Addressing sexual health concerns in Tanzania: perceived barriers among healthcare professionals and students in the "training for health professionals" study.

Little is known about the factors that may prevent healthcare professionals as key stakeholders from exploring sexual health issues in Tanzania. This study examined healthcare professionals' perspectives on the barriers to addressing sexual health concerns in practice. In June 2019, we conducted an exploratory qualitative study involving 18 focus group discussions among healthcare professionals (n = 60) and students (n = 61) in the health professions (midwifery, nursing, medicine) in Dar es Salaam, Tanzania. Study participants and design were purposively selected and stratified. We used a focus group discussion guide in Kiswahili. Data were transcribed in Kiswahili and translated into English. A thematic analysis approach was used for data analysis. Two themes were developed: (1) differences between health care professional and patient socio-demographic characteristics; (2) health care system and patients' backgrounds, such as communication barriers, lack of confidentiality and privacy within health facilities, type of clinical presentation and complaint, patient behaviours, and their clinical background. Several key barriers prevented sexual health communication between healthcare professionals and patients, affecting the quality of sexual health service delivery. Additional sexual health clinical training is warranted for health professions students and professionals to optimise sexual health care delivery in a culturally conservative country like Tanzania.

[Sexual health and the migrant population: the challenges of the care pathway]. / Santé sexuelle et population migrante, les défis du parcours de soins.

Migrants living in precarious conditions face many health-related vulnerabilities, particularly in the area of sexual health. This is a real challenge for healthcare professionals, who need to adopt appropriate approaches in order to help them become anchored in a care pathway.

Gaps in sexual health content of healthcare professional curriculum: a systematic review of educational interventions.

BACKGROUND: Sexual health care, including assessment and patient teaching, is part of comprehensive patient care. Health professional (medical and nursing) students' education in sexual health lacks uniformity in content and assessment skills. OBJECTIVES: The current systematic review aimed to assess sexual health educational curriculum for health professional students regarding the educational content, duration, and evaluation of these educational interventions. METHODS: This systematic review followed the preferred reporting guidelines for systematic reviews. A comprehensive search was conducted between May-August, 2023 across four databases (PubMed, Scopus, CINAHL, EMBASE), outlining 614 sources. Following the screening process, 36 educational intervention studies were deemed eligible for inclusion. The quality assessment of these studies was conducted using The Effective Public Health Project tool, which was found appropriate for evaluating this type of research. RESULTS: The studies had a global representation, with most studies conducted in the US. Limited nursing educational interventions were found. Three main categories emerged from the analysis of the educational interventions: one-time interventions, workshops, and semester courses. These categories differed in terms of their duration. Upon evaluating the educational intervention programs, it was found that the majority relied on participant self-reporting, while only a few included objective evaluations. CONCLUSIONS: This review revealed inconsistencies in educational content for healthcare professional students and may impact their clinical skills, particularly in sexual health. The variation in content, duration, and evaluation methods created challenges in assessing the interventions. The lack of standardized sexual health education highlighted a significant gap, raising concerns about students' ultimate proficiency in this area. Bridging this divide is essential by integrating comprehensive sexual health content and assessment skills into the health professional curriculum.

Educational interventions to improve communication about sexual health between nurses and gynecologic oncology patients: A narrative review.

Despite the desire of gynecologic oncology (GO) patients to speak openly about their sexual health experience with nurses, nurses often feel ill equipped to engage in these conversations. There are very few educational interventions available to GO nurses to improve sexual health communication with patients. The purpose of this narrative review is to identify and summarize existing educational interventions in this field. A literature search conducted in three databases, for the years 2010 through 2020, identified 11 papers. The results of the review indicate a mix of nurse training modalities and explore the potential for improving this communication. Existing training programs vary in terms of mode of delivery (online or in person), length, type of instructor, learning strategies and themes addressed. Overall, however, the results show a general lack of sexual health training for nurses caring for GO patients.

Effectiveness of a Sexual Health Care Training to Enhance Psychiatric Nurses' Knowledge, Attitude, and Self-Efficacy: A Quasi-Experimental Study in Southern Taiwan.

