Vaginal Douching in Latina Women and Adolescents

描述（由申请人提供）：阴道灌洗的健康风险已得到充分证明，包括盆腔炎、异位妊娠、衣原体感染、生育能力下降和早产的风险增加。然而，由于不太清楚的原因，灌洗仍然是一种常见的做法，特别是在美国的少数民族妇女中。灌洗的做法很可能受到有关女性卫生和性行为的社会规范，以及民间的阴道和生殖解剖学模型的影响。然而，很少有研究采用定性的、人种学的方法来理解灌洗的文化和社会背景；没有人探讨过拉丁美洲人潜在的独特信仰和习俗。本研究的总体目标是设计一种基于初级保健实践的干预措施，以减少或消除拉丁裔妇女和青少年的阴道灌洗。这种干预将具有文化敏感性，在繁忙的初级保健环境中实用，并以跨理论模型和动机性访谈为基础。我们建议分两个阶段。在第一阶段，人种学调查将描述社会和文化塑造的信仰和态度，这些信仰和态度从青少年和年轻的拉丁美洲人和西班牙裔男子的角度影响冲洗行为。我们还将描述背景（如月经后，性交后，或预防），产品，并与冲洗有关的做法。在第二阶段，我们将根据定性研究结果设计一种文化敏感的基于实践的行为咨询干预，以减少灌洗。我们将创建和评估患者教育材料，作为咨询干预的辅助手段。研究人员将接受行为改变咨询的培训，并对20名青少年和20名年轻成年女性进行行为干预的试点测试，以评估干预的可行性和可接受性，为更大规模的疗效试验做准备。

DESCRIPTION (provided by applicant): The health risks of vaginal douching are well documented, including increased risk of pelvic inflammatory disease, ectopic pregnancy, Chlamydia infection, reduced fecundity, and preterm delivery. However, for reasons that are not well understood, douching remains a common practice, especially among ethnic minority women in the United States. Douching practices are likely to be shaped by social norms regarding feminine hygiene and sexuality, and by folk models of vaginal and reproductive anatomy. Yet there has been little research taking a qualitative, ethnographic approach to understanding the cultural and social context of douching; none have explored the potentially unique beliefs and practices of Latinas. The overall goal of this study is to design a primary care practice-based intervention to reduce or eliminate vaginal douching among Latina women and adolescents. This intervention will be culturally sensitive, practical to deliver in busy primary care settings, and grounded in the Transtheoretical Model and Motivational Interviewing. We propose two phases. In Phase I, ethnographic investigation will describe the socially and culturally shaped beliefs and attitudes that influence douching practices from the perspective of adolescent and young adult Latinas, and Hispanic men. We will also describe the contexts (e.g. postmenstrual, post-coital, or prophylactic), products, and practices associated with douching. In Phase II, we will design a culturally sensitive practice-based behavioral counseling intervention to reduce douching, informed by the qualitative findings. We will create and evaluate patient education materials to be used as an adjunct to the counseling intervention. The investigators will be trained in Behavior Change Counseling, and pilot test the behavioral intervention with 20 adolescents and 20 young adult women to assess feasibility and acceptability of the intervention in anticipation of a larger efficacy trial.