Personal meaning of human papillomavirus and pap test results in adolescent and young adult women.

Abstract

Objective: As new cervical cancer screening recommendations are adopted, more adolescents may learn they are infected with human papillomavirus (HPV). The objective of this study was to explore personal meaning of HPV and Pap test results in adolescent and young adult women. Design: The authors recruited sexually active 14-to 21-year-old adolescent girls from an urban teen health center. Participants underwent HPV and Pap testing at baseline and returned 2 weeks later to receive test results and to be interviewed about their responses to test results. The authors analyzed interview transcripts using qualitative methods and developed a conceptual framework to explain participants' responses. Main Outcome Measures: Of the 100 participants, 51% were HPV positive and 23% had an abnormal Pap test. Personal meaning was comprised of four core dimensions: labeling of results, perceived risk of HPV-related disease, personal accountability, and anticipated shame or stigma. The association between test result and personal meaning was mediated through cognitive understanding of test results, which in turn was influenced by education about HPV and prior health experiences. Conclusion: Clinicians who communicate HPV and Pap test results to adolescent girls should provide accurate information in a nonjudgmental manner, take into account adolescents' personal experiences with sexually transmitted infections and cancer, and explore personal meaning of results such as anticipated risk and stigma. In this way, clinicians may be able to minimize adverse psychosocial outcomes while promoting positive reproductive health behaviors.

Development of an HPV Educational Protocol for Adolescents

“…In preliminary studies of both adults and adolescents, HPV testing has been associated with anxiety, distress, perceived stigma, and fear of further testing and treatment procedures. (13,15,16,25) These types of responses may adversely impact adolescent decisions about future STI screening and follow-up. (26,27) Our previous work has demonstrated that cognitive understanding of HPV infection and Pap tests is a key factor in predicting psychosocial and behavioral responses to HPV infection and abnormal Pap tests.…”

“…Research suggests that these types of negative responses could decrease follow-up for diagnostic or treatment procedures. (13,(15)(16)(17)(18) Education may prevent or alleviate psychosocial distress by addressing women's concerns about HPV. (19) Finally, HPV vaccines have been developed that target the HPV types most commonly associated with cervical cancer, genital warts, or both.…”

Clinician Attitudes Toward CDC Interim Pre-Exposure Prophylaxis (PrEP) Guidance and Operationalizing PrEP for Adolescents

“…Field notes taken during interviews were added to transcripts prior to analysis. Data were analyzed using a five-step framework analysis approach (familiarization, identification of thematic frameworks, indexing, charting, mapping/interpretation) 20,21 and employing NVivo (version 10). Following familiarization with the data, the first author generated preliminary themes.…”

“…11,30 When considering how these clinicians adapted the guidance, several general lessons emerged. In general, clinicians (20) ''The first important thing is to make sure, number one, that the person who you're prescribing for understands what PrEP is, that it's not 100% protection against getting HIV, and that we do recommend using it as part of a comprehensive HIV prevention strategy if they're using condoms and STI testing, partner communication, all the things that we're already doing and using PrEP as an added component to that.'' Counseling about need for adherence to PrEP medication…”

Psychological Aspects Associated with the Acquisition and Development of HPV Infection and its Repercussion on Quality of Life

“…In this way we will manage to minimize the adverse psychosocial consequences and promote positive sexual behaviour [11].…”