Volunteer NPs' Screening Practices for Hispanic Women in Faith Clinics
Rationale/Background: Hispanic women residing in the state of Arizona have a risk profile for cervical cancer that is above the state mean despite the fact that low-income clinics are available for obtaining cervical cancer screenings. Of the studies that have explored the barriers and enablers for Hispanic women in receiving cervical cancer screening, the lack of provider recommendation is a predominant factor. In addition, studies have revealed that providers inconsistently follow standard screening guidelines. Clinics using volunteer providers, recognize that the volunteers have varied educational backgrounds and practice specialties, which could affect performance of preventive health counseling. No studies were found that examined volunteer nurse practitioners screening practices serving in faith-based clinics. Pender’s Health Promotion Model guided the study.
Methods: This study was a quantitative descriptive correlation design. The setting included two low-income faith-based clinics. The sample consisted of volunteer health care providers who participated in an online survey. In addition a chart audit was completed. Data analysis included descriptive statistics, chi-square, logistic regression and trend analysis.
Results: Logistic regression revealed that nurse practitioner (NP)/physician assistant (PA) providers were 4.589 times more likely to recommend screening than physicians at a client’s first clinic visit (OR = 4.589; 1.161, 18.139). Chi-Square provided a comparison of documented guideline consistent recommendations to providers’ self-reports. The findings were significant, revealing provider documentation was more guideline consistent than provider self-report X2(1, N = 36) = 7.034, p < .05, V = 0.44. Chi-square with chart audit data from 2008 to 2013 revealed that there was a significant difference in guideline consistent recommendation for screening at the initial visit before and after the 2009 and 2012 guideline changes X2(2,N = 27) = 7.855, p < .05, V = .539. Trend analysis confirmed that there was evidence of an increasing positive trend for providers to be guideline consistent in recommendations.
Implications: Perceived benefits of action for screening effectiveness, self-efficacy through recent training, interpersonal and situational influences appear to have a direct influence on the recommendations practices of providers. Given that 62.5% of NPs/PAs and 55.6% of physicians reported attending training on cervical cancer screenings within the last two years, further studies should explore how recent training may have impacted the findings for an increasing trend in guideline consistent recommendations. In addition, examining what underlying characteristics of NPs/PAs contributed to this type of provider being more likely than physicians to recommend screenings could lead to interventions that increase the number screenings that the Hispanic population receives. Since only 50% of providers indicated they were aware of screening guidelines at their clinic, having current guidelines available to providers in the clinic at a designated location may be another way to continue to improve the rate of recommendations given to the Hispanic population seeking care at the clinics.