Saturday, September 28, 2002

This presentation is part of : Research in Health Maintenance and Promotion

"It's About Time: College Age Women's Perceptions of Breast and Gynecologic Health

Mary K. Canales, RN, PhD, assistant professor, Jeanine M. Carr, RN, PhD, associate professor, and Jeri Wohlberg, RN, BSN, graduate research assistant. School of Nursing, University of Vermont, Burlington, VT, USA

Objective: The purpose of this study was to examine college-age women's perceptions of breast and gynecologic health, with a particular emphasis on health care decision-making. Considering that this period in a young woman's life informs and often determines the choices made during adulthood, it is critical to identify what influences breast and gynecologic health behaviors and decisions among this population. Studies were not located that specifically examined college women's definition of and decisions about breast and gynecologic health; however, studies were found that support the need for this research. For example, Bauer et al. (1991) found that college age women are among those at greatest risk of acquiring human papillomavirus (HPV) genital infection, which predisposes them to pre-cancerous cell changes. Despite this, college age women lack information about HPV infection, often engage in unprotected sex, and do not seek adequate preventive gynecologic care (specifically pap smears) (Yacobi et al., 1999). Morin (1998) suggests that a more holistic perspective of gynecologic and breast health is needed. Rather than focusing on women's pelvic structures and the problems associated with these specific body parts, nurses need to consider other aspects of the client including age, life style, health behaviors, culture and ethnicity, and education (Morin). The research being reported examined breast and gynecologic health from a holistic perspective, with a particular emphasis on socio-cultural influences on decision making processes. Women's perceptions of health promotion efforts that would influence breast and gynecologic health were also examined. Design: A qualitative research design using theoretical sampling and constant comparative analysis techniques. Population, Sample, Setting, Years: Thirty-four college-age women, 18-25, from a university in New England participated in the study. Recruitment efforts targeted women experiencing their first pelvic examination and those with repeat pelvic examinations, those who self identified as members of a racial/ethnic minority group, and those who identified themselves as members of the lesbian and bisexual communities. The study required 1.5 years to complete. Concepts: Decision making related to breast and gynecologic health, guided by feminist philosophy. Methods: A semi-structured interview guide with broad, open-ended questions intended to explore participants' perspectives and decision-making related to breast and gynecologic health was developed. Data collection included 20 individual and two focus group interviews, all tape-recorded and transcribed verbatim. Concurrent data collection and analysis led to more focused questions examining perceptions of health risks, understandings of the purpose for health screenings, and the sources of breast and gynecologic information women received. Findings: Data suggest that college is "about time" for women to begin to think about and act on decisions about breast and gynecologic health. Three themes were derived from the data: (Dis) Connecting with their changing bodies; Preparation and reflection; and Socio-cultural influences on health and health care decisions. These themes reflect the role of knowledge acquisition and integration in health care decision making and perception of health risks; how the characteristics of providers affect continuity of care; and the important role of family, especially mothers, as an influence on health care behavior. Conclusions: College-age women, as members of an academic environment, have a multidimensional view of health and are often aware of health promotion activities that maintain health. However, they are not adequately informed about personal health risks or the need for routine breast and gynecologic health care. College life, particularly the stresses and time constraints, can impede their ability to act on the limited knowledge and beliefs they do possess. These impediments, combined with social and cultural factors such as availability of female providers, provider assumptions regarding sexual orientation, previous negative health care experiences, and family beliefs about women's bodies, further complicate women's decisions to seek and continue to receive health care. Implications: The findings suggest that nurses can design health promotion initiatives around three areas. First, relationship development, including efforts to improve continuity of care and personal connections between campus health care providers, particularly women's health nurse practitioners, and students; second, educational materials designed to meet the unique needs of women experiencing their first pelvic examination, as well as general materials explaining the need for regular health screening for all women; and third, outreach initiatives, such as peer education and mother-daughter sessions, to convey the importance of routine breast and gynecologic health care.

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