BACKGROUND: Sexual health is a taboo issue in some societies. Limited assessments were conducted during nursing care in mental health services. It is unknown whether psychiatric nurses' competencies would be enhanced through short training courses. OBJECTIVE: The present study employed a quasi-experimental design to evaluate the effectiveness of an 8-hour sexual health care training for psychiatric nurses to improve sexual health knowledge, attitude, and self-efficacy in a teaching psychiatric hospital in southern Taiwan. METHOD: Volunteered psychiatric nurses were randomly assigned to the experimental or control group. The 8-hour training program contained sexual health knowledge and attitudes, case discussion, role play, and sexual identity or harassment issues. Each nurse received a pretest and a posttest in the 1-month period between August and September 2019. Descriptive and multivariate statistical analyses were used to evaluate the effects. RESULTS: Among the 75 psychiatric nurses, 43 were in the control group and 32 were in the experimental group. The two groups were not significantly different in the working year, gender, education, marriage, and other psychosocial variables. After the training, the overall performance of sexual health care knowledge, attitudes, and self-efficacy of the experimental group improved significantly than the controls. CONCLUSIONS: The sexual health care training program enhanced psychiatric nurses' confidence and generally improved their sexual knowledge and attitudes. It is suggested that sexual health care needs to be highlighted during in-job training to augment the well-being and life quality of psychiatric patients.

Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses' consultations.

BACKGROUND: Increasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the 'human' aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses. METHODS: Patient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman's correlation and principal component analysis. Internal consistence was assessed through Cronbach's alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland. RESULTS: Female patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of 'not applicable' and missing responses' were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach's alpha showed the measure's high internal consistency (Cronbach's alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses. CONCLUSIONS: Within this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.

Engaging young people with sexual health services in general practice surgeries - A qualitative study of health care professionals.

Background: Evidence to date suggests that young people are becoming more sexually active and are forming relationships during the early stages of their lives, sometimes engaging in sexual risk-taking, which contributes to high rates of conception and sexually transmitted infections (STIs). Young people at risk of adverse sexual health outcomes are the least likely to engage with reproductive and sexual health promotion programmes and services (RSHPPs), especially in mainstream clinics such as general practice (GP) surgeries. The study aimed to explore the views and experiences of service providers. Materials and Methods: A qualitative approach to explore the views and experiences of designing and implementing RSHPPs for young people in GP surgeries was used. A total of seven participants were interviewed, including four general practitioners (GPs), two of whom were managers at the practice; one nurse; one healthcare and support worker; and one practice manager. Results: The context of RSHPPs such as local health priorities and partnerships to address STIs and unplanned pregnancies among young people contribute to the implementation and engagement of young people with RSHPPs. Training of GPs, nurses, and support workers helps develop confidence and overcome personal factors by promoting effective engagement of young people with RSHPPs. Conclusion: Addressing local health priorities such as reducing teenage pregnancies and STIs requires organisations to provide RSHPPs in both non-clinical and clinical settings to ensure that RSHPPs are accessible to young people. There is room for improvement in access to RSH for young people in GP surgeries by addressing organisational and structural barriers to access.

Sexual satisfaction and vaccine application in health professionals in the COVID-19 pandemic.

INTRODUCTION: The negative effects of the COVID-19 pandemic on sexual satisfaction have been emphasized in many studies. However, there is not much information about the effects of the COVID-19 pandemic on the sexual satisfaction of healthcare professionals. In addition, it is not known exactly how vaccination application affects sexual satisfaction. Therefore, in this study, we aimed to evaluate whether the sexual satisfaction of male health personnel would change with vaccination. MATERIALS AND METHODS: One hundred and two unvaccinated and 95 vaccinated male healthcare professionals participated in this study. The COVID-19 Phobia Scale (C19P-S) and The New Sexual Satisfaction Scale (NSSS) were administered to the participants. RESULTS: We did not detect any difference in sexual satisfaction according to vaccine administration. However, we found significant relationships between COVID-19 anxiety and sexual satisfaction. On the other hand, age, fear of COVID-19, and previous COVID-19 infection story were predictive factors on sexual satisfaction. CONCLUSION: The effects of the COVID-19 pandemic on sexual satisfaction are multifaceted. Our findings indicate that fear of COVID-19, rather than vaccination, determines sexual satisfaction.

Discussing sexual health with patients eligible for spine surgery: An online survey in spine surgeon and pain physicians.

