1. The Effect of an Educational Program for Nursing Students on HPV Disease and Vaccine
Colleen R. Barrett, MSN, CRNP, DNP (c)
Principal Investigator
Mary Cothran, PhD, CRNP, FNP-BC
Capstone Advisor

2. Purpose
To determine the effect of an educational program about human papillomavirus (HPV) on the knowledge base of baccalaureate nursing students
3. Implications for Study
Limited research has shown a knowledge deficit about HPV among nursing students
Educational programs on HPV for this group may translate to improved personal and public health
4. Background and Significance
HPV
Most common STI in the US (1,2)
Infects 6.2 million US residents annually (1)
5. Background and Significance
HPV
Over 100 strains; at least 40 known to be oncogenic (3).
Types 6 and 11-low risk. Cause majority of genital warts (condyloma) (4).
Types 16 and 18 most oncogenic. Together cause over 80% of cervical cancers (4).
6. Cervical Cancer
In the US in 2005 (7)
11,999newly diagnosed
3,924 died of the disease
7. Cervical Cancer
Worldwide (9)
HPV causes over 500,000 cases of genital cancers annually
370,000 of those are known cervical cancers
270,000 of those will lead to death
8. HPV prevention
Primary prevention of the human papillomavirus is now possible.
9. HPV PREVENTION
Vaccination
June 2006: prophylactic, quadrivalent HPV 6/11/16/18 VLP vaccine (Gardasil) was licensed for use
Indicated for males and females ages 9-26
Has been shown to prevent up to 70% of cervical cancers caused by HPV 16/18 (14).
10. Knowledge Deficit
Numerous surveys on college campuses in US and Canada:
Low level of HPV knowledge among college students and nursing students
11. Knowledge Deficit
Ingledue, et al.
College students
Denny-Smith, et al.
nursing students
Both studies revealed poor knowledge, low perception and high risk sexual behaviors
12. Knowledge Deficit
Data support the need to educate adolescents and women about HPV
Studies reveal women desire more information about HPV (24)
13. HPV Education
Few studies on effect of HPV-focused educational programs
Lambert (25) evaluated the effectiveness of a brief HPV focused educational program
Physician Assistant and Psychology students
Data revealed statistically significant improvement in HPV knowledge scores after the program
14. STD and Pregnancy Prevention Programs
Have been shown in literature to be successful
Anderko and Uscian (22)
Studied decreasing risky sexual behavior
Kirby
Research review revealed success with educational programs on HIV prevention
15. Study Design
Pre-test/Post-test
16. Sample
Convenience sample of full time senior level undergraduate nursing students (n=18)
Demographic data analyzed using frequencies and averages
Mean age of students was 22.53 years (SD 1.13) after removal of 3 outliers (ages 33, 37, 42)
17. Sample
Participation was voluntary
Completion of study materials considered implied consent
No incentives offered for participation
Study approved by IRB at RMU and Human Subjects Review Board at host university
18. Instrument
The Awareness of HPV and Cervical Cancer Questionnaire (23)
40 item multiple choice questionnaire
Developed to assess knowledge, perceptions, and preventive behaviors regarding HPV and cervical cancer
19. Instrument
Permission to use granted by author, Ingledue (23)
Stability reliability established by test-retest procedures
Test-retest coefficients of 0.90 reported for knowledge; 0.95 for perceptions and 0.90 for behaviors
20. Instrument
No data reported for internal consistency
Content validity established via consensual validity using a panel of health experts
Instrument was approved by a Human Subjects committee
21. Instrument
For present study, only the knowledge items of the instrument were used
Multiple choice questions
One correct answer
Correct answers assigned one point
Score range of 0 to 15
22. Data Collection
Demographic questionnaire with cover letter describing study
Questionnaires numbered by author
Pre-test/post test-numbered by participants
All placed in privacy envelopes upon completion.
23. Educational Intervention
Objectives
Increase general knowledge of HPV disease and its sequelae
Identify-
Risk factors for HPV and cervical cancer
Symptoms of HPV infection
Means to prevent HPV and cervical cancer
Means of detecting HPV and cervical cancer
24. Educational Intervention
Content:
HPV types
HPV incidence, prevalence and pathogenesis
HPV risk factors and sequelae
Various stages of cervical dysplasia and cervical cancer
Cervical cancer statistics
Knowledge deficit
Quadrivalent HPV vaccine
25. Educational Intervention
Concluded with open question and answer period
26. Data Analysis
Data entered into AccessExcel
Paired t-test
Analysis performed using SPSS 17.0
27. Results
Mean of pre-test: 10.83 (SD 1.043)
Mean of post-test: 13.78 (SD 1.166)
t=7.517(7), p=.000
28. Discussion
Mean pre-test score: 72%
Mean post-test score: 91%
29. Discussion
Undergraduate nursing students
Will be able to disseminate accurate information about HPV disease and vaccine to patients
May be of the age group recommended to receive the vaccine themselves
Improved knowledge in this group may contribute to public health both directly and indirectly
30. Discussion
Study limitations
Small sample size
Homogeneity of sample
Vaccine knowledge not assessed
38.9% of students reported some previous education on HPV disease
Entire tool not utilized
31. Future Research
Should include larger sample size
Nursing students in various pre-licensure programs
More heterogeneous sample
Assess knowledge retention over time
Vaccine knowledge (instrument development)
Vaccination status pre- and post-program
Include practicing nurses and their practice habits as they pertain to patient education
32. Implications for Study
HPV incidence and subsequent cervical disease burden may be reduced through education of nurses
Nurses can have positive effect public health as they disseminate accurate information
33. References
1. Fontenot HB, Collins Fantasia H, Allen JD. HPV in adolescents: Making the wake up call. Adv Nurse Pract. 2007;15(10): 73-76.
