- Email: [email protected]
Perceptions of perinatal depression training among primary care providers and obstetricians in Kumasi, Ghana
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Abstracts / Contraception 88 (2013) 297–318
scope reproductive care and abortion services. In order to increase the numbers of nurse providers and expand access to reproductive health and abortion services, a comprehensive reproductive health care curriculum must be integrated into core nursing training.
P25 PERCEPTIONS OF PERINATAL DEPRESSION TRAINING AMONG PRIMARY CARE PROVIDERS AND OBSTETRICIANS IN KUMASI, GHANA Ramakrishnan A University of Michigan Medical School, Ann Arbor, MI, USA Spangenberg K, Gold KJ Objectives: Pregnancy and the postpartum are vulnerable periods for maternal mental health conditions and at least 15% of postpartum women in developing countries experience depression. Maternal depression has also been shown to be associated with poor infant health outcomes. As developing countries such as Ghana have few psychiatrists, perinatal depression screening and management rely on primary care providers and obstetricians. The purpose of this study was to investigate providers' views of and training in perinatal depression identification and management in Kumasi, Ghana. Method: Between June 2012–July 2012, semi-structured interviews were conducted with 24 physicians and nurses from the departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Family Medicine at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Interviews were recorded and transcribed. Results were coded and grouped to elucidate themes regarding providers' perspectives on perinatal depression training and on their role in identification and treatment of mental health disorders. Results: Fourteen out of 24 providers reported lack of training in identification and management of perinatal depression. 24 out of 24 providers stated needing more practical training such as workshops and clinical opportunities focused on depression. Providers also specified that such training would be useful particularly when providers must serve in less specialized settings such as district-level hospitals. Conclusions: These results reveal that the majority of providers believe perinatal depression training is valuable for improving patient treatment in their fields, yet report that their training has not adequately prepared them to identify and manage depression. As there is a severe shortage of psychiatrists in Ghana and in other developing countries, medical education should be revised to integrate more clinical training in mental health for primary care providers and obstetricians who play significant roles in prevention and management of perinatal depression.
P26 WHAT COLLEGE WOMEN KNOW, THINK AND DO ABOUT HUMAN PAPILLOMAVIRUS (HPV) AND HPV VACCINE Ratanasiripong N California State University-Dominguez Hills, Carson, CA, USA Objectives: Approximately 20 million Americans between the ages of 15 and 49 are currently infected with HPV and another 6 million people become newly infected each year. Among these HPV infections, 74% occur in the 15 to 24 year old age group. Researchers have documented an increased awareness of HPV and HPV vaccine among college-aged women. However, the national vaccine uptake rate among young women has been low. HPV vaccine mandatory proposals have also been met with a controversy — whether receipt of HPV vaccine might encourage unsafe sexual behaviors because of a misunderstanding that HPV vaccine prevents all sexually transmitted infections (STIs). This crosssectional study, guided by Theory of Planned Behavior, aimed to identify factors
influencing the HPV vaccine uptake rate among college women and to examine the relationships among these factors. Method: An electronic self-administered survey was utilized to collect data. An email invitation was sent to 3074 college women attending a large, public university in southern California, aged between 18 to 26 years. The email directed the recipient to click on a web-based survey link if she wanted to participate in the study. Results: There were 384 participants in the study (175 HPV non-vaccinees and 209 HPV vaccinees). The participants knew that the HPV vaccine does not protect against other STIs. Both non-vaccinees and vaccinees had positive attitudes about mandating HPV vaccine. Knowledge and attitudes toward the vaccine were not directly linked to the outcome predictors -intention to obtain the vaccine and vaccine uptake. Attitude about receiving HPV vaccine, subjective norms (complying with the expectations of others), and perceived behavioral control were correlated with the outcome predictors. Subjective norms consistently predicted intention to obtain HPV vaccine and vaccine uptake. Conclusions: A proposal to mandate HPV vaccination was acceptable to this population. The vaccination promotion strategies should include attention to college women's subjective norms. Health care provider's recommendation and encouragement from significant others are critical in order for the college women to obtain the vaccine.
