Chlamydia infection increases the likelihood of being at risk for HIV infection and cervical cancer (Steben, 2004). Known as the "hidden STD" because of the relative difficulty in detecting infection, chlamydia is particularly common among young women (Alexander, 2006). Numerous prevalent studies in various clinical populations have shown that sexually active adolescents and young adults have higher rates of chlamydia infection compared to the general population (Adderley-Kelly, 2005). In addition, regional infertility projects that perform routine large-scale screening and assessment among women have found that younger women are more likely than older women to be tested positive for chlamydia infection (Alexander, 2006; Adderley-Kelly, 2005).
Curbing the spread of chlamydia has been a priority of The Centers for Disease Control and Prevention (CDC) (2010). CDC recommends that sexually active females aged 20 years old and below and those over 20 years old possessing risk factors (e.g. multiple sex partners) be screened annually. Literature also supports the recommendation that Chlamydia screening through nursing health assessment can aid in early identification of the disease (Steben, 2004). Moreover, education on prevention could also be implemented to raise awareness about the risk factors that are associated with the spread of this infection. Ahmed et al. (2009) identified several risk factors of Chlamydia, including age, race. lack of general knowledge, having multiple partners, non-use of proper protection like condom use, and the utilization of resources or available programs to educate and prevent.
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This study recognizes that the high incidence of chlamydia can be mitigated through proper screening and early identification. More specifically, screening at-risk individuals such as females aged 12 to 15 years old, would help in the early detection and prevention of chlamydia infection. Due to the fact that the increase in chlamydia infection is among adolescents, and the fact that it is many times asymptomatic, failure to seek medical attention occurs and subsequently leads to long-term health concerns (Alexander, 2006).
According to Burns, Briggs, & Gaudet, (2007), establishing a chlamydia testing or screening program for adolescents has always been difficult. Barriers to screening include the inability to pay for health screening due to a lack of health insurance, lack of transportation to the clinic site, discomfort with the clinic, and confidentiality issues. These barriers, in conjunction with a disease that exhibits minimal or no symptoms, generate a challenge for STD programs to screen a high-risk population.
The U.S. Preventive Service Task Force (USPSTF, 2001) strongly recommended that clinicians routinely screen all sexually active women aged 25 and younger, and other asymptomatic women at increased risk for infection. Since age is the most important risk factor, women and adolescents through age 20 years are at highest risk for chlamydia infection. Other risk factors associated with high prevalence included: being unmarried, African-American race, having a prior history of sexually transmitted disease, having new, or multiple sexual partners, having cervical ectopy, and using barrier contraceptives inconsistently (Adderley-Kelly, 2005). Individual risk depends on the number of risk factors and local prevalence of the disease.
Studies have shown that inadequate screening, also result from three things: first, it takes time for any new recommendations to be implemented. Second, practitioner's adherence to screening recommendations varies widely. Third, adherence to screening recommendations varies by site of care. Therefore, it is important to be able to discuss and obtain a sexual health history with all patients, identify the signs and symptoms of chlamydia and recognize potential risk factors that are associated with chlamydia infection that would place individuals at higher risk (Steben, 2004). As nurses, it is imperative that we complete a full health assessment which would include a sexual history to identify early risk and detection of the disease. Appropriate screens have not being followed to assess individuals with potential risk factors.
The purpose of the study is to investigate whether yearly screening of sexually-active females aged 13 to 25 will increase prevention and early detection of chlamydia infection, as compared to females aged 13 to 25 who are sexually active and are not screened.
Identification of Variables and Target Population
The independent variable related to this research is screening. The dependent variables are 1) prevention and 2) early detection. The target population is sexually active females aged 13 to 25 years old.
Hypothesis or Research Question(s)
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This study aims to answer the following question: Does screening lead to prevention and early detection of chlamydia infection among sexually active females aged 13 to 25 years old?
In relation to this research question, the study hypothesizes that:
RH1: Sexually active females aged 13 to 25 years old who are screened are less likely to have chlamydia infection than females who are not screened.
RH2: Sexually active females aged 13 to 25 years old who are screened are detected earlier for chlamydia infection than females who are not screened.
Definition of Terms
The following terms are defined in theoretical and operational terms, as follows:
Theoretical Definition: According to the CDC (2010), chlamydia is defined as a common sexually transmitted disease (STD) caused by chlamydia trachomatis, a bacterium that can damage women's reproductive organs. Even though the symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman recognizes a problem.
Operational Definition: For the purposes of this study, chlamydia refers to a positive diagnosis made by a physician through a urine-based PCR screening for chlamydia.