2. Denny-Smith T, Bairan A, Page M. C.A survey of female nursing students knowledge, health beliefs, perceptions of risk, and risk behaviors regarding human papillomavirus and cervical cancer.J AmAcad Nurse Pract. 2006;18:62-69.
3. OBrien J.11th annual conference on vaccine research.Expert RevVaccines. 2008;7(6):721-723.
4. Bosch, FX, & de Sanjose, S.(2003).Chapter 1: Human papillomavirus and cervical cancer burden and assessment of causality.J Natl CancerInst Monogr. 2003;31;3-13
34. References
5. Walboomers JMM, Jacobs M, Manos N, Bosch F, Kummer A, Shah K.Humanpapillomavirus is a necessary cause of invasive cervical cancer worldwide.J Pathol. 1999;189:12-19.
6. Oaknin A, Pilar-Barretina M.Human papillomavirus vaccine and cervical cancer prevention.Clin and Transl Oncology. 2008;10:804-811.
7. Cervical cancer statistics.Centers for Disease Control Website. http://www.cdc.gov/cancer/cervical/statistics/index.htm.Updated July 20, 2009.Accessed September 3, 2009.
8. Buttin B, Herzog T, Mutch D.Abnormal cytology and human papillomavirus. In: Curtis M, Overholt S, Hopkins M.Glass Office Gynecology. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2006:80-106
35. References
9. Block S, Nolan T, Sattler C, Barr E, Giacoletti KED, Marchant CD, et al.Comparison of the immunogenicity and reactogenicity of a prophylactic quadrivalent human papillomavirus (types 6, 11, 16, 18) l1 virus-like particle vaccine in male and female adolescents and youngadult women. Pediatrics. 2006;118(5);2135-2145.
10. Future I Study Investigators.Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N England J Med. 2007;356(19):1928-1943.
11. Parkin D, Pisani P, Ferlay J.Estimates of the worldwide incidence ofmortality from 25 cancers in 1990.Int J Cancer. 1999;80:827-841.
36. References
15. Cancer Prevention & Early Detection Facts & Figures.American Cancer Society Website
http://www.cancer.org/downloads/STT/CPED_2008.pdf.Reported as of November 30, 2007.Accessed September 3, 2009.
16. Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review.Ann Intern Med. 2000;132:810-819.
17. Adams M, Jasani B, Fiander, A.Human papillomavirus (HPV) prophylactic vaccination: challenges for public health and implications for screening. Vaccine. 2007;25:3007-3013.
37. References
18. Future II study group.Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356(19):1915-1927.
19. Zimet GD, Liddon N, Rosenthal SL, Lazcano-Ponce E, Allen B.Psychosocial aspects of vaccine acceptability. Vaccine. 2006;24S3, S3/201-S3/209.
20. Ramirez J, Ramos D, Clayton L, Kanowitz S, Moscicki.Genital human papillomavirus infections: Knowledge, perception of risk, and actual risk in a nonclinic population of young women. J Womens Health. 1997;6:113-121.
38. References
21. Pitts M, Clarke T. Human papillomavirus infections and risks of cervical cancer: what do women know? Health Educ Res. 2002;17(6):706-714.
22. Baer H, Allen S, Braun L.Knowledge of human papillomavirus infection among young adult men and women: implications for health education research. J Community Health. 2000;25:67-78.
23. Yacobi E, Tennant C, Ferrante J, Naazneen P, Roetzheim R. University students' knowledge and awareness of HPV. Prev Med. 1999; 28:535-541.
39. References
24. Zimet GD.Improving adolescent health: focus on HPV vaccine acceptance. J Adolesc Health. 2005;37:19-23.
25. Anderko L, Uscian M.Academic-community partnerships as a strategy for positive change in the sexual behavior of rural college-age students.Nurs Clin North Am. 2002;37:341-349.
26. Ingledue K, Cottrell R, Bernard A.College womens knowledge, perceptions, and preventive behaviors regarding human papillomavirus infection and cervical cancer. Am J of Health Stud. 2004;19(1):28-34.
40. References
27. Holcomb B, Bailey J, Crawford K, Ruffin M. Adults' knowledge and behaviors related to human papillomavirus infection. J Am Board Fam Practice. 2004;17(1):26-31.
28. Lambert E.College students knowledge of human papillomavirus and effectiveness of a brief educational intervention. J Am Board Fam Pract. 2001;14(3):178-183.
29. Kirby D.Emerging answers: research findings on programs to reduceteen pregnancy (summary).Washington, DC: National Campaign to Prevent Teen Pregnancy. 2001.