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A Systematic Review and Quantitative Meta-Analysis of the Accuracy of Visual Inspection for Cervical Cancer Screening: Does Provider Type or Training Matter?
Title
A Systematic Review and Quantitative Meta-Analysis of the Accuracy of Visual Inspection for Cervical Cancer Screening: Does Provider Type or Training Matter?.
Creator
Driscoll, Susan D., Tappen, Ruth M., Florida Atlantic University, Christine E. Lynn College of Nursing
Abstract/Description
Background: A global cervical cancer health disparity persists despite the demonstrated success of primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical cancer is the leading cause of cancer incidence and death for women in many low resource areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers and systems. Using...
Show moreBackground: A global cervical cancer health disparity persists despite the demonstrated success of primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical cancer is the leading cause of cancer incidence and death for women in many low resource areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers and systems. Using community health workers (CHWs) may overcome these barriers, increase facilitators, and improve participation in screening for women in remote areas with limited access to clinical resources. Aim: To determine whether the accuracy of VI performed by CHWs was comparable to VI by physicians or nurses and to consider the affect components of provider training had on VI accuracy. Methods: A systematic review and quantitative meta-analysis of published literature reporting on VI accuracy, provider type, and training was conducted. Strict inclusion/exclusion criteria, study quality, and publication bias assessments improved rigor and bivariate linear mixed modeling (BLMM) was used to determine the affect of predictors on accuracy. Unconditional and conditional BLMMs, controlling for VI technique, provider type, community, clinical setting, HIV status, and gynecological symptoms were considered. Results: Provider type was a significant predictor of sensitivity (p=.048) in the unconditional VI model. VI performed by CHWs was 15% more sensitive than physicians (p=.014). Provider type was not a significant predictor of accuracy in any other models. Didactic and mentored hours predicted sensitivity in both BLMMs. Quality assurance and use of a training manual predicted specificity in unconditional BLMMs, but was not significant in conditional models. Number of training days, with ≤5 being optimal, predicted sensitivity in both BLMMs and specificity in the unconditional model. Conclusion: Study results suggest that community based cervical cancer screening with VI conducted by CHWs can be as, if not more, accurate than VI performed by licensed providers. Locally based screening programs could increase access to screening for women in remote areas. Collaborative partnerships in “pragmatic solidarity” between healthcare systems, CHWs, and the community could promote participation in screening resulting in decreased cervical cancer incidence and mortality.
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Date Issued
2016
PURL
http://purl.flvc.org/fau/fd/FA00004755
Subject Headings
Women--Health and hygiene., Cervix uteri--Cancer--Diagnosis., Cervix uteri--Cancer--Prevention., Medical screening., Medical care--Quality control., Community health services.
Format
Document (PDF)
Native American Early Adolescents Response to a Cultural-Based Prevention for Obesity
Title
Native American Early Adolescents Response to a Cultural-Based Prevention for Obesity.
Creator
Kelley, Melessa N., Lowe, John, Florida Atlantic University, Christine E. Lynn College of Nursing
Abstract/Description
Over the past 30 years, obesity has increased rapidly as an epidemic and major public health concern in the United Stated, particularly among Native American children and adolescents. Native American adolescents have the highest prevalence rates of obesity of all ethnic groups in the United States. Although there has been an increasing effort to develop and evaluate obesity prevention programs for children and adolescents, very little attention has been devoted to understanding culturally...
Show moreOver the past 30 years, obesity has increased rapidly as an epidemic and major public health concern in the United Stated, particularly among Native American children and adolescents. Native American adolescents have the highest prevalence rates of obesity of all ethnic groups in the United States. Although there has been an increasing effort to develop and evaluate obesity prevention programs for children and adolescents, very little attention has been devoted to understanding culturally effective approaches for ethnic populations. There is a significant gap in the research literature regarding effective obesity intervention and prevention studies for Native American children and adolescents. The purpose of this study was to explore the impact of a culturally based talking circle approach, KCTC-O, for the prevention of obesity among early adolescent Native American (Keetoowah-Cherokee) and to examine the relationships between Cherokee self-reliance; perceived stress levels; and obesity knowledge, attitudes, and behavior. A 7-week intervention in which a 2-condition quasi-experimental design was implemented to compare the KCTC-O experimental condition with a standard school health education (SE) control condition on three outcome variables (Cherokee self-reliance; perceived stress levels; and obesity knowledge, attitudes, and behavior at pre- and post-intervention. A total sample of 100 participants were recruited for this study, 50 participants per condition. The participants were distributed almost evenly in terms of gender: 55 females compared to 45 males for both groups combined. Participants ranged in ages from 10 to 13, with a mean age of 11.5 years of age, and ranged in grades from 4 through 7, with Grade 6 being the most frequently reported grade in school. The results of this study revealed the effectiveness of the KCTC-O condition was not significantly greater than the SE condition. However, although not statistically significant, the results of this study provided some evidence that a culturally based intervention was slightly more effective for the prevention of obesity than a non-culturally based intervention for Native American early adolescents. This study helps to validate the need for more robust obesity prevention programs from a cultural perspective among Native American early adolescents.
