Running head: STI EDUCATION 1

STI Education and Awareness for Youth in Whatcom County

Western Washington University

Nursing 432: Community Based Care for Vulnerable Population

By Kalen Jordan, Janet Palmer & Lacey Ruby

Bonnie Blachly MN, RN

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Abstract

This paper focuses on change theory as it applies to the problem of STI rates of 20-24-year-olds

in Whatcom county. The authors worked with the Whatcom County Health Department on a

project to reduce the rates of STI infections. Assessment of community resources such as local

secondary schools was performed. Interventions were developed based on needs presented by

community partners and supported by a brief literature review.

Keywords: change theory, sexually transmitted infections, young adults

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Introduction

In Whatcom County there has been a sudden rise in the rates of reported sexually

transmitted diseases (STIs) between those between 20 and 24 years of age. The Whatcom County

Health Department, noticing these trends, asked the students and faculty at Western Washington

University to perform a community assessment and identify possible causes, as well as making

any recommendations.

During the community assessment one of the trends noticed was the disconnect in

communication between the multiple agencies. The Whatcom County Health Department

described their own disconnect in communicating with this age group, understanding that many

of this youth is plugged-in, often getting their health information from online resources or their

peer group. Representatives from the Whatcom County Health Department, Bellingham

Technical College, Family Care Network and Western Washington University were met with, as

well as a telephone communication with the educating nurse at Planned Parenthood, and an

attempt was made to make contact with Whatcom Community College. In this paper this groups

chosen change theory and recommendations for the Whatcom County Health Department and

community partners will is discussed.

Change Theory and Planning Phase

The change theory we had collectively chosen in our Readiness for Change discussion

was Lippitt, Watson and Westleys Three Stages of Change. The problems we recognized in

our community (communication barriers and lack of education) are more up-stream, cultural

practices which require a dynamic behavioral modification in order for new practices to take

place. With old communication methods being relied upon, such as family communication, and

teaching through the mandatory education system, youth of our modern age may be finding it
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difficult to swallow older, more traditional teachings towards of sexual health, and may be fall

victim to cultural taboos and possible shaming of sexual practices.

Because of this cultural barrier in the practice of sexual health, we believe both cultural opinion

and behaviors must be re-established.

Unfreezing:

In the stage of unfreezing, the factors of causation must be identified and labeled as either

restraining or driving in their relationship to maintaining the status quo. The restraining

causes in our culture's sexual health education that need to be addressed, are avoidance, shaming,

cultural taboos, with an overall goal of open communication. Positive, or driving forces, are

sexual health education in schools and clinics, as well peer communication on sexual practices

and habits.
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Change:

The subject of change in this assignment is not black and white, as the demographic at

hand is widespread both in terms of geography, years of education, socioeconomic status,

ethnicity and religion. In terms of change, as sexual health is generally taught, though minimally,

at a secondary school level, we feel the focus of change should be on the breaking of cultural

taboos. Doctors offices, health clinics and post-secondary schools must may assist to raise

awareness with their clients and families on these issues, and promote an environment of

acceptance and healthy practice in sex. By raising awareness with the community at large, less

stigma will be held against this very human practice.

Refreezing:

With the goal of preventing backslide into older patterns, we must ensure that sexual

health information and county statistics on current STI rates are being communicated to both the

schools and clinics. With this information, these organizations would act as front runners for

raising awareness and demystifying the realities of sexual health and sexual practice.

Organizational Readiness for Change/Likeliness to Adopt Innovation.

Utilizing Lewins Force Field Analysis: enabling forces are the push to change and

restraining forces are the pull to stay the same. In evaluating the readiness-for-change of the

community partners, we must consider each partner individually.

For Whatcom Health Department, the enabling forces would be the large increase in

sexually transmitted infections and accountability to the public; and the restraining forces would

be funding, staffing, and participation of other community partners. In order for the changes to

be successful, the effort and cost of staffing would be involved and the Whatcom Health
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Department is a small department with limited staffing. The health department cannot do this

work alone and thus a limiting factor would be the willingness of others to work with them.

Three of those partners are the colleges in Whatcom County such as Western Washington

University (WWU), Whatcom Community College (WCC), and Bellingham Technical College.

Enabling forces include access to the patient population, active interest in healthy students to

attend classes, active nursing or health related programs, and a want to be perceived as an active

and helpful participant in the community; restraining forces are funding, staffing, and a lack of

support. WWU already has great resources available for sexual health and health care, and their

staff is willing to help other colleges with their programs. WCC has a health fair and an active

nursing program, and BTC has a willingness to start a health fair. Without resources, training,

and support these schools cannot move forward in educating their students about the possible

STIs and prevention methods.

Recommendations

Each of the partners we met with spoke to the fact that they felt like communication

between agencies could be improved. Currently the Whatcom Health department sends out a

monthly epi-watch to clinicians which includes updates on current disease concerns in the

county. Many of the community partners that we spoke with expressed desire to learn from other

community partners, not just the Whatcom Health department. Encouraging communication

within the community seems to be the single largest over reaching recommendation that our

research and assessment has turned up.

