Assessment of Female Sexual Health by Advanced Practice Nurses in Primary Care Setting

Purpose: Female Sexual Dysfunction (FSD), persistent, recurrent problems with sexual response or desire, affects an estimated 43% of women in the United States. Assessment of female patients’ sexual health is infrequent and inadequate among Advance Practice Nurses (APNs). Research suggests that limited time and inadequate communication skills are barriers APNs face when initiating and completing sexual health histories. Female sexual health history assessment is important because it could be a sign of underlying medical conditions and sexual health and satisfaction is vital for the patients’ overall well being. This study will examine primary care APN practice as it relates to the assessment of female sexual health. In particular, the study will explore (a) barriers preventing APNs from initiating and completing sexual health assessments, (b) facilitators to successful completion of assessments, (c) frequency of female sexual health history assessments by APNs in the primary care setting, and (d) perceptions of the assessment from the providers’ perspective.

Design: Grounded theory will be used to explore and describe the process of the female sexual health assessment by APNs from the perspective of APNs and develop a substantive grounded theory.

Methods: Setting: This study will be conducted at a minimum of three community based primary care health centers in New York City with ethnically and socioeconomically diverse populations. Sampling plan: Convenience sampling will be employed by sending invitations via email and postal service to members of the Nurse Practitioner Association New York State (the NPA NYS) Brooklyn/Queens Chapter and American Academy of Nurse Practitioners (AANP) practicing in Brooklyn, NY. Sampling will occur serially and will be on-going. Maximum variation sampling will be employed to seek variability in the APNs gender, age, ethnicity, years of experience, average patient load, and diverse zip codes of Brooklyn based clinics where samples are recruited. Theoretical sampling will be used to ensure sufficient numbers of APNs are recruited. The sample size will be adjusted until data saturation is reached. Sample descriptors: Inclusion criteria for APNs are: (1) New York State certified; (2) Practice at community-based health clinics in Brooklyn, NY; (3) Care for cis-gendered female patients ages 18 and older receiving their primary care from the APN. Because continuity of care and related opportunity to establish therapeutic relationships is not generally possible with APNs who work per diem without regularly paneled patients, these APNs will be excluded. Data collection and analysis: Participants will complete a brief self-administered paper-and-pencil survey developed by the investigators to measure demographic characteristics (i.e., gender, age), clinical background (i.e., years in practice), working conditions (i.e., average patient load, health center zip code), and sexual health assessment experience (i.e., frequency). Semi-structured interviews will be conducted using an interview guide to assess whether and what barriers exist regarding the sexual health assessment, what facilitators assist with the process, and the perceptions of their assessments. Interviews will be conducted in a neutral and confidential environment and will be digitally recorded and transcribed verbatim. The data will be collected and stored responsibly to ensure confidentiality and anonymity for all participants. Initial data analysis, constant comparison of transcribed interviews, coding, categorizing, and memoing will determine if more data needs to be collected throughout the process. Data will be analyzed until themes emerge.

Findings: This study is in the proposal stage and thus findings are not yet available, however it is anticipated that findings will reveal that APNs do not adequately assess female sexual history in the primary care setting due to personal and system barriers despite widespread recognition of sexual health history as an important part of comprehensive health history.

Clinical relevance: The results of this study will be used to promote APNs self-reflection of their current practice as well as to understand common barriers APNs face while conducting female sexual health histories.  Identifying the problem and its key elements is an essential step for the development of future studies with the focus on generating strategies to enhance APN clinical practice as it relates to sexual health, and as a result, improve health outcomes for female patients.