Training Haitian Healthcare Providers Perform Cervical Cancer Screening - Paper Example

Training Haitian Healthcare Providers Perform Cervical Cancer Screening

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Abstract

Cervical cancer screening tests, such as papanicolaou (Pap) smears with human papilloma testing, as performed in developed countries are an essential part of preventative healthcare services for women between the ages of 21 through 65. However, in third world countries such as Haiti, there are no cervical cancer screening (CCS) programs. Cervical cancer is the number one cancer diagnosis of Haitian women, which represents the highest cancer mortality rate in the Western hemisphere. The purpose of this project is to evaluate the effect of an evidence based practice educational program on Haitian healthcare providers knowledge, attitudes and practices (KAP) when trained to perform CCS using visual inspection with acetic acid (VIA), colposcopy (COLPO) using enhanced visual assessment (EVA), and cryotherapy (CRYO) procedures using a screen and treat approach (SATA). The Johns Hopkins Nursing Evidence Based Practice (JHNEBP) model will be used to guide the project and the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) educational manuals and protocols will be used as training tools. Multiple research studies support training non-physician healthcare providers to perform VIA/COLPO/CRYO and the use of these procedures as effective CCS tools. The location for this training will be in Hinche, Haiti in partnership with Midwives for Haiti. The primary stakeholders are Haitian healthcare providers who will take a pre-survey assessment, complete training, and then take a post-assessment (KAP) survey. The survey will determine if there is a difference in self-perceived knowledge and competency levels before and after the formal training program using a t-test. Demographic variables and a evaluation of the JHPIEGO VIA/COLPO/CRYO program outcomes will also be collected and analyzed.

Table of Contents

List of Abbreviations

CCS---------------Cervical cancer Screening

COLPO-----------Colposcopy

CRYO------------CryotherapyCVR---------------Content Validity Ratio

EBP---------------Evidence-Based Practice

EVA--------------Enhanced Visual Assessment

HPV--------------Human Papilloma Virus

JHNEBP---------Johns Hopkins Nursing Evidence-Based Practice

JHPIEGO--------Johns Hopkins Program for International Education in Gyn/OB

KAP--------------Knowledge, Attitudes, Practice

MFH-------------Midwives for Haiti

MobileODT-----Mobile Optical Detection Technology

MSPP------------Ministry of Health in Haiti

NGO-------------Non-government agency

PAP--------------PapanicolaouPET--------------Practice Question, Evidence, Translation

PICOT-----------Population, Intervention, Comparison, Outcomes, Time Frame

SATA------------Screen-and-Treat-Approach

SVA--------------Single Visit Approach

TBD--------------To be determined

VIA---------------Visual Inspection with Acetic Acid

WHO-------------World Health Organization

APPENDICES Page

APPENDIX A. JHNEBP Individual Evidence Summary Tool

APPENDIX B. JHNEBP Synthesis and Recommendations

APPENDIX C. JHNEBP Evidence Level and Quality Guide Definitions

APPENDIX D. AGREE II Instrument

APPENDIX E. MobileODT

APPENDIX F. JHPIEGO Training Participants Registration Form

APPENDIX G. English KAP Survey

APPENDIX H. Creole KAP Survey APPENDIX I. JHPIEGO Guide for Trainers/Tests for Trainees APPENDIX J. JHPIEGO Evaluation of Clinical Trainer

APPENDIX K. JHPIEGO Quality Assurance Handbook APPENDIX L. Referral form to Mirebalais Hospital APPENDIX M. Patient intake and demographic forms APPENDIX N. Client Assessment, findings, diagram, and treatment recommendations APPENDIX O. Cervical Cancer Information Sheet APPENDIX P. Cryotherapy Information and Patient Discharge Instructions

APPENDIX Q. Tickler File Patient Sheet APPENDIX R. Patient consent to participate in project (English and French version)

APPENDIX S. University of Toledo IRB approval

APPENDIX T. Permission to use KAP survey

APPENDIX U. Content Validity Results

APPENDIX V. Permission for using name of Midwives for Haiti APPENDIX W. Permission for using JHPIEGO materials APPENDIX X. MFH permission for DNP project APPENDIX Y. Permission for using JHNEBP materials APPENDIX Z. Permission for using WHO materials

APPENDIX AA. Permission from Haitian Ministry of Health for DNP project

Description of Problem Human papilloma virus (HPV) is the worlds most prevalent sexually transmitted disease. Risk factors for contracting cervical HPV include multiple sexual partners, age of first coitus, poverty, multi-parity, smoking, malnutrition, HIV status, and lack access to HPV vaccine. These factors increase a womans risk of progression to cervical cancer (Denny et al., 2005). Women in the United States have easy access to cervical cancer screenings (CCS) with cytological tests, i.e., papanicolaou (Pap) smears. The majority of American women have some form of health insurance and can afford preventative health care services such as routine Pap smears. However, developing countries and low resource settings (LRSs) do not have funding to provide cytological screening nor the pathologists needed to interpret the Pap smear (ACOG, 2015).

According to the World Health Organization (WHO), the highest burden of cervical cancer occurs in developing countries (Ncube, Bey, Knight, Bessler, & Jolly, 2015; Bruni, Barrionuevo-Rosas, & Albero, 2016). Caribbean countries have extremely high cervical cancer mortality rates; of these countries, Haiti has the highest rate. Cervical cancer is the leading cause of cancer deaths among women in Haiti (Ferlay, Soerjomataram, & Ervik, 2013). Third world countries such as Haiti have age-adjusted incidence rates of cervical cancer ranging from 11-47 per 100,000 women per year which is considered high (Villa, 2012). The most recent estimate of cervical cancer in Haiti is 23.2 per 100,000 women; this cancer claims the lives of 18.3 women annually, which is approximately at a rate 2 times higher than the United States (National Cancer Institute, 2016). The lack of organized and effective CCS and treatment programs are primary reasons why Haitian women succumb to this disease (Roger & Nwosu, 2014).

Most developing countries do not fund cytological screening, laboratories to process Pap smears, or have trained cytologists and pathologists to assess Pap smears. Haiti has only four pathologists for a population of 10 million people and only a handful of laboratory services. Likewise, there is no tracking of women with abnormal results for follow up care. Other barriers to CCS are lack of healthcare insurance; limited access to medical care; few trained healthcare professionals; lack of knowledge regarding cervical cancer; poverty; remot...