The services used by our target age group are varied as this is a very transitionary phase

in a persons life. We met with college campuses as well as clinics and doctors offices. Each of
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these partners expressed a need that was unique to them and their practice. However, it remains

obvious that each partner could benefit from collaboration within the community.

Bellingham Technical College (BTC) serves a population that is slightly older than our

target demographic, but have many programs for students in our age range such as their IMPACT

program and Running Start. What we learned from this campus is that health services available

on campus are nearly non-existent, but the school offers many health science programs to train

health professionals. They expressed an interest in hosting a health fair for their students with

information that included STI statistics and education, while also perhaps offering flu shots and

other health information of interest to their students.

Western Washington University has a health clinic on campus that is free for full-time

students to use. They also have volunteer peer sexual health mentors that work with the wellness

department to host quarterly learning programs in the dorms and offer one-on-one peer

mentoring for questions around birth control and STI screenings. Tracy, the mentor for the

sexual health peer educators, mentioned that she would love to discuss her program with the

other campuses, if they wished to start something similar.

When we spoke to Nancy, the clinical advisor for Family Care Network, about how they

engaged this age group in regards to sexual health, she expressed that there was room for

improvement within their practice setting. She was open to suggestions and suggested we likely

have a lot we could learn from Planned Parenthood. She was interested in improving sexual

health history practices within their network.

A brief literature search supported many of these interventions. Wagner (2011) states that

student seek sexual health information from many sources including peers, the internet, providers
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and school programs. As a young person develops they turn more and more to peers for support

rather than their families (Kachur et al., 2013). As students leave home for college, this can be

even more true.

School programs are an important way that this age group receives trusted and factual

sexual health information. These could be formal classes or things like that dorm teaching

programs that Western already uses (Wagner, 2011).

When students do reach out to providers for sexual health information, the research

shows that these students are more likely to receive STI testing than those who seek their

information from other sources (Wagner, 2011). Accurate sexual health history taking helps

providers target interventions to needs of their patients (Carabez, Pellegrini, Mankovitz, Eliason,

& Scott, 2015).

We cant change what information student access on the internet, but we can have a

positive influence in other arenas. By encouraging collaboration and communication between

resources already located in Whatcom County, we can have an impact on STI rates.

Conclusion

Means of reducing STI among youth remains generally in the realm of communication

and education. By reducing the push mechanics, such as cultural taboos and sexual shaming,

todays youth may find more comfort and ease in exploring their sexual health. We must ensure

that sexual practice and sexual health remain a topic that is not avoided or looked down upon,

but is seen as a fundamental human behavior and topic of health by normalizing the conversation

and creating easy access to accurate information on sexual health and infection prevention and

treatment.
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References

Carabez, R., Pellegrini, M., Mankovitz, A., Eliason, M., & Scott, M. (2015). Does your

organization use gender inclusive forms? Nurses confusion about trans* terminology.

Journal of Clinical Nursing, 24(21/22), 33063317. https://doi.org/10.1111/jocn.12942

Kachur, R., Mesnick, J., Liddon, N., Kapsimalis, C., Habel, M., David-Ferdon, C., Brown, K.,

Gloppen, K., Tevendale, H., Gelaude, D.J., Romero, L., Seitz, H., Heldman, A. B.,

Schindelar, J. (2013). Adolescents, Technology and Reducing Risk for HIV, STIs and

Pregnancy. Atlanta, GA: Centers for Disease Control and Prevention.

Wagner, I., William E. (2011). Source of Safe Sex Knowledge and Sexual Behavior Among

University Students. Californian Journal of Health Promotion, 9(1), 2535.

Sare, M. & Ogilvie, L. (2010). Strategic Planning for Nurses: Change management in Health

Care. Burlington, MA. Jones and Bartlett Learning.

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Appendix

Statement of Need: STI Prevention and Awareness for youth between 20 - 24 years of age in

Whatcom County.

In order to accomplish In order to address our We expect that once We expect that if We expect that if
our set of activities, we problem or asset we will accomplished these accomplished these accomplished these
will need the following: accomplish the following activities will produce activities will lead to the activities will lead to the
activities: the following evidence following changes in 1-3 following changes in 7-
or service delivery: then 4-6 years: 10 years:

Establish a line of
Assessment of the
communication between Better education towards A better flow of A possible decreased in
current means of
the Whatcom County STI prevention communication from the the upward trend of STI
communicating STI rates
Health Department and measures, the need for Whatcom County Health infections among this
and raising awareness
educational / health continued screening and Department to age group.
among this demographic.
institutions which serve increased community community partners, and
this population. involvement and an increased need in
awareness. surrounding health
clinics to address sexual
health practices among
this age group.