1. Intervention and evaluation of Kent County’s increased Risk of Chlamydia
Jessica Behrenwald, RN, Amy Hills, RN,
Cheryl Rose, RN, Julie Simon, RN,
and Sueann Unger, RN

2. Community Health Problem
Women years of age in Kent County are at risk for developing reproductive disorders related to chlamydia infection as evidenced by an increase of 229 cases from 2009 to Subsequently, females have a 46% higher rate of positive cases compared to males. Finally, Kent County has 561 cases compared to Michigan’s 482 per 100,000 population (Hartl, 2011).

3. At risk population
Young women are more vulnerable to chlamydia infections due to immature reproductive tissue, as well as immature localized immune systems (Risk Behaviors, 2011).
Nationally over one million cases of chlamydia are reported to the Centers for Disease Control and Prevention (CDC) annually (CDC, 2011).
In Kent County an average of 874 per 100,000 women are reported to have chlamydia annually (“Number of Chlamydia”, 2011).
The numbers of cases are believed to be less than what was actually reported, due to lack of screening.

4. Kent County Resources Reducing the Risk
Kent County Health Department provides six Public Health Clinics throughout the community.
Reducing the Risk
Free evidence-based program formed to reduce exposure to sexually transmitted diseases (STDs).
Focused on delaying intercourse, reducing number of partners, and promoting the use of condoms (“Health Education Programs”, 2011).
Planned Parenthood of West & Northern Michigan provides services in Kent and surrounding Counties.
STD testing, treatment, and education are provided (“Education & Training”, 2011).

5. Additional Resources inSpot
Free anonymous way to notify all sex partners of possible exposure to STDs – to encourage screening and treatment (“About this site”, 2011).
Use of electronic messaging to provide up to date information with a focus on young population.
Same Day STD Testing is a national service, with three Kent County locations.
Offers affordable and confidential STD testing. Trained counselors are also available to answer questions (“About Us”, 2011).

6. Current Community Involvement
Kent County Health Department offers free condoms and free STD testing.
Students Against Destructive Decisions (SADD)
SADD was founded on the simple philosophy that young people, empowered to help each other, are the most effective force in prevention.
SADD has expanded their education program to promote healthy decision making for teens to decrease the incidence of STD’s by promoting abstinence (Bermudez & Ovidio , 2011).

7. Statistical comparison
Statistically, the rate of chlamydia in surrounding counties are comparable to Kent County in regards to:
Gender
Age
Race
Available resources were also found to be comparable to those in Kent County.
There have been no noted decreases in incidence with the use of current prevention programs.

8. Need for Chlamydia Prevention Program
With appropriate diagnosis, chlamydia and the related adverse outcomes are preventable and easily treated.
When left untreated, chlamydia can cause increased healthcare cost and burden.

9. Primary Prevention Changing Behavior
Engage in developing health care delivery systems to address barriers at federal, state, and local levels.
Educate physicians and patients about chlamydia screening, diagnosis, treatment, and public health laws.
Only 6 out of 10 providers answer questions correctly regarding common STDs (Gottlieb, Satterwhite, Romaguera, Bolan, & Burstein, 2010).
Increase awareness and normalize conversations about STD prevention and sexual health among young adults.
Expand the Reducing the Risk program into every public high school. Providing this knowledge earlier in life will help prevent disease later.

10. Primary Prevention Changing Behavior
Promote abstinence or mutually monogamous relationships.
Increase education/awareness by providing educational brochures/flyers (example provided on next slide) in public areas such as:
Public restrooms
College campuses
Healthcare offices
Social networking sites (Facebook, blogs, etc)

11. You should GET TESTED!!!!! Educational Flyer Have you been TESTED????
Do you know WHAT you have been EXPOSED to?
Have you been TESTED????
You should GET TESTED!!!!!
CHLAMYDIA is one of the most COMMON & TREATABLE sexually
transmitted diseases.
You may have NO SIGNS or SYMPTOMS, but still be infected and
infecting others.
TESTING is FREE and CONFIDENTIAL.
ENCOURAGE OTHERS to get TESTED TODAY!!!!