Introduction: Spinal pain syndromes have a severe impact on the patient's sex life, contributing to a decrease in sexual function and sexual satisfaction. Despite the importance of sexual health on mental and physical wellbeing, sexual health is rarely discussed during consultations. Research question: The aim of this study is to explore to what extent influencing factors can alter the discussion about sexual health during consultations. More specifically, we will evaluate the influence of healthcare profession, sex of the patient and the surgical approach that is proposed. Material and methods: An online survey was sent to neurosurgeons, pain physicians and orthopedists in Belgium and The Netherlands in April 2019. Participants were asked about; counseling routine, knowledge, and opinion on sexual health. Answers were scored on a 5-point Likert scale. Independence between the response levels and type of surgery as well as profession were tested. Results: In total, 350 respondents were approached of whom 57 completed the survey. The majority of respondents (61.4%) indicated that they rarely or never discussed sexual disturbances. Profession and type of surgery had an influence on discussing erectile dysfunction, retrograde ejaculation, and alterations in orgasms. Thirty-five percent of healthcare providers considered it the patient's responsibility to bring up the subject of sexual health. Discussion and conclusion: Sexual health is rarely addressed by healthcare providers during spinal care. Profession as well as type of surgery seems to play a role on whether sexual health is discussed during consultations.

Barriers experienced by nurses in communication for sexual health education for children with intellectual disability: a qualitative study.

Nurses have important responsibilities in the development of health and care services for children with intellectual disabilities. This is because it is usually the nurse who first encounters the child in all kinds of care and treatment services. Barriers to the provision of sexual healthcare by nurses have not yet been clearly discovered. This study aimed to identify the barriers experienced by nurses regarding communication for sexual health education for children with intellectual disabilities. This study was carried out with 19 nurses through in-depth interviews. The thematic analysis method was used for data analysis. Four themes emerged related to barriers in communication for sexual health education for children with intellectual disabilities by nurses as (1) communication of nurses with their patients, (2) communication on an individual level, (3) communication on the family level, and (4) institutional factors. These barriers included the lack of knowledge of children, families, and nurses, insufficient institutional support, attitudes towards sexuality and stigmatization of the family, and the prevention of sexual health education services by the aggressive behaviors of children. It is recommended to provide sexual health education to nurses and families to minimize problems in the sexual health of children with intellectual disabilities. Nurses should also be trained on sexual health policy and how to put it into practice.

Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study.

BACKGROUND: The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults' attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. OBJECTIVE: The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. METHODS: A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen's feasibility framework. RESULTS: A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). CONCLUSIONS: The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion.

Health professionals working with First Nations, Inuit, and Métis consensus guideline.

OBJECTIVE: Our aim is to provide health care professionals in Canada with the knowledge and tools to provide culturally safe care to First Nations, Inuit, and Métis women and through them, to their families, in order to improve the health of First Nations, Inuit, and Métis. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, Sociological Abstracts, and The Cochrane Library in 2011 using appropriate controlled vocabulary (e.g.,cultural competency, health services, indigenous, transcultural nursing) and key words (e.g., indigenous health services, transcultural health care, cultural safety). Targeted searches on subtopics (e.g., ceremonial rites and sexual coming of age) were also performed. The PubMed search was restricted to the years 2005 and later because of the large number of records retrieved on this topic. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of selected related agencies (e.g., Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement). VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task force on Preventive Health Care (Table).

