D025: Essentials of Advanced Nursing Roles and Interprofessional Practice, STIs Education Program for Youths

Executive Summary

Summary of the Context and Scope of the SDOH in My Community

Adolescents remain highly vulnerable to sexually transmitted infections (STIs) in the community. In Washtenaw County, an increased rate of STIs was identified as one of the major health issues among youths aged 15 to 24 years. The increased rates were associated with the lack of enough knowledge on the diseases among the adolescents. To solve the healthcare issue in the county, the plan was to propose a policy that could ensure the education of the youths about sexual health. Upon the review of the literature, an evidence-based STI educational program among college and university students was identified as the probable solution to STIs’ management.

Summary of How the Proposed Policy will Address the SDOH in My Community

The proposed policy involved the incorporation of STIs education into the university and college curriculum to capture students aged 18 to 24 years. It was necessary to use this approach because the majority of the affected individuals were adolescents seeking education in universities. The new policy was going to ensure that all students received basic education on STIs to promote responsible sexual behavior. Additionally, the new change could ensure the youths understood the resources available for disease management including early screening for STIs.

Proposal of Persuasive Course of Action for Policy Makers

To effectively implement the new change, policymakers including the public health officer, public health director, public health nurse, medical director Washtenaw county, and Michigan State representative were contacted. Communication using emails, letters, meetings, and phone calls were done to ensure the policymakers understood the new change and their role in ensuring its success. To convince the policy makers, data about the increasing rate of STIs among the adolescents was provided. An evidence-based approach was used to present facts about the use of an educational approach in reducing the rate of STIs in universities and colleges. During the persuasion, an explanation about the stakeholders’ power, influence, and expertise was given to convince them about their importance in the proposal.

 

 

Context and Scope

Social Determinant of Health (SDOH) in My Community

Social determinants of health (SDOH) refer to the conditions in the environment in which people are born, live, learn, work, and age that affects their health and quality of life. The social determinants have a major impact on the health outcomes of people and they include factors such as education, level of income, environment, and access to healthcare services (Office of Disease Prevention and Health Promotion (ODPHP), n.d-a.). The SDOH affecting Washtenaw county is lack of evidence-based educational program on sexually transmitted infections (STIs). Education is a powerful tool for ensuring people have knowledge and skills to handle diseases in the community. The main problem observed is the lack of education in universities and colleges in the county leading to an increased rate of STIs among the youths. Findings suggest that there is a lack of enough education and guidance of the adolescent regarding reproductive health. The use of an evidence-based education program can greatly improve knowledge about STIs among the youths in Washtenaw county.

Data to Support the SDOH

Sexually transmitted infections refer to more than 35 infectious organisms transmitted sexually. The healthy people 2020 goal for STIs was to promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications (ODPHP, n.d.-b). The aspect of promoting healthy sexual behavior is yet to be achieved in the US with approximately 20 million new STD cases being diagnosed each year. It is also observed that half of these infections are present in individuals aged 15 to 24 years. The healthy people 2020 indicate that undiagnosed and untreated STIs are the cause for over 24000 women infertilities in the US. Washtenaw County is among the areas with high rates of STIs in Michigan. approximately 456.2 individuals out of 100,000 people have an STI in the county, a value that is far above the national average (County Health Rankings and Roadmaps, 2020). The Michigan Department of Health and Human Services (2020) data shows an increased rate of chlamydia infection since 2014 indicating a gap in education and prevention of the diseases. Health education programs in universities and colleges will greatly help in reducing the STIs rate in the county.

There is supporting evidence on the lack of education among teenagers on STIs including vaccination activities to prevent the diseases. For example in 2013, only 57% of adolescent girls had received at least one dose of HPV vaccine in the US. Consequently, it was observed that only 38% were able to complete all three doses of HPV vaccine as required (CDC, 2014). These statistics indicate a gap in sex education in schools including the use of preventive measures such as vaccination for common STDs.

