Sexual health knowledge, attitudes, and beliefs among nurse practitioners and certified nurse midwives who work with adolescents in non-acute care settings

Adolescents frequently experience perceived and actual barriers to sexual and reproductive healthcare related to confidentiality, access, and their relationship with healthcare providers. Advanced Practice Registered Nurses (APRNs) are well positioned to work with adolescents in a variety of non-acute care settings to provide preventative sexual healthcare services. No studies have recorded Nurse Practitioners' (NPs) and Certified Nurse Midwives'/Certified Midwives' (CNMs/CMs) adolescent sexual health knowledge, attitudes, and beliefs. The purpose of this study was to determine whether there were any differences between Women's Health Nurse Practitioners (WHNPs) and CNMs/CMs whose educational programs have a concentration in sexuality, and APRNs from other specialties (ANPs, FNPs, PNPs, and PMHNPs) regarding knowledge, attitudes, and beliefs toward adolescents' sexual health. The study used a cross-sectional, descriptive comparative design. A convenience sample was recruited through the National Association of Nurse Practitioners in Women's Health (NPWH) and the Nurse Practitioner Association- New York State (NPA) e-newsletters and surveyed online with The Sex Knowledge Attitude Test (SKAT), the Sexuality Attitudes and Beliefs Survey (SABS), and the National Violence Against Women Survey (NVAWS) to assess sexual health knowledge, sexuality attitudes, beliefs about addressing adolescent's sexual health, and personal experience of sexual violence. One open ended question elicited responses of qualitative data. Demographic data of participants (n = 204) were analysed and 171 participants finished the online survey. Multiple logistic regression analysis shows that the WHNP/CNM/CM group have significantly more positive beliefs about addressing adolescents' sexual health than the Other NPs group, [beta] = -3.36, p = .003. Chi-square of attitude scores by region of the U.S. show that positive attitudes toward adolescent sexuality vary significantly with the South showing the least positive attitude scores (p < .01). Religion (not being Christian), [beta] = 1.69, p = .04, and religiosity (frequency of attending religious services), [beta] = -6.05, p < .0001, were significant predictors of adolescent sexuality attitudes. In addition, results of logistic regression of sexual health knowledge, and adolescent sexuality attitudes between the WHNP/CNM/CM group and the Other NPs group trends towards significance. The open ended question was analyzed using content analysis. Categories and constructs derived from respondents (n = 29, 17%) further support the quantitative findings, such as adolescents' lack of access to comprehensive sexual health education and sexual health care services led by APRNs, discomfort in addressing adolescent's sexual health, and the need for further adolescent sexual health education. Further research needs to be done with a larger sample size and more advanced knowledge questions for APRNs. Competency-based curriculum in the area of adolescent sexual health that promotes professional values and compassionate care in educational programs for APRNs is essential to improve adolescent's access to sexual healthcare services and outcomes.