12. Secondary Prevention Indentify and Treat
Provide free screening and follow for patient and partner(s).
Encourage annual screening.
Provide and educate both patient and partner(s) on treatment regimen.
Set up rescreening for three months after initial positive test, educate on increased adverse outcomes related to repeat infections.
Promote peer discussion to educate others in community.
Provide appropriate conversation examples to assist patients to be comfortable with topic.

13. Need for Permission Permission is necessary to provide brochures in:
Local businesses
Healthcare offices
College campus’
Permission granted by:
Business owners
Healthcare administrators
College administrators
Individual client permission for screening is needed.

14. Evidence-Based Practice for Intervention
Behavioral counseling to prevent sexually transmitted infections (Lin, Whitlock, O’Connor, & Bauer, 2008).

15. Relevant Change Models
Health Belief Model depends on:
Severity of potential illness.
Personal perception of susceptibility.
Personal benefits from behavior change.
Personal barriers.
Social Learning depends on:
Environmental factors.
Personal factors.
Attributes to behavior.
(Harkness & DeMarko, 2012)

16. Evaluation The desired outcomes include:
Reduce incidence of chlamydia in Kent County.
Decrease adverse outcomes related to chlamydia.
Increase awareness in the desired outcomes.
Although increased screening would cause an initial rise in chlamydia cases, increasing education and awareness will lead to decreased transmission, thus decreased numbers.
It is anticipated to see an initial rise in chlamydia cases for the first 1-2 years; with a significant decrease in cases in the next 3-5 years. A graph demonstrating these outcomes is provided on the next slide.

18. Evaluation Interim outcomes:
Initial and re-screening rates
Partner notification and treatment
Cure rate
Current available measures for tracking changes:
Behavioral Risk Factor Survey (“Communicable Disease and”, 2011).
Data is continually collected through the Kent County Health Departments.
Line graphs are completed yearly in Kent County with the collected data.

19. Conclusion
Chlamydia is one of the most common and treatable sexually transmitted diseases. Due to the lack of signs and symptoms this disease is often under treated. With nursing interventions, community awareness will be enhanced and chlamydia rates will be reduced.

20. Education Lights up the Community

21. References
About this site (2011). In inSpot Michigan. Retrieved from About Us (2011). In Same Day STD Testing. Retrieved from Bermudez & Ovidio (2011). Students Against Destructive Decisions. Retrieved November 16, 2011 from Center for Disease Control (2011). Chlamydia - CDC Fact Sheet. In Sexually Transmitted Diseases (STDs). Retrieved from Communicable Disease and Epidemiology (2011). In accessKent. Retrieved from Education & Training (2011). In Planned Parenthood of West & Northern Michigan. Retrieved from: Gottlieb, S., Satterwhite, C., Romaguera, R., Bolan, G., & Burstein, G. (2010, May 20). Chlamydia prevention: challenges and strategies for reducing disease burden. In CDC Grand Rounds. Retrieved from:

22. References Continued
Hartl, B. (2011), (Reportable Sexually Transmitted Infections of Greatest Frequency, Five Year Average (2006 – 2010), Kent County), Unpublished raw data . Harkness, G. A., & DeMarco, R. A., (2012). Community and Public Health Nursing Practice: Evidence for Practice. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins. Health Education Programs (2011). In accessKent. Retrieved from Lin, J. S., Whitlock, E., O'Connor, E., & Bauer, V. (2008). Behavioral Counseling to Prevent Sexually Transmitted Infections. In U.S. Preventive Services Task Force. Retrieved November 13, 2011, from Number of Chlamydia Cases and Rates per 100,000 Population By Gender and Selected Age Group Kent County, 2010 (2011). In STD by Disease and Year. Retrieved November 19, 2011, from Risk Behaviors - Sexually Transmitted Diseases (2011). In StateUniversity.com. Retrieved from