Three Characteristics of Target Population Affected by SDOH

Sexually transmitted infections are common among the young generation due to a lack of education and information on responsible sexual behaviors. The first characteristic of the target population is individuals between the age of 18 and 24 years. It is evident that almost half of the STI cases in Washtenaw county are from the youths within the bracket of 15 to 24 years. The second characteristic involves boys and girls between the identified age bracket in Washtenaw county. According to information from healthy people 2020, women suffer more frequently from STDs than men (ODPHP, n.d.-b). However, there is no significant difference in the number of affected individuals making both boys and girls within the bracket of affected individuals. The third characteristic of the focus population is boys and girls attending universities and colleges in Washtenaw county. The geographical distribution of STIs in the region indicates that the most affected areas are those that harbor students from universities and colleges. Additionally, the majority of the people aged 15 to 24 years are in their school life making them a target of the new STI education policy.

The rate of STIs in the county varies according to age, race, sex, and geographical location. For example, recent statistics indicate that black females have an incidence rate of 1709.27 making them the most affected individuals in Michigan state (County Health Rankings and Roadmaps, 2020. Diversity is also observed depending on the age of individuals where adolescents aged 20 to 24 years are most affected by Chlamydia and other STIs. Geographically, individuals from Ann Arbor and Ypsilanti cities have the highest rates of STIs in the state.

Identification of Appropriate Policy Maker(s) or Legislator(s)

The policy brief will be directed to four individuals who have an influential role in policymaking. The first individual will be the public health officer, Washtenaw county, Ms. Jimena Loveluck. Together with the public health director of the county, Dr. Robert Ernst, the individuals will work in the interest of the youths to ensure support for the proposed change. Another key stakeholder for the support of the new policy is the sexual health public health nurse, Washtenaw county, Ms. Katie Keppen. She will be an important key player in ensuring the policy is implemented for the interest of sexual health in the region. The medical director of Washtenaw county, Penrose Alice will be contacted to ensure the county health department is behind the proposed change.

Because the new policy change will affect the department of education, the department of education state superintendent, Michel F. rice will be contacted to aid in making policies that will change sexual education delivery in schools. Another crucial stakeholder that will help in reaching the state department of education is David Dugger, the executive director of Washtenaw educational options Consortium. Lastly, Michigan county state representative Ben Frederick will be contacted to provide support for the new policy which will potentially improve the health of the county and the state. I believe these individuals have the power and influence that will see through the proposed policy change.

Why the SDOH Requires the Policy Maker’s Attention

Sexually transmitted infections have huge health and financial impact on the people and the economy of the United States. The CDC estimates indicate that around $16 billion are spent annually to deal with the increasing rate of STDs in the country (Centers for Disease Prevention and Control, 2016). Nationwide data shows that individuals of age between 15 and 24 years account for two-thirds of chlamydia diagnoses and nearly half for gonorrhea diagnoses. For instance, since 2010 the rates of primary and secondary syphilis have increased by 10% (Michigan Department of Health and Human Services, 2020). Statistics also indicate fluctuating rates of chlamydia and gonorrhea in Washtenaw county. STIs are preventable diseases that require the use of effective preventive measures. The new policy will ensure that sexual education is made compulsory among the youths attending universities and colleges to help in reducing the burden in the county and the state. Without proper education and prevention measures, the rates of chlamydia, syphilis, and gonorrhea will increase.

The proposed policy requires the attention of the healthcare sector, the department of education and state. The county public health nurse, county public health director and the sexual health public health nurse are responsible for ensuring health is maintained in the county. The increasing rate of STIs in among the adolescents means the department of health needs to increase awareness on the issue and propose changes that can improve the health of individuals. The education sector representatives include the county educational options consortium executive director and the state department of education superintendent. These individuals have the power to influence curriculum change in universities and colleges to help improve the health of students.

Current Policy or the Effect of Not Having a Current Policy

There is a lack of clear guidelines to control the increasing rate of STIs in Washtenaw county. The county health department has in place various services for the control and prevention of STIs including free HIV testing, free STIs screening, free condoms, and free pregnancy testing. Education and outreach are part of the prevention program but the increasing rate of diseases over the years indicates how ineffective these strategies are in the county. There is no active program observed to maintain education and outreach services for the youth s alongside other materials like protective equipment. Perhaps an evidence-based education program will serve to ensure the youths and the public get adequate information about screening and other preventive measures for the diseases.