Theoretical Definition: Screening is performed to identify the presence of the disease or of a risk factor for a disease, typically among asymptomatic persons (those who do not already manifest symptoms of disease). In this way, a disease or the risk factors for a disease can be detected early, allowing either treatment or prevention, including preventing the further spread of communicable or transmissible diseases (Robinson, 2002).
Operational Definition: For the purpose of this study, screening involves a health history which identifies the risk factors such as a previous history of STD, having multiple sex partners, having sex with new partner, the use of non-barrier types of contraception, or having cervical ectopy.
Theoretical Definition: prevention is the keeping of something (such as an illness or injury) from happening (Miller-Keane, 1997).
Operational Definition: For the purpose of this study, prevention is the absence of chlamydia which will be indicated by a negative result diagnosed by a physician through a urine-based PCR testing for chlamydia infection.
Theoretical Definition: Sexually active means involvement or participation in a sexual act, being involved, and an active participant.
Operational Definition: For the purpose of this study, sexually active females will refer to those who arranged a visit for pregnancy, STD diagnosis, screening, contraception, or treatment.
The appropriate framework selected for this proposal is Nola Pender's health promotion model (HPM). The HPM, originally developed in the early 1980s, is a framework that serves as "a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in health behaviors directed toward the enhancement of health" (Pender, 1996, p. 51). The HPM is widely represented in the nursing literature and is the framework that underpins over 100 research studies.
Pender's HPM is a valuable tool for the identification of motivators and barriers toward individuals' active involvement in activities that promote health (Pender, 1996). Pender proposed in the HPM that there are generally three areas which influence the adoption of health-promoting behavior: "cognitive, perceptual, modifying factors and cues to actions" (Pender, 1996, p. 53). Pender focuses on initiative from the individual to strive for wellness and positive health and views the benefits of such self-directing behaviors to include vitality and even self-actualization.
Pender measures an individual's "perceived control of health" by his or her ability to control behaviors that are necessary to promote changes in overall health and well-being. Pender views health promotion as active rather than passive. The person must perceived that he or she wields total control of his health. Hopefully, this perception will lead to a more frequent and consistent application of health-promoting behaviors. The understanding of health promoting behaviors in adolescents may not simply be an application of existing knowledge related to health promotion in adults (Srof, 2006). Rather the development of independence and the associated tasks of teen development contribute to unique body of knowledge of health promotion in teens (Srof, 2006).
Pender's HPM provides a paradigm in an effort to come up with intervention programs to address health concerns such as chlamydia infection. Literature has revealed that there are several barriers to prevention efforts initiated by government agencies and not-for-profit organizations to curb the spread of Chlamydia infection among younger women (Alexander, 2006). The HPM model identifies seven perceptual and cognitive factors which could deter or enhance the likelihood of a person's adoption of health behaviors. For adolescents, these factors could be perceived benefits of action, barriers to action, self-efficacy, and activity-related effects are related to interpersonal influences, such as family, peers, situational influences, options, and demands.
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As I relate this model primarily to adolescents and their increased risk of chlamydia infection, the fact that adolescents do not take part in their own health promotion/disease prevention through the use of condoms to prevent the spread of STD infections demonstrates the need to address and identify each individual's perception of chlamydia infections which could affect his or her quality of life in all developmental stages of life. This study will emphasize on modifying factors to include demographics, biological characteristics, interpersonal influences, situational factors, and behavioral factors that could affect a young woman's chances of engaging in behaviors that promote health (Pender, 1996).
Significance of Study
This research proposal seeks to investigate the importance of screening as a mechanism to decrease the risk of chlamydia infections among sexually active females aged 13 to 25. It is important to screen and educate this population about potential risk factors and preventive measures such as the use of education, supportive resources, condoms and abstinence. Because the disease is primarily asymptomatic in females, it is important for nurses and other healthcare providers to identify and follow recommended screening and assessment of these individuals. A problem identified in the literature review is that there is some inconsistency in screening females for STDs due to varies reasons (Streben, 2004). The CDC (2010) has recommended screening of all sexually active females ages 13-25 annually, but it is questionable whether such screening is actually taking place. It is also doubtful how many females of this age group routinely see healthcare providers unless a problem has been identified.
This study would make a difference by drawing a relationship between screening and prevention and early detection of chlamydia in a high-risk population. In so doing, it contributes to the body of literature formed by government agencies, researchers, and non-profit health organizations that have initiated programs to reduce the prevalence of chlamydia in young women. Screening will also describe barriers and risk factors to infection such as multiple sex partners, STD history, or lack of use of protective barriers such as condom use. In the process, this study will highlight the significant role of healthcare providers in screening, educating, and detecting signs and symptoms of chlamydia infection and the importance of consistently performing sexual health history, assessment, and screenings to bring about a decrease in the incidence of this disease.