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Date Issued
2016
PURL
http://purl.flvc.org/fau/fd/FA00004685, http://purl.flvc.org/fau/fd/FA00004685
Subject Headings
Community based social services, Health behavior in adolescence, Indians of North America -- Health, Indians of North America -- Psychology, Obesity in adolescence -- Prevention
Format
Document (PDF)
How do home and community based services change long-term care?
Title
How do home and community based services change long-term care?.
Creator
Perez, Enrique M., College for Design and Social Inquiry, School of Public Administration
Abstract/Description
The relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act ...
Show moreThe relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act (ADA), plays a huge role in promoting social awareness and bringing down barriers of stigmatization, understanding, and access. This struggle is fought on many fronts. A significant part of the effort focuses on moving the locus of long-term care of the disabled, including the IDD population, from an institutional setting to the least restrictive setting that will foster social ties and integration. Since the early 1980s as part of this effort to deinstitutionalize the disabled, legislation at both the federal and state level has supported and incentivized the creation of Home and Community Based Service (HCBS) programs. HCBS waivers, as they are typically called, are also promoted as a means of containing government expenditures for long-term care. However, the effectiveness of these waivers is poorly understood. The critical questions being - Do HCBS waivers promote and create an environment that increases awareness of the needs of IDD individuals? Do the programs help reduce stigmatization, promote understanding, and increase access to services and activities that foster social interaction? Or, do HCBS waivers create a new "iron cage" where the intellectually or developmentally disabled are once again relegated to existing as second class citizens? In this research, programs are mapped and then evaluated to paint a better picture of how HCBS waivers change long-term care., This research combines qualitative and quantitative approaches to triangulate on these phenoamea as a means to investigate when and how HCBS waiver programs facilitate, promote, or stifle the social integration of those with IDD. How does social integration manifest itself in the quality long-term care of those who often cannot take care of themselves?
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Date Issued
2011
PURL
http://purl.flvc.org/FAU/3318667
Subject Headings
Long-term care of the sick, Medical care, Quality control, Sociology of disabiltiy, Heath care rationing, Outcome assessment (Medical care), Community health services
Format
Document (PDF)
How Community College Nursing Faculty View Service Learning Integration
Title
How Community College Nursing Faculty View Service Learning Integration.
Creator
Norris, Shelby D., Guglielmino, Lucy M., Maslin-Ostrowski, Patricia, Florida Atlantic University
Abstract/Description
The purpose of this study was to explore the attitudes and experiences of community college nursing faculty related to the integration of service learning. An exploratory case study was conducted at three Florida community college nursing programs. The data were collected primarily through structured interviews with 14 community college nursing professors, three nursing administrators, and one service learning coordinator along with document analysis and site observation. The researcher posed...
Show moreThe purpose of this study was to explore the attitudes and experiences of community college nursing faculty related to the integration of service learning. An exploratory case study was conducted at three Florida community college nursing programs. The data were collected primarily through structured interviews with 14 community college nursing professors, three nursing administrators, and one service learning coordinator along with document analysis and site observation. The researcher posed six research questions related to service learning integration. These six questions addressed: (a) the differentiation of service programs at the three sites, (b) the meaning of service learning, (c) faculty motivation to use service learning, (d) institutional supports needed by nursing faculty, (e) the obstacles that nursing faculty face, and (f) the strategies they use to overcome them. The major conclusions were that community college nursing faculty members are vital to the integration of service learning and need training in service learning procedures. Service learning has potential for further development in community college nursing programs and may lead to a perspective change in how nursing students view the social dynamics of nursing. Time and workload obstacles, along with confusion regarding service learning, clinicals and community service have contributed to the slow growth of SL in nursing programs. There is a need for new models to guide service learning integration in nursing education. Two models for integration of service learning into community college nursing are offered. Recommendations for practice, educational leadership and further research are presented.
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Date Issued
2007
PURL
http://purl.flvc.org/fau/fd/FA00000684
Subject Headings
Nursing--Study and teaching, Nurses--In-service training--Evaluation, Mentoring in education, Community health nursing--Study and teaching
Format
Document (PDF)