By Melinda Young
The resurgence of some sexually transmitted infections (STIs) in recent years is partly because of the lack of resources to provide routine STI testing and treatment in rural areas, where residents may live an hour or two away from the nearest public health department that can offer daily STI services.
Another obstacle is a lack of trust in healthcare clinicians among communities that have had poor experiences with their local providers.
“A lot of individuals we worked with over time do not love to go [to a health clinic] for one reason or another,” says Haley Townsend, EdD, RN, FNP-BC, MSN, an assistant professor at Capstone College of Nursing, The University of Alabama in Tuscaloosa, AL.
“They’ll see a provider about a general health concern like high blood pressure and wait two to three weeks for medication to come through to manage chronic conditions,” Townsend says. “So there is not a lot of trust and rapport among [healthcare providers] and communities.”
Community members interviewed by researchers say they often feel their providers and nurses, including those at federally qualified health centers (FQHCs), do not care about them and are just going through the motions, she adds.
“They are not satisfied with the care they receive, so they’d rather drive to Tuscaloosa to receive [sexual health] care,” Townsend explains. “But they lack access to transportation or getting time off to drive and forth is a barrier to care.”
The Capstone College of Nursing has been doing outreach in these rural areas for decades, typically providing general health screenings through health fairs or pop-up clinics. They look at height, weight, body mass index (BMI), blood pressure, and cholesterol. In recent years, they decided more is needed to help these communities with their health problems.
“Alabama’s STI rates are dismal; teenage pregnancy rates are dismal, and reports of people having sex without a condom are more frequent here than in other states, so are reports of people having sex under the influence of drugs or alcohol,” Townsend explains. “Many schools create their own sex education, and it’s not comprehensive. It’s abstinence education.”
The state’s poverty, rural settings, and lack of sexual health education create a perfect storm for increased rates of STIs, she adds.
This is why Capstone College decided three years ago to expand its quarterly health fair offerings to include STI testing, using new technology that provides results for chlamydia and gonorrhea testing within 30 minutes. People can self-collect samples, which are placed on a testing medium, and the results arrive within half an hour.
“It’s very user-friendly. There are onscreen instructions, and in the machine you hit this button,” Townsend says. “Even medical assistants in an office or pop-up clinic can be properly trained to get the results.”
The mobile units also can test people for HIV infection, which has very fast results.
Waiting 30 minutes for the test results is not a problem for most people because the health fair events include some free and fun activities for attendees. These include free school supplies and backpacks for children, free haircuts, and free food.
“So, they can venture out to other parts of the health fair while waiting for STI testing results,” she says. “It works out really well.”
The health fair format is convenient as a one-stop-shop and has achieved satisfaction among participants, according to a recent paper by Townsend and co-researchers.1
But building trust and rapport among people distrustful of researchers and healthcare providers is not easy.
“When people enter a health fair, they’re usually very hesitant to give a fingerstick of blood for HIV testing; they’re hesitant to give any sample,” Townsend says.
Some people fear their deoxyribonucleic acid (DNA) will be given to law enforcement, she adds.
“We affirm with them that we do obviously have to let them know if they test positive, and it is reported to the Alabama Department of Public Health, but their DNA will not be given to law enforcement or to the state,” she says. “In all that time, only two individuals said they weren’t going to do this after receiving reassurance.”
Because of the cost of testing, including $13,000 machines and $40 for each testing cartridge, the mobile units can only visit four remote rural communities per year, she adds.
“We have two machines and we borrow four from a neighboring institution, so we can run six tests at one time, up to 12 per hour,” Townsend explains. “That is the really big con or drawback in this model we’re using.”
The university has a mobile van that can be used for the health fairs. Or, when the van is not available, they hold the fair in a community facility.
“We’re touching a small part of the population,” she says. “As we go out in these communities more often, I hope we can gain trust and rapport with the community and the word of mouth will spread [news] that we know what we’re doing and they can trust us.”
Townsend has seen how trust and rapport build when healthcare officials show up consistently over time.
“In one community, when the white girls come down, they say, ‘I know you, your name is Haley, right?’” she says. “Our faces are becoming more well known in the communities.”
Another strategy for building trust is through community outreach that does not involve research and sometimes does not even involve healthcare services.
For example, one colleague brought turkeys to a community at Thanksgiving time, Townsend recalls.
“We’re offering a service through the health fairs, but since these communities are close to the University of Alabama, they are heavily researched, and we don’t want them to think those University of Alabama people only come to study them or take data from them,” she explains.
To provide a different image of university folks, Capstone will bring free drugstore-type items to one rural county’s community center. These include baby items, Tylenol, and condoms for both men and women.
They also offer adolescent female health classes in one community. Nurses tell young people what to expect when their menstruation begins and show them how to use a menstrual pad.
“We also assist with revitalization efforts of playgrounds in these communities and donate playground equipment and supplies and equipment to schools,” she adds.
Community leaders have come to rely on the Capstone providers to help them with health problems. For instance, when a high school student died in a car crash, Capstone nurses drove to the high school and met with students who were in pain over their friend’s death.
“The first people the principal called was us. He said, ‘We know you are nurses and not mental health professionals, but would you be willing to come down to the high school and give a listening ear to any kids who want someone to talk to?’” Townsend says. “That shows the connection we try to have with the people we work with.”
REFERENCE
- Townsend H, Hobbs J, Kaylor S, et al. Point-of-care STI testing in rural settings: A feasibility project. Public Health Nurs 2024;June 25:10.1111/phn.13361. [Online ahead of print].