P27 INTRAUTERINE CONTRACEPTION DURING THE FIRST 6 MONTHS: A COMPARISON BETWEEN ADOLESCENTS AND NON-ADOLESCENTS' CLINICAL CONCERNS, CONTINUATION AND INFECTION Ravi A Beth Israel, New York, NY, USA Rubin S, Waltermaurer E, Miller N, Prine L Objectives: Intrauterine contraception (IUD) is among the most effective reversible contraceptives, yet is underutilized. Reasons for underuse include clinicians' concerns that, as compared to non-adolescents, adolescents who use IUDs are more likely to (1) require post-insertion clinical attention, (2) prematurely discontinue IUD use, and/or (3) acquire sexually transmitted infections (STIs) including PID. We sought to determine if there is a significant difference in the post-IUD insertion experience of adolescents vs. non-adolescents with regard to these issues. Method: Retrospective chart review of women up to 35 years old with IUDs inserted in 2011 at a NYC Federally Qualified Health Center network of 13 family physician staffed clinical sites. Women were followed six-months post-insertion or until device was discontinued, whichever occurred first. We compared adolescents (women not yet 21years at insertion visit) to nonadolescents on our variables of interest. Results: Six hundred eighty-four women (182/adolescents, 502/nonadolescent) had IUDs inserted (73% levonorgestrel and 27% Copper-T, no significant difference by age). In the 6 months post-insertion, 331 women (113/adolescents, 218/non-adolescents) had at least one followup clinical contact. The most frequent IUD related concerns for both age groups were bleeding changes and pelvic/abdominal pain. Adolescents made an average of 3.7 visits, non-adolescents made 2.7. Among adolescents with follow-up visits, 16% (n=18) had removals, 8% (n= 9) expelled and 5% (n= 6) were diagnosed with Chlamydia. Among non-adolescents, 17% (n=37) had removals, 5% (n=11) expelled and 2% had Chlamydia (n=3) or PID (n= 1). Conclusions: During the 6-month post-IUD insertion, these urban adolescents as compared to non-adolescents were more likely to make an IUD-related follow-up visit; however, clinical concerns and removal rates are similar. While adolescents' expulsion and STI rates are slightly higher than non-adolescents, the overall rates are relatively low. These results may reassure providers about the safety of inserting IUDs in urban adolescents.
Abstracts / Contraception 88 (2013) 297–318
scope reproductive care and abortion services. In order to increase the numbers of nurse providers and expand access to reproductive health and abortion services, a comprehensive reproductive health care curriculum must be integrated into core nursing training.
P25 PERCEPTIONS OF PERINATAL DEPRESSION TRAINING AMONG PRIMARY CARE PROVIDERS AND OBSTETRICIANS IN KUMASI, GHANA Ramakrishnan A University of Michigan Medical School, Ann Arbor, MI, USA Spangenberg K, Gold KJ Objectives: Pregnancy and the postpartum are vulnerable periods for maternal mental health conditions and at least 15% of postpartum women in developing countries experience depression. Maternal depression has also been shown to be associated with poor infant health outcomes. As developing countries such as Ghana have few psychiatrists, perinatal depression screening and management rely on primary care providers and obstetricians. The purpose of this study was to investigate providers' views of and training in perinatal depression identification and management in Kumasi, Ghana. Method: Between June 2012–July 2012, semi-structured interviews were conducted with 24 physicians and nurses from the departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Family Medicine at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Interviews were recorded and transcribed. Results were coded and grouped to elucidate themes regarding providers' perspectives on perinatal depression training and on their role in identification and treatment of mental health disorders. Results: Fourteen out of 24 providers reported lack of training in identification and management of perinatal depression. 24 out of 24 providers stated needing more practical training such as workshops and clinical opportunities focused on depression. Providers also specified that such training would be useful particularly when providers must serve in less specialized settings such as district-level hospitals. Conclusions: These results reveal that the majority of providers believe perinatal depression training is valuable for improving patient treatment in their fields, yet report that their training has not adequately prepared them to identify and manage depression. As there is a severe shortage of psychiatrists in Ghana and in other developing countries, medical education should be revised to integrate more clinical training in mental health for primary care providers and obstetricians who play significant roles in prevention and management of perinatal depression.
