A technology-enhanced community health nursing intervention proved useful as a method for preventing gonorrhea and chlamydia infections. It also helped patients improve management of pelvic inflammatory disease (PID).1

Research shows that adolescents and young adults experience difficulty with self-care. Researchers wanted to develop an intervention that would provide them with the support they needed in an outpatient setting, says Maria Trent, MD, MPH, professor of pediatrics, adolescent/young adult medicine at Johns Hopkins School of Medicine.

The theory-based intervention was designed to help people better understand their illness and to remove barriers to care. Some barriers are related to transportation and knowledge, Trent says. “We found that community health nursing is demonstrated to be an effective strategy for young people to receive care. Adolescents are largely online, and it’s safe and effective to send them text messages related to their reproductive healthcare.”

“We created a service package that provided community health nursing, along with text messaging, to provide support to young people dealing with illness over a 14-day treatment period,” Trent explains. “Pelvic inflammatory disease treatment requires that women take medicine twice a day for 14 days, usually including one injectable and then 14 days of doxycycline.”

In addition to text-messaging support, the intervention included a community health nursing visit within five days of diagnosis of the sexually transmitted infection (STI). Nurses used a Sister-to-Sister Teen Intervention, including a 20-minute skills-based sexual risk reduction and condom negotiation counseling session. Nurses also provided a PID-specific, short-term clinical follow-up visit with an abdominal examination.

The text messages, which were key to engaging with patients, were sent daily for two weeks. Participants who did not have a phone were provided a prepaid, disposable mobile phone for one month. The automated booster messages reminded patients to take their medications and asked them to give information about how many scheduled doses they had consumed each day. Each message was tailored to encourage adherence to the treatment regimen.

For example, a text message might ask, “Did you take your medicine?” If the woman answered, “no,” or that she took only one of her pills, the text message would say, “Tomorrow is a new day. It’s really important that you take both pills,” Trent explains.

Women with PID are vulnerable to infertility issues, Trent says. “Our goal with the intervention was to address an unmet need in healthcare and help preserve future fertility of young women,” she adds.

The home visits were a standard part of the intervention, unless the patient did not want a nurse to come to the home or when it was not safe for a home visit.

“We have an alternative space where community visits could occur, and that was mutually agreed upon with the nurse,” Trent says. “The visits lasted 30-45 minutes, depending on the adolescent’s knowledge level and whether they had concerns or questions.”

The Sister-to-Sister intervention is brief and includes a short video that the nurse watches and discusses with the patient. “They discuss questions about self-efficacy, self-care, and education around PID and how to prevent it in the future by making sure the partner uses condoms,” Trent says. “This being kept short is an important part of delivering that intervention in the field.”

Investigators assessed participants for changes at three months. “Our biggest finding was we were able to change the rate at which women were acquiring disease,” Trent says. “At baseline, one group had higher chlamydia rates than another, so we had to look at the differential rate of decrease. The intervention group’s rate of decrease was higher than the control group, so they were not acquiring disease at the same rate.”

Also, the absolute reductions in the prevalence of gonorrhea infection were greater in the intervention group, in which 1.5% of patients had infection at 90 days, vs. the control group, with 7.2% of patients with infection at 90 days.1

The study began well before the COVID-19 pandemic, but its findings are useful for this new era of more telemedicine strategies, Trent notes. “I think this pandemic we’re in right now has emphasized how the use of alternative communication strategies can transform health for people,” she says. “Our research demonstrated that adolescents love to talk with people, have telemedicine visits, text with people. We have to work hard to build relationships with people.”

One drawback — found in research for a separate study — is that adolescents and young adults might rely a little too heavily on text support, Trent notes.

“Text messages are great, but at the end, some of the girls’ visits fell off. When a nurse asked about it, the girls would say, ‘Why didn’t you text me?’”

Another important feature is that participants wanted a connection with the people behind the text messages. “We had relationships with them, and our nurse and outreach worker,” Trent says. “Text messages are a vehicle to further build that relationship with young people.”

Future reproductive health interventions likely will use a combination of in-person visits and telemedicine. “Sometimes, people still want a doctor to lay hands on them, and it will be a mix of the two,” Trent says. “Once we see patients, our ability to follow up will be enhanced by the use of telemedicine.”

REFERENCE

  1. Trent M, Perin J, Gaydos CA, et al. Efficacy of a technology-enhanced community health nursing intervention vs. standard of care for female adolescents and young adults with pelvic inflammatory disease. JAMA Netw Open 2019;2;2:e198652.