Ethical Implications of Current Policy or Absence of Existing Policy

In recent, there is evidence that medical institutions have demonstrated more explicit efforts to practice ethically than public health institutions. Although the two sectors serve different purposes, there is a need for the public health sector to focus on providing essential care to the populations served. For instance, public health should address principally the causes of diseases to prevent adverse health outcomes. I believe the public health sector has not managed to prevent adverse outcomes regarding STIs in the county due to the unavailability of clear policies on the matter. Additionally, ethical guidelines for public health delivery stipulates that public health institutions should act promptly on the information they have within the resources and the mandate given to them by the public (Lee et al., 2020). Failure to establish proper means for STI control indicates there is a gap in practicing ethically. The new policy will serve to ensure the public health sector is actively engaged in promoting STIs prevention in the county.

 

 

Demographics Table

(Place Title of SDOH here)	Statistics/facts	Summary of statistics/facts	Source for statistics/facts
Demographic Information (Provide 2 or more  statistics/facts associated with demographics for SDOH in column to the right)	Approximately 456 individuals out of 100,000 people get affected by STIs annually  in Washtenaw.	Higher rates of STIs are observed in the county than most parts of the US.	County Health Rankings and Roadmaps, 2020.
	Primary and secondary syphilis together with chlamydia infections have increased from 2010 to 2019 in the state.	There is an increasing trend of STIs in Washtenaw county	Michigan Department of Health & Human Services , 2020.
Risk Factors (Provide 2 or more statistics/facts regarding risk factors associated with SDOH in column to the right).	Having unprotected sex and homosexuality.	Irresponsible sexual behavior is a contributing factor to STIs.	Centers for Disease Prevention and Control, 2016.
	Young adults, aged 15 to 24 years.	High incidence of STIs is observed among college and university students.	Centers for Disease Prevention and Control, 2016
Trends in SDOH Over Recent Year(s) (Provide 2 or more statistics/facts associated with trends in SDOH over recent year(s) in column to the right.)	Since 2010, primary and secondary syphilis  have demonstrated an annual increase rate of cases by 10%.   Only five abstinence-based educational programs are found to be incorporated in the US education system.   Data indicates that these programs have failed to reduce the number of sexual partners, increase the use of condoms and reduce the number of STIs in schools.	Lack of adequate STIs prevention leading to more cases annually.           School-based educational programs have failed to address the issues of condom use and multiple sexual partners.	Michigan Department of Health & Human Services , 2020.             Manlove et al., 2015
	The Chlamydia rate in Washtenaw county  have constantly increased from 2018 (453 cases) to 2019 (490 cases) per 100,000 people.	Increasing rate of STIs in the region  yearly.	Michigan Department of Health & Human Services , 2020.

 

 

 

Policy Proposal and Implementation Plan

Two Policy Alternatives to Address the SDOH

The first policy to address the problem of STIs in Washtenaw county is the use of an evidence-based education program implemented in universities and colleges. There are various programs highlighted on the county website to help the youths including timely screening and free services in hospitals. However, the main challenge is that the youths do not have adequate information about the burden of the disease in the county, state, and nation. They do not have an adequate understanding of the risk factors and other preventive measures for the diseases. An STI education program implemented in Universities and colleges will serve to ensure all students joining higher education have adequate exposure to STI education.

The second alternative to improve awareness is the use of planned outreaches to schools and public places to educate people about the diseases. The planned outreaches can be organized by the department of health through the use of volunteers and qualified healthcare providers. This approach is supported  by many scholars because it improves knowledge among teenagers and is proven to be effective in reducing teen pregnancies (Manlove et al., 2015). The program can be held monthly at different institutions in the county to serve as an awareness and screening program for the youths. I believe this approach can also serve to ensure the affected population gets enough education about the burden of STIs in the county and its preventive measures.