Objectif : Nous avons pour objectif de fournir aux professionnels de la santé du Canada les connaissances et les outils qui leur permettront d'offrir des soins sûrs sur le plan culturel aux Inuites, aux Métisses et aux femmes des Premières Nations, et par leur intermédiaire, à leur famille, en vue d'améliorer la santé au sein de ces peuples. Résultats : La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed, CINAHL, Sociological Abstracts et The Cochrane Library en 2011, au moyen d'un vocabulaire contrôlé (p. ex. « Health Services ¼, « Indigenous ¼, « Transcultural Nursing ¼, « Cultural Competence ¼) et de mots clés (p. ex. « indigenous health services ¼, « transcultural health care ¼, « cultural safety ¼) appropriés. Des recherches ciblées sur des sous-sujets (p. ex. « ceremonial rites ¼ et « sexual coming of age ¼) ont également été menées. Les recherches menées dans PubMed ont été restreintes à l'année 2005 et aux années suivantes, en raison du nombre important de dossiers récupérés sur le sujet. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en mai 2012. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes connexes sélectionnés (p.ex. Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement). Valeurs : La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau). Commanditaires : La présente directive clinique de consensus a été soutenue par la Direction générale de la santé des Premières nations et des Inuits, Santé Canada. Déclarations sommaires 1. Sur le plan démographique, les peuples inuits, métis et des Premières Nations sont plus jeunes et plus mobiles que les peuples non autochtones. Cela nécessite donc, de la part des professionnels de la santé, la mise en œuvre d'efforts supplémentaires en vue d'établir un environnement de confiance et de sûreté culturelle au sein de leurs lieux de travail, et ce, car les occasions d'offrir des soins pourraient être brèves. (III) 2. Selon l'indice du développement humain de l'Organisation mondiale de la santé, le Canada se classe au 6e rang mondial; les Premières Nations, quant à elles, se classent au 68e rang. (II-3) 3. Des ententes officielles ont été conclues pendant des siècles entre les gouvernements européens et les Premières Nations. Elles ont, à l'origine, été conclues dans un esprit d'amitié et de coopération; toutefois, elles en sont plus tard venues à être centrées sur la propriété des terres et l'extraction des ressources. Puisque ces ententes ont été bafouées à répétition, les Premières Nations entretiennent une attitude de méfiance à l'endroit du gouvernement, de ses représentants, de ses politiques et de quiconque étant perçu comme exerçant une quelconque autorité. (III) 4. La Loi sur les Indiens et ses amendements subséquents ont été conçus pour assurer le contrôle de tous les aspects de la vie des Indiens inscrits et pour promouvoir l'assimilation. Il s'agissait également d'un outil dont s'est servi le gouvernement pour obtenir accès aux terres et aux ressources des Premières Nations. (III) 5. Les traumatismes intergénérationnels qui ont été infligés aux Inuits, aux Métis et aux Premières Nations, sont le produit du colonialisme. Les pensionnats, la relocalisation forcée, la stérilisation involontaire, l'adoption forcée, la conversion religieuse et l'émancipation sont quelques exemples des politiques du gouvernement à l'endroit des Inuits, des Métis et des Premières Nations qui ont généré un stress et un dysfonctionnement post-traumatiques intergénérationnels. Quoi qu'il en soit, ces peuples continuent d'être résilients. (III) 6. La plupart des Canadiens ne savent pas qu'une forte proportion du produit intérieur brut du Canada repose sur des ressources naturelles extraites de terres autochtones, tandis que les Inuits et les Premières Nations doivent dépendre de transferts monétaires insuffisants de la part du gouvernement fédéral. (III) 7. Certaines sociétés multinationales procèdent à l'extraction de ressources se trouvant dans des terres qui se situent souvent dans des communautés autochtones ou dans les environs de celles-ci, ou encore dans des terres étant visées par des revendications territoriales. Le fait que la gestion des terres et des ressources soit assurée par les provinces, dans certaines régions, et par les gouvernements fédéral et territoriaux, dans d'autres régions, complique la communication entre les sociétés multinationales et les communautés inuites, métisses et des Premières Nations, particulièrement dans les cas où des revendications territoriales sont en cours de négociation ou dans ceux où de telles négociations n'ont toujours pas été entreprises. Ces sociétés multinationales ne fournissent pas de revenus à ces communautés. La plupart des communautés autochtones sont pauvres, ne disposent pas d'une infrastructure de santé publique adéquate et n'ont pas les moyens économiques d'améliorer leur condition. (III) 8. De nos jours, des problèmes de nature juridictionnelle rendent difficile l'offre de soins de santé, la bonne gestion des terres et la promotion de la santé au sein des communautés. (III) 9. Bien que la consommation d'aliments traditionnels contribue à la préservation de l'identité culturelle, la présence croissante de contaminants environnementaux (tels que le plomb, l'arsenic, le mercure et les polluants organiques persistants [POP]) pourrait compromettre la sécurité de ces aliments. (II-3) 10. Compte tenu des changements démographiques (population en croissance rapide comptant une importante composante jeunesse) et de l'urbanisation croissante que connaissent les Inuits, les Métis et les Premières Nations au Canada, force est de constater que la plupart des cliniciens en viendront à compter des Inuites, des Métisses et des femmes des Premières Nations parmi leurs patientes. (II-3) 11. Traditionnellement, les hommes et les femmes des peuples inuits, métis et des Premières Nations tenaient des rôles égaux et complémentaires. Le colonialisme