pap test result of ASCUS or higher are tested for HPV (HCII) (“reflexive testing”) • HCPs are predominantly nurse practitioners and family medicine practitioners • Pee Dee region of South Carolina • Predominantly rural (60%) • Large minority population (42%) • Low income (% families w/children in poverty=23%) • Low education level (<9th grade 19%) • High cervical cancer incidence rate (15.27 per 100,000)

4. Pee Dee Region Study Population Pee Dee Region *15.27 per 100,000 cervical ca incidence South Carolina *8th in USA in cervical ca mortality *10.25 per 100,000 cervical ca incidence

5. Methods • Background Information Questionnaire • Perception of prevalence of HR-HPV • Perception of vaccine acceptability • Patient counseling topics for HPV+ women • Sociodemographic variables • Discussion Group Questions • HPV testing protocol • Counseling messages • Treatment recommendations • Women’s responses to HPV positivity • Patient education challenges

6. Methods • Data Collection • Four, one-hour discussion groups (one at each of four clinics) conducted in May and June 2002 • Facilitated by public health researcher • Audiotaped and field notes recorded • Informed consent completed

7. Methods • Data Management • Audiotaped groups were transcribed verbatim and reviewed for quality control purposes • Data Analysis • “Paper and pen,” note-based analysis to identify overarching themes and to conduct more detailed analyses • Key concepts and themes specific to knowledge emerged from the data • Descriptive statistics analyzed in SPSS 10.1

8. Participant Characteristics • 35 total participants • 6-11 health care providers in each group • 34 women, 1 man • 18 White, 17 African American • Most between ages 30-39 • MDs (n=5), FNPs (n=4), CNMs (n=2), Others (n=23) including CMAs, CNAs, social workers, lab techs, radiologic techs

9. Results • Background Information • Estimate of high-risk HPV prevalence among their women patients: 5-70%; majority 30% or less • 91% would recommend HR-HPV vaccine to women patients • HCPs perceive that women patients would be “somewhat” to “very” receptive of vaccine • Reported most commonly counseling HPV+ women about sexual health issues, cervical cancer and HPV, transmission of HPV, reproductive health, disclosure to sexual partners, and viral nature of HPV

10. Results • HCPs were receptive to vaccine for HR-HPV • Low awareness of recent vaccine trials • Mixed level of awareness of the corporate policy on reflexive HPV testing • Mentioned other criteria for testing: woman’s previous STI history, “promiscuous” behavior, age • Varied responses to woman’s request for HPV test when Pap test is normal • HCPs had concerns about over-treating younger women patients

11. Results • HCPs preferred in-person discussion of HPV results, when possible • Giving results over phone is not ideal • HCPs reported discussing range of HPV-relevant topics with women patients • HCPs’ perceptions of women’s responses to HR-HPV diagnosis • Consistent with current literature: angry, mad, scared, blaming • Testing men??? • Providers alluded to testing men for HPV

12. Results • HCPs were frustrated with “repeat offenders” • Past history of STIs • History of “noncompliance” with recommended medical care • HCPs need simple educational materials, free of medical jargon, for patients • Encouraging, friendly materials • Color print • Pictures, diagrams • Referral to free resources outside of clinic

13. Discussion • HCPs want clear messages about HPV to share with patients; • HCPs want training and current information to assist them in counseling patients about HPV; • HCPs recognize absence of appropriate materials for their population of rural, low-income women; and • HCPs perceive that their patients want more information on HPV.

14. Recommendations • Continuing education opportunities for HCPs that address current issues related to cervical health • Available and appropriate educational materials for patients are needed to supplement patient-provider communication

15. Acknowledgment • This project was supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through the Association of Schools of Public Health (ASPH). Grant Number U36/CCU300430-22. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC or ASPH. • Special thanks to Dr. April Winningham for facilitating the focus groups and to the health care providers for participating in the focus groups.