SEXUAL RISK HISTORY APPROACH THAT IMPROVES SEXUAL RISK HISTORY APPROACH THAT IMPROVES ADOLESCENT-PROVIDER ADOLESCENT-PROVIDER COMMUNICATIONCOMMUNICATION

KKristy K. Martyn, PhD, FNP-BC, CPNP-PCristy K. Martyn, PhD, FNP-BC, CPNP-PCaa, Cynthia Darling-Fisher, PhD, FNP-BC, Cynthia Darling-Fisher, PhD, FNP-BCaa, Michelle Pardee, MS, FNP-BC, Michelle Pardee, MS, FNP-BCaa, Katherine Kristofik, MSN, FNP-BC, Katherine Kristofik, MSN, FNP-BCbb, , David L. Ronis, PhDDavid L. Ronis, PhDacac, Irene L. Felicetti, MLS, BS, Irene L. Felicetti, MLS, BSaa, and Melissa A. Saftner MS, CNM, and Melissa A. Saftner MS, CNM a a

aaSchool of Nursing, University of Michigan, Ann Arbor, Michigan School of Nursing, University of Michigan, Ann Arbor, Michigan bbOakwood Hospital, Detroit, Michigan Oakwood Hospital, Detroit, Michigan

ccDepartment of Veterans Affairs, Ann Arbor, MichiganDepartment of Veterans Affairs, Ann Arbor, Michigan

This was a mixed methods exploratory Phase II pilot study. Adolescent patients (n=30; 19 females; 11 males) in a school-linked clinic who reported being sexually active in the past 3 months self-administered the EHC and then discussed their EHC with a nurse practitioner (NP) (n=2) during a clinic visit.

Adolescents reported sexual risk behaviors and perceptions about EHC communication with providers on a questionnaire at pre- and post-clinic visit, at 1and 3-months (retention was 95.5%), and during an interview at post-visit. The NPs reported their perceptions about the use of EHCs by questionnaire post-visit and in an interview.

Quantitative and qualitative analyses were performed.

• Descriptive statistics, paired t-tests, and Chi-square tests were used to analyze questionnaire responses.

• The constant comparative method was used to identify common themes related to clinical use of the EHC and communication.

To explore the effects of clinical use of an event history calendar (EHC) approach that encourages conversation and disclosure of adolescent sexual risk histories on: adolescent-provider communication and avoidance of unprotected sexual intercourse post-intervention.

BACKGROUND AND SIGNIFICANCE

OBJECTIVES/AIMS

Sexual risk history using Event History Calendars (EHCs) has been proposed as an efficient approach to improve adolescent-provider communication and potentially reduce risk behaviors. The EHC approach addresses limitations of adolescent brain development, such as not fully developed judgment and self-awareness, by allowing the adolescent to concretely see their patterns of risk behaviors over time and discuss risks in context with providers.

Teens said, “We talkedabout the other things…..not just my sexual history..like my life history and thatmade me feel more openand more able to talk tothe practitioner.”

METHODS RESULTS

Statistically significant results related to the EHC approach included: Scores increased on Amount of Communication, t(29)=8.174, p<.001; Satisfaction with Communication, t(29)=3.112, p=.004; Client Involvement in Decision Making, t(29)=3.901, p=.001, and Client Satisfaction with Interpersonal Style, t(29)=3.763, p=.001.

Adolescents also reported decreased sexual intercourse at one month, p=.031. Adolescents and NPs reported the EHC approach improved sexual risk communication, and increased adolescent awareness of their risk behaviors.

CONCLUSIONS/IMPLICATIONS

EVENT HISTORY CALENDAR

The EHC approach improved adolescent-provider communication and identification of risk behaviors, was well received by adolescents, and can be efficiently used in clinic settings. Next steps include an NIH randomized clinical trial focused on reduction of adolescent sexual risk behavior.

FUNDING MECHANISM

We gratefully acknowledge the following grant support by the National Institutes of Health and National Institute of Nursing Research, The Michigan Center for Health Intervention, P30 NR009000.

Year2005

(2 years ago)2006

(last year)2007

(current year)2008

(next year)

What is your age?        

What is your grade in school?        

What are your activities?        

Where do you stay, and who do you stay with?

       

Who are your family and friends?

       

What positive events have you had?

       

What negative events or losses have you had?

       

What is your sexual activity?        

Have you had any of these behaviors: smoking, alcohol, drugs, cutting?

       

Providers said they could partner with teens to obtain a “richer amount of information,” “show [the teen] visually what their behavior was,” and “intervene on a different level” to promote sexual risk reduction. 

“I never thought it was a big deal until I had to write it down and see it for my own eyes.” (female 17 yrs.)

“It brought back a lot of stuff that I didn’t even remember . . . people that I’ve had sexual encounters with . . . made me think of a lot of stuff.” (male 18 yrs.)

“I think they enjoyed filling it out . . . allowed them to look at their behavior in a way that they haven’t in the past.” (provider)