s'est généralement affairer à mépriser et à ignorer les Inuites et les femmes des Premières Nations, et à les réduire au statut d'objet. Par l'intermédiaire de lois spécifiques, les femmes des Premières Nations (en particulier) ont perdu leurs droits et leurs pouvoirs au sein de leurs communautés, y compris leur rôle en matière de promotion de la santé et de l'éducation traditionnelles. (III) 12. Au sein des communautés autochtones, le taux de chômage est beaucoup plus élevé que celui qui est constaté chez les Canadiens non autochtones. Il contribue de façon importante aux écarts socioéconomiques et aux lacunes en matière d'accès à des soins de santé équitables et de qualité. (II-3) 13. La terminologie de la mesure des issues de santé a souvent pour effet de perpétuer des stéréotypes négatifs envers les Inuits, les Métis et les Premières Nations, puisque les données générées sont souvent signalées sans tenir du contexte social, politique et économique des communautés visées. (III) 14. Les conflits juridictionnels entre les gouvernements fédéral, provinciaux, territoriaux et de bande rendent difficile l'offre de services de santé et de santé publique exhaustifs aux Premières Nations. (III) 15. L'harmonie des sociétés inuites, métisses et des Premières Nations a été troublée par le colonialisme européen à la fin du 18e siècle, lequel est à l'origine d'effets à grande échelle sur la santé sexuelle des femmes et des hommes des communautés inuites, métisses et des Premières Nations. (III) 16. La recherche a démontré que la mise en œuvre de stratégies visant la compétence culturelle menait à l'amélioration des issues de santé et à celle de la satisfaction de la patiente. (II-3) 17. Une forme insidieuse de racisme peut se manifester de façon non intentionnelle; ceux qui en font l'objet sont donc les mieux à même de définir ce qui constitue une telle manifestation de racisme et d'en identifier la présence. (III) Recommandations 1. Les professionnels de la santé devraient disposer d'une compréhension des termes qu'utilisent les Inuits, les Métis et les Premières Nations pour s'identifier. (III-A) 2. Les professionnels de la santé devraient disposer d'une compréhension des termes « sensibilisation culturelle ¼, « compétence culturelle ¼, « sûreté culturelle ¼ et « humilité culturelle ¼. Les professionnels de la santé devraient reconnaître que les Inuits, les Métis et les Premières Nations pourraient avoir des points de vue différents quant à ce qui constitue des soins sûrs sur le plan culturel; ils devraient donc chercher à en savoir plus sur les valeurs propres à la communauté desservie. (III-A) 3. Les professionnels de la santé devraient être conscients des limites des statistiques recueillies au sujet des Inuits, des Métis et des Premières Nations, et devraient éviter d'avoir recours à des généralisations au sujet des risques de mortalité et de morbidité, au moment de comparer les populations inuites, métisses et des Premières Nations les unes aux autres et aux populations non autochtones. (III-A) 4. Les professionnels de la santé qui souhaitent mener des recherches auprès des Inuits, des Métis et des Premières Nations doivent utiliser des cadres éthiques reconnus qui tiennent compte des principes PCAP (propriété, contrôle, accès et possession), de l'Énoncé de politique des trois conseils et des lignes directrices propres aux communautés visées. (II-2A) 5. Les professionnels de la santé devraient reconnaître les effets intergénérationnels des pensionnats comme étant l'une des causes fondamentales des inégalités sociales et en matière de santé qui affectent les Inuits, les Métis et les Premières Nations, ces effets ayant des implications importantes sur les expériences et les pratiques entourant la grossesse et l'éducation des enfants. (II-3A) 6. Les professionnels de la santé devraient savoir que le discours sur les politiques de santé et les négociations quant aux revendications territoriales perpétue souvent des stéréotypes négatifs, sans adéquatement faire mention des effets du colonialisme. (III-L) 7. Les professionnels de la santé devraient connaître le Principe de Jordan (un principe qui place l'enfant au premier plan et qui exhorte l'agence gouvernementale auxquels les parents se sont d'abord adressés d'assumer les frais des services prodigués à l'enfant, pour ensuite entreprendre des démarches de remboursement, et ce, en vue d'assurer l'offre de soins adéquats en temps opportun) et être au courant des débats en cours (en ce qui concerne les responsabilités juridictionnelles) qui nuisent à l'offre de soins de santé de qualité, opportuns et sûrs sur le plan culturel aux Inuits et aux Premières Nations. (III-A) 8. Les professionnels de la santé qui offrent des soins aux Inuits et aux Premières Nations devraient connaître le programme de services de santé non assurés (SSNA), les critères d'admissibilité de ce dernier et la couverture qu'il offre, ainsi que les exceptions et les permissions spéciales qui sont requises dans certains cas. Les professionnels de la santé devraient reconnaître qu'ils ont un rôle crucial à jouer dans la défense des droits de leurs patientes inuites et des Premières Nations, en vue de les aider à obtenir accès à ces prestations. Les professionnels de la santé devraient savoir que leurs patientes métisses n'ont pas accès au programme SSNA et qu'elles pourraient faire face à des difficultés particulières au moment de chercher à obtenir des soins de santé. (III-A) 9. Tous les professionnels de la santé devraient reconnaître et respecter le rôle des sages-femmes autochtones et traditionnelles dans la promotion de la santé sexuelle et génésique des femmes, et devraient savoir que ce rôle ne se limite pas à la grossesse et à l'accouchement, mais bien qu'il se prolonge souvent au-delà de l'année de la naissance. (II-2A) 10. Dans le cadre des consultations régulières (y compris celles qui visent les soins prénataux), les