Efficacy of Provider Cultural Competency Training for Research Proposal

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Efficacy of Provider Cultural Competency Training for Reducing HIV Prevalence among African-American Adolescent Females

Risky behavior is common among adolescents, some might even say expected, but the risks taken can sometimes lead to tragic, life-long consequences. Sexually transmitted infections (STIs), for example, can cause cervical cancer or acquired immunodeficiency syndrome (AIDS). The adolescent group most susceptible to HIV exposure in the United States is African-American females (reviewed by Aronowitz & Eche, 2013). Across all females between the ages of 13 and 19 in the U.S. African-Americans accounted for 70% of all new infections in 2006, even though only 14% of the American population is Black. More generally, a 2008 study revealed that nearly 50% of all African-American female teenagers were infected with at least one common STI.

Differences in risky behavior among racial and ethnic groups has been associated with other adverse outcomes, including substance abuse, exposure to violence, and mental health issues (reviewed by Gonzalez-Guarda, McCabe, Florom-Smith, Cianelli, & Peragallo, 2011). When Gonzalez-Guarda and colleagues (2011) examined these and other adverse outcomes in a Latina population they discovered that the dependent variables represented a syndemic. In other words, race/ethnicity predicted the prevalence of multiple, seemingly distinct health outcomes. The prevalence of risky behavior would therefore be expected to predict the prevalence of STI, substance abuse, exposure to violence, and mental health problems.

The age of sexual debut is widely regarded to be an accurate indicator of risky behavior in adolescents, such that a younger age of sexual debut would correlate with an increased risk of HIV (reviewed by Aronowitz & Eche, 2013). Other common indicators are condom use and a willingness to talk openly about sex with parents, friends, and intimate partners.

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The latter indicator has been shown to depend on discussions about sex with mothers during early adolescents; therefore, parenting style impacts the prevalence of risky behavior among teens. Among the parenting styles and methods examined in African-American mother-daughter dyads, authoritarian and authoritative appeared to be most effective; however, the efficacy of an authoritarian style depended on the strength of the mother's social support network and living in a dangerous neighborhood (Aronowitz & Eche, 2013). The characteristics of an optimal parenting style that would decrease the prevalence of risky behavior included setting limits, monitoring the whereabouts of the teen, communicating unconditional love, and fostering an ethnic identity as protection against societal discrimination.

Research Question

Provider cultural competency is widely believed to have a significant impact on health disparities (Millender, 2010; Gonzalez-Guarda, McCabe, Florom-Smith, Cianelli, & Peragallo, 2011), but empirical studies investigating a causal relationship between these two variables are lacking. Aronowitz and Eche (2013) qualitatively examined parenting styles utilized by African-American mothers toward their adolescent daughters and concluded parenting style probably influences the risk of HIV in adolescents. Nurse practitioners (NPs) providing services in minority communities may therefore be in a position to reduce health disparities, using interventions designed to normalize mother-daughter discussions about sexual issues. The efficacy of such an intervention, however, will depend on the cultural competency of the NP. The research question is presented in PICOT format below:

P = Early adolescent African-American Females

I = Cultural competency training to help NPs normalize discussions about sex and other risky behaviors between African-American mothers and early adolescent daughters.….....

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