Preferred Policy 

I prefer the first alternative of implementing an education program in schools to reach adolescents and youths aged 18 to 24 years. An education approach will provide a medium through which every student will be informed about the disease. The approach will promote life-long learning about the diseases and many individuals are likely to understand how to effectively prevent themselves. Evidence suggests that school-based education is effective in promoting responsible sexual behaviors such as the use of protection and avoiding multiple partners (Morales et al., 2018). The programs also increase awareness of the importance of screening leading to more individuals seeking healthcare services. The efficacy of educational intervention for STI prevention is high than the use of the second alternative. I prefer the use of education for university/college policy over the community outreach policy because most of the affected students stay in schools rather than in the community. The outreach services will not provide adequate coverage compared to education of STIs in schools which will ensure every student attends the educational program.

How the Desired Results of the New Policy will Optimize Health in Community

Health optimization refers to the use of self-regulating mechanisms to deal with health-related issues. The proposed policy aims to empower the youths to make the right choices concerning their sexual health. The new policy will optimize the health of individuals in Washtenaw County through the promotion of good decision making on a sexual health matter. For example, the community will be able to have educated youths who are ready to condemn bad sexual behaviors in society. The program will also see the community have responsible citizens ready to seek healthcare when necessary. Increased awareness will ensure a reduced number of STIs and decreased use of resources by the community due to STIs management.

Financial Costs and Benefits of Proposed Policy Alternative

The CDC estimates that the direct and indirect costs associated with STDs management in the US sum up to $16 billion annually (CDC, 2016). There are also many cases of mortality and morbidity resulting from serious illness associated with STDs with women being the most affected. The proposed policy will ensure that the healthcare costs associated with treatment are decreased. Using the educational approach, many youths will be able to seek medical care earlier reducing complications that are otherwise the case of the huge costs. The proposed policy will be able to ensure sexual education reaches every youth aged 18 to 24 years especially those attending colleges.

Activities associated with curriculum development or revision in education require financial support for time spent on the project and other associated costs. An example is the staff required to educate students about sexual education and the provision of education material to schools. The new policy change will require a lot of capital to facilitate the passing of the policy and incorporating the new policy into the current educational program in universities/colleges. Personnel costs will represent the largest expenditure for supporting the new curriculum than other anticipated costs such as infrastructure design, hardware installation, and purchasing of supplies.

Two Ethical Implications of Proposed Policy Alternative

Fidelity.  Fidelity is an ethical principle that governs nursing practice whereby the nurse must be faithful and true to their professional promises and responsibilities by providing high-quality, safe care in a competent manner (American Nurses Association (ANA),  2015). The proposed policy aims at maintaining improving the health of the adolescent population through education and increased awareness. The sexual health public health nurse, county public health officer, and county public health director will work towards upholding this ethical principle by addressing the issue of STIs in the region.

Beneficence. This ethical principle involves the act of doing good and the right thing for the patient (ANA, 2015). The proposed policy aims at doing the right thing for the public by increasing awareness of sexual health for the adolescent population. Through advocacy, the identified stakeholders will be able to push for the incorporation of an educational program in universities/colleges to reduce the rate of STIs among the youths.

Barriers to Implementation of Proposed Policy Alternative

The implementation of the new policy is likely to be faced by different barriers. These barriers include uncertainty of the period of the policy change and incorporation of the new policy into the educational curriculum. The policy change is a process that requires the input of county and state government. Due to various political interests and pending policy projects in the county, there is likely to be a problem with pushing for the policy change. Secondly, the new policy is both political and educational because it deals with the health sector and the educational sector. It will be challenging to bring a new policy into an existing educational program across all institutions in the county. It will require review by the education sector and probably curriculum change. Other barriers that are likely to affect the proposal include adequate funding from the sponsors, rejection of the policy by policymakers, and lack of cooperation from parents and students.

Communication Methods used to Introduce the Proposed Policy

The first approach to introduce the policy brief to the policymakers will be through letters. The letters will explain the purpose of the new change and how the input of the stakeholders will be crucial towards realizing the goal. Secondly, I will write emails to request an appointment to further explain the policy and present facts that will act as a persuasive course to bring on board the policymakers. These channels of communication will introduce the policymakers to the new policy and help get their attention.