professionnels de la santé devraient se renseigner au sujet de l'utilisation de pratiques médicales et de médicaments traditionnels par leurs patientes. (III-A) 11. Les professionnels de la santé devraient savoir que chaque communauté inuite, métisse et des Premières Nations compte ses propres traditions, valeurs et pratiques de communication; ils devraient donc participer aux activités de la communauté en question de façon à se familiariser avec ces traditions, valeurs et pratiques. (III-A) 12. Les professionnels de la santé devraient être au courant des lois du Code criminel canadien qui traitent des activités sexuelles chez les mineurs (y compris les enfants de moins de 12 ans et les enfants dont l'âge se situe entre 12 et 16 ans) et de la différence d'âge entre les partenaires. (III-A) 13. Compte tenu de la prévalence de l'exploitation et des sévices sexuels, les professionnels de la santé doivent, après avoir établi une relation de confiance avec la patiente, se pencher sur la présence possible de tels méfaits. Tous les examens gynécologiques et obstétricaux doivent être abordés avec sensibilité, de façon à permettre à la patiente de déterminer elle-même le moment où elle est prête à s'y soumettre. (III-A) 14. Les professionnels de la santé devraient être avisés de la prévalence accrue du VIH/sida chez les Inuits, les Métis et les Premières Nations, et devraient offrir des services de counseling et de dépistage du VIH aux femmes enceintes ou en âge de procréer. La mise en œuvre d'approches sûres sur le plan culturel envers le counseling, le dépistage, le diagnostic et le traitement en présence du VIH et d'autres maladies transmissibles par le sang devrait être soutenue et adoptée. (III-A) 15. Les professionnels de la santé devraient être avisés des taux élevés de cancer du col utérin que l'on constate chez les patientes inuites et des Premières Nations, ainsi que des piètres issues qu'elles connaissent à la suite du diagnostic d'un tel cancer. Les professionnels de la santé devraient s'efforcer de limiter les disparités entre leurs patientes autochtones et leurs patientes non autochtones, en faisant la promotion d'options de dépistage sûres sur le plan culturel. (I-A) 16. Les professionnels de la santé doivent s'assurer que les Inuites, les Métisses et les femmes des Premières Nations ont accès à des services pouvant répondre à tous leurs besoins de santé génésique, y compris l'interruption de grossesse, sans préjugés. Les professionnels de la santé devraient s'efforcer d'assurer la confidentialité, particulièrement dans les petites communautés et dans celles qui ne sont accessibles que par avion. (III-A) 17. Les professionnels de la santé devraient considérer la grossesse comme étant une occasion en or de s'engager envers les droits sexuels et génésiques, les valeurs et les croyances des Inuites, des Métisses et des femmes des Premières Nations, et de prendre position en leur faveur. (III-L) 18. Les fournisseurs de soins de santé devraient s'enquérir des souhaits de la patiente et de sa famille à l'égard de l'élimination ou de la préservation des tissus provenant de la conception, de la grossesse, de la fausse couche, de l'interruption de grossesse, de l'hystérectomie et d'autres interventions, les respecter et plaider en faveur de la mise en œuvre de politiques et de protocoles institutionnels permettant de les soutenir.(III-A) 19. Les professionnels de la santé devraient reconnaître que des troubles mentaux tels que les troubles de l'humeur, l'anxiété et l'assuétude à des substances psychotropes constituent d'importants problèmes de santé publique pour de nombreuses communautés inuites, métisses et des Premières Nations. (II-3B) L'utilisation de substances psychotropes qui mènent à l'assuétude constitue souvent un mécanisme d'adaptation à la douleur causée par les traumatismes intergénérationnels. Les professionnels de la santé devraient se familiariser avec des stratégies de réduction des dommages sûres sur le plan culturel pouvant être utilisées pour soutenir les Inuites, les Métisses et les femmes des Premières Nations (et leur famille) qui sont aux prises avec une telle assuétude. (II-2A) 20. Les professionnels de la santé devraient soutenir et promouvoir le retour de l'accouchement au sein des communautés rurales et éloignées pour ce qui est des femmes qui ne sont exposées qu'à de faibles risques de complications. La participation nécessaire de la communauté à la prise de décisions au sujet de la distribution et de l'affectation des ressources destinées aux soins de maternité devrait être reconnue et facilitée. (III-A) 21. Les professionnels de la santé devraient prendre conscience du fait que très peu de recherches, de ressources et de programmes visent particulièrement la santé des femmes d'âge mûr (y compris la ménopause) au sein des communautés inuites, métisses et des Premières Nations. Les professionnels de la santé devraient plaider en faveur de la tenue de plus amples recherches dans ce domaine. (III-A) 22. Les professionnels de la santé devraient chercher à en savoir plus au sujet des pratiques de communication adaptées à la culture et devraient adapter leurs communications aux situations et aux antécédents particuliers que présentent leurs patientes. (III-A) 23. Les professionnels de la santé pourraient exprimer à leurs patientes qu'ils souhaitent établir avec elles une relation respectueuse marquée par l'écoute, la reconnaissance des différences et la sollicitation de leurs commentaires. (III-L) 24. Les Inuites, les Métisses et les femmes des Premières Nations devraient recevoir des soins prodigués dans leur propre langue, dans la mesure du possible. Les programmes et les établissements de santé offrant des services à un nombre important de patientes inuites, métisses et des Premières Nations devraient compter des interprètes et des défenseurs de la santé inuits, métis et des Premières Nations parmi leurs employés. (III-A).

Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline.

OBJECTIVE: Our aim is to provide health care professionals in Canada with the knowledge and tools to provide culturally safe care to First Nations, Inuit, and Métis women and through them, to their families, in order to improve the health of First Nations, Inuit, and Métis. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, Sociological Abstracts, and The Cochrane Library in 2011 using appropriate controlled vocabulary (e.g., cultural competency, health services, indigenous, transcultural nursing) and key words (e.g, indigenous health services, transcultural health care, cultural safety). Targeted searches on subtopics (e.g, ceremonial rites and sexual coming of age) were also performed. The PubMed search was restricted to the years 2005 and later because of the large number of records retrieved on this topic. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of selected related agencies (e.g, Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement) VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task force on Preventive Health Care (Table). SPONSORS: This consensus guideline was supported by the First Nations and Inuit Health Branch, Health Canada.

RETIRED: Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Delivering HIV prevention medication online: Findings from a qualitative study exploring the acceptability of an online HIV pre-exposure prophylaxis (PrEP) care pathway among service users and healthcare professionals.

Objective: Eliminating HIV transmission worldwide could become a reality with the advent of HIV pre-exposure prophylaxis (PrEP) where people take HIV medication to prevent HIV acquisition. Incorporating digital health into PrEP provision could help services scale up and meet increasing demand. We aimed to explore the prospective acceptability of a novel online PrEP care pathway (the ePrEP clinic) among PrEP users and healthcare professionals. The ePrEP clinic is composed of online postal self-sampling for HIV and other sexually transmitted infections, an online consultation, and remote medication provision. Methods: We conducted semi-structured interviews with 15 PrEP users recruited from a large sexual health service and online cohort, and focus groups with nine healthcare professionals from the same sexual health service (May to December 2021). We analysed data using framework analysis. Results: Participants found the ePrEP clinic highly acceptable, anticipating that it would provide convenience, empower PrEP users, and increase capacity within sexual health services. The need for blood self-sampling was a considerable barrier for some. Participants anticipated that the ePrEP clinic would be appropriate for established PrEP users with adequate digital health literacy and no medically significant conditions requiring in-clinic monitoring. Participants highlighted the need for support, including access to in-clinic care, and the integration of the ePrEP clinic within existing services. Conclusions: Our findings provide clear justification for the development of the ePrEP clinic as an addition to in-clinic PrEP care pathways and provide useful insights for those developing digital services for other conditions incorporating testing, consultations, and prescribing.