P26 WHAT COLLEGE WOMEN KNOW, THINK AND DO ABOUT HUMAN PAPILLOMAVIRUS (HPV) AND HPV VACCINE Ratanasiripong N California State University-Dominguez Hills, Carson, CA, USA Objectives: Approximately 20 million Americans between the ages of 15 and 49 are currently infected with HPV and another 6 million people become newly infected each year. Among these HPV infections, 74% occur in the 15 to 24 year old age group. Researchers have documented an increased awareness of HPV and HPV vaccine among college-aged women. However, the national vaccine uptake rate among young women has been low. HPV vaccine mandatory proposals have also been met with a controversy — whether receipt of HPV vaccine might encourage unsafe sexual behaviors because of a misunderstanding that HPV vaccine prevents all sexually transmitted infections (STIs). This crosssectional study, guided by Theory of Planned Behavior, aimed to identify factors
influencing the HPV vaccine uptake rate among college women and to examine the relationships among these factors. Method: An electronic self-administered survey was utilized to collect data. An email invitation was sent to 3074 college women attending a large, public university in southern California, aged between 18 to 26 years. The email directed the recipient to click on a web-based survey link if she wanted to participate in the study. Results: There were 384 participants in the study (175 HPV non-vaccinees and 209 HPV vaccinees). The participants knew that the HPV vaccine does not protect against other STIs. Both non-vaccinees and vaccinees had positive attitudes about mandating HPV vaccine. Knowledge and attitudes toward the vaccine were not directly linked to the outcome predictors -intention to obtain the vaccine and vaccine uptake. Attitude about receiving HPV vaccine, subjective norms (complying with the expectations of others), and perceived behavioral control were correlated with the outcome predictors. Subjective norms consistently predicted intention to obtain HPV vaccine and vaccine uptake. Conclusions: A proposal to mandate HPV vaccination was acceptable to this population. The vaccination promotion strategies should include attention to college women's subjective norms. Health care provider's recommendation and encouragement from significant others are critical in order for the college women to obtain the vaccine.
P27 INTRAUTERINE CONTRACEPTION DURING THE FIRST 6 MONTHS: A COMPARISON BETWEEN ADOLESCENTS AND NON-ADOLESCENTS' CLINICAL CONCERNS, CONTINUATION AND INFECTION Ravi A Beth Israel, New York, NY, USA Rubin S, Waltermaurer E, Miller N, Prine L Objectives: Intrauterine contraception (IUD) is among the most effective reversible contraceptives, yet is underutilized. Reasons for underuse include clinicians' concerns that, as compared to non-adolescents, adolescents who use IUDs are more likely to (1) require post-insertion clinical attention, (2) prematurely discontinue IUD use, and/or (3) acquire sexually transmitted infections (STIs) including PID. We sought to determine if there is a significant difference in the post-IUD insertion experience of adolescents vs. non-adolescents with regard to these issues. Method: Retrospective chart review of women up to 35 years old with IUDs inserted in 2011 at a NYC Federally Qualified Health Center network of 13 family physician staffed clinical sites. Women were followed six-months post-insertion or until device was discontinued, whichever occurred first. We compared adolescents (women not yet 21years at insertion visit) to nonadolescents on our variables of interest. Results: Six hundred eighty-four women (182/adolescents, 502/nonadolescent) had IUDs inserted (73% levonorgestrel and 27% Copper-T, no significant difference by age). In the 6 months post-insertion, 331 women (113/adolescents, 218/non-adolescents) had at least one followup clinical contact. The most frequent IUD related concerns for both age groups were bleeding changes and pelvic/abdominal pain. Adolescents made an average of 3.7 visits, non-adolescents made 2.7. Among adolescents with follow-up visits, 16% (n=18) had removals, 8% (n= 9) expelled and 5% (n= 6) were diagnosed with Chlamydia. Among non-adolescents, 17% (n=37) had removals, 5% (n=11) expelled and 2% had Chlamydia (n=3) or PID (n= 1). Conclusions: During the 6-month post-IUD insertion, these urban adolescents as compared to non-adolescents were more likely to make an IUD-related follow-up visit; however, clinical concerns and removal rates are similar. While adolescents' expulsion and STI rates are slightly higher than non-adolescents, the overall rates are relatively low. These results may reassure providers about the safety of inserting IUDs in urban adolescents.