The other approach that will serve to communicate the whole plan will be through meetings. I will organize an educational meeting either through zoom or a face-to-face meeting to present fully my proposal. During the meeting, data about the burden of STIs in the county and the evidence-based approach proposed will be shared. Various aspects of the project like the financial implications, curriculum development for schools, and strategies to support the policy will be communicated. Routine updates will be provided using phone calls and emails.

Potential Results of Inaction

The combined cases of sexually transmitted infections including chlamydia, gonorrhea, and syphilis have increased in the United States. These diseases have a significant effect on the health status of individuals and the economy. Failure to implement the new policy will mean the youths will have inadequate information about STIs in Washtenaw county. The result is an increase in the number of cases in the future. The increased number of cases will mean an increase in deadly STIs like syphilis which is a significant cause of mortality. The increase in the number of cases will mean that healthcare expenditure on STIs management will increase.

Reflection

Change Agent Description

Nurses are change agents in the clinical care of patients and matters involving policy design and development. As a change agent, I did my research and realized that there is a problem with sexual education in Washtenaw county. There were preventable causes of increased STIs in the region and I opted to chose the path of formulating a policy to influence healthy sexual behaviors among the youths. I had to diversify my knowledge on the policy issue by researching evidence-based strategies to solve the problem and essential policymakers that could spear a revolution. I used my skills to propose a persuasive course of action that involved engaging the policymakers through effective communication. I believe the policy is going to be a success and it will help improve sexual health in Washtenaw county.

Knowledge and Skills to Develop

Leadership is an influence that involves the use of knowledge and skills to induce others to achieve set goals. Throughout the project, I demonstrated leadership skills such as commitment, advocacy, time management, and effective communication. I believe I need to work on interprofessional collaboration and outcome monitoring. I would like to be able to work with members from different healthcare teams to help in setting goals and monitoring processes. Secondly, I did not properly monitor the outcome of the policy proposal because I was too much focused on the results. I realized that I need to work on intermittent process evaluation and re-assessment of goals to effectively achieve better outcomes.

References

American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/

Centers for Disease Control and Prevention. (2014). Genital herpes – CDC fact sheet. Retrieved from http://www.cdc.gov/std/herpes/herpes-factsheet-july-2014.pdf

Centers for Disease Prevention and Control. (2016). NCHHSTP newsroom: Reported STDs at unprecedented high in the US. Retrieved from https://www.cdc.gov/nchhstp/newsroom/2016/std-surveillance-report-2015-press-release.html

County Health Rankings and Roadmaps. (2020). A Robert Wood Johnson Foundation program: Michigan, Washtenaw (WA). Retrieved from https://www.countyhealthrankings.org/app/michigan/2020/rankings/washtenaw/county/outcomes/overall/snapshot

Office of Disease Prevention and Health Promotion. (n.d.-a). Social determinants of health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Office of Disease Prevention and Health Promotion. (n.d.-b). Sexually transmitted infections. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases

Lee, L. M., Ortiz, S. E., Pavela, G., & Jennings, B. (2020). Public health code of ethics: Deliberative decision-making and reflective practice. American Journal of Public Health, 110, 489-491. https://doi.org/10.2105/AJPH.2020.305568

Manlove, J., Fish, H., & Moore, K. A. (2015). Programs to improve adolescent sexual and reproductive health in the US: A review of the evidence. Adolescent Health, Medicine and Therapeutics, 6, 47. https://doi.org/10.2147/AHMT.S48054

Michigan Department of Health & Human Services. (2020). STD trends in Michigan, 2019. Retrieved from https://www.michigan.gov/documents/mdhhs/2010-2019_STD_trends_in_Michigan_tables_summary_697339_7.pdf

Morales, A., Espada, J. P., Orgilés, M., Escribano, S., Johnson, B. T., & Lightfoot, M. (2018). Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016. PloS One, 13(6), e0199421. https://doi.org/10.1371/journal.pone.0199421