Chinese medical staff's knowledge, attitudes and practices towards breast cancer patients' sexual health management: A cross-sectional study.

Objective: The objective of this research was to assess the level and determinants of medical personnel's knowledge, attitudes, and practices regarding the management of sexual health in breast cancer survivors residing in western China. Background: Sexual well-being is a crucial aspect of one's overall satisfaction with life. Once female sexual dysfunction (FSD) occurs, it will affect patients' satisfaction and life quality seriously. In all healthcare settings, the management of sexual health relies heavily on the vital contribution of medical personnel. Nevertheless, the sexual requirements of individuals with breast cancer are still partially unmet. Design: A web-based questionnaire was used to conduct a multi-centered, cross-sectional study involving medical staff from 26 hospitals in nine cities of Guizhou Province, China. Methods: Data was gathered from healthcare professionals using a validated tool, the knowledge, attitudes, practices assessment scale for managing the sexual health of breast cancer patients in medical staff. This tool was used to evaluate the knowledge, attitudes, and practices of medical staff regarding sexual health management. Results: In this study, a grand total of 3181 healthcare professionals took part. The overall KAP scores, including knowledge, attitudes, and practices, were 47.15 ± 11.91, 72.55 ± 12.56, and 58.61 ± 11.45, respectively. Three variables exhibited a strong and favorable correlation. The study identified significant concerns regarding the limited understanding of medical personnel regarding effective strategies for enhancing sexual health function in breast cancer patients, as well as their diminished confidence in addressing FSD. The scores of knowledge, attitudes, and practices related to sexual health management were significantly influenced by whether or not training was received. Conclusions: The study results emphasize the importance of adopting a holistic approach to enhance the understanding, perspectives, and behaviors of healthcare professionals regarding the management of sexual health. In addition to enhancing the standard of care for individuals with breast cancer.

Knowledge, attitude, and practice of sexual healthcare and its influencing factors among oncology nurses: a multicenter study.

Background: The provision of sexual healthcare plays an integral role in the field of oncology nursing. However, limitations in the knowledge, attitude, and practice perspectives of oncology nurses require detailed study. Aim: In this study the authors sought to describe the knowledge, attitude, and practice of oncology nurses regarding sexual healthcare from a nationwide perspective and to explore the factors that influence them. Methods: This was a cross-sectional descriptive study using stratified random sampling of certified oncology nurses from 55 hospitals in 6 provinces in Central South China. In total, 2530 nurses participated and completed the Knowledge, Attitude and Practice questionnaire of Sexual Health Care (KAP of SHC), the Nurses Clinic Communication Competency Scale, the Nurses Professional Values Scale, and the General Self-efficacy Scale. Multivariate linear regression was used to explore influencing factors. Outcomes: The primary variable was the knowledge, attitude, and practice of sexual healthcare provision. Secondary variables included professional value, clinical communication competency, self-efficacy, and demographic factors. Results: The median KAP of SHC score was 139 (possible range 72 to 288). Attitude of SHC scored highest, followed by knowledge and practice scores. Professional values were positively associated with knowledge (odds ratio [OR] = 0.057; 95% CI: 0.023-0.091; P < .01) and attitude (OR = 0.319; 95% CI: 0.268-0.370, P < .01) of SHC. Clinical communication competency was only positively related to the attitude of SHC (OR = 3.960; 95% CI: 2.701-5.218, P < .01). Self-efficacy was positively related to KAP and the knowledge (OR = 0.616; 95% CI: 0.506-0.725, P < .01), attitude (OR = 0.187; 95% CI: 0.052-0.322, P < .01), and practice (OR = 0.840; 95% CI: 0.735-0.944, P < .01) of SHC. Clinical Implications: Knowledge assistance, attitude training, and practice coaching resources must be on the agenda to optimize professional practice for oncology nurses. Strengths and Limitations: This study provides data based on the Knowledge, Attitude, Belief and Practice (KABP) model in a nationwide sample of oncology nurses. In addition, the relationship between self-efficacy and KAP of SHC has been explored for the first time. The limitations are that this study may have some bias and did not take into account mediating relationships. Conclusions: Oncology nurses exhibit moderate levels of KAP of SHC. It is noteworthy that self-efficacy and position are the only 2 factors that influenced all aspects of KAP of SHC.