Evaluation in a Nutshell: A Practical Guide to the Evaluation of Healthpromotion Programs, Essay Example

Abstract

This research proposal is focused with assessing the treatment failure of chlamydial infection in female and males within the Pinellas County, Florida. This study seeks additionally to identify contributing factors to the Chlamydia re-infection of previously infected patients in the Pinellas Country. Looking at data from January 2013 to June 2014 from the local health department STD clinics, the data that is region-specific looks at both the Chlamydia and treatment failure rates. These rates are further used in helping to understand the demographic and environmental underpinnings of Chlamydia. The structure of this research is to determine the factors in which cause this increase rate of reinfection within the specific country. The research methodology that will be utilized is an exploratory method, in which takes the already reported data, as well as additional literature, and research to come to a conclusive result, which will expound on this topic. This research will evaluate the factors that this pertains to, as well as seek to obtain an accurate data in regards to the rate of Chlamydia, and the treatment failure rates that are recorded in the Pinellas County. Based on the information gathered from this research, the findings will be used to change the practice in which clinics and other facilities use to treat individuals that are treated for Chlamydia, including providing more educational material, as well as distributing more information within the country and neighbors, where the rate of infection, and reinfection are the highest. This impact to society will be beneficial to decreasing the susceptibility for individuals, majority women that are the highest infected, to practice safe sex, as well as protect against infected partners, or spreading Chlamydia to others. This will help with conception, and developing further infection.

Specific Aims

The socio-demographic of those that are more susceptible to re-infection has turned into the most regularly reported bacterial disease in North America over the previous decade. Thirty-eight cross-sectional studies and six companion studies were incorporated in the present survey. Most studies showed that women and younger individuals are at higher danger of being infected with chlamydia than more seasoned subjects. Chlamydia is by all accounts found in an assorted gathering of individuals, and dissimilar to gonorrhea, is not packed in low pay, minority center groups with high rates of accomplice change.Most astounding frequency rates of contamination are accounted for reliably in young people and adolescent grown-ups in the United States. Since it is for the most part proposed that individuals with gonorrhea and their accomplices likewise be dealt with for chlamydia, the rate of chlamydial contamination in some low-SES minority groups may be lower than anticipated due to incessant introduction to double anti-infection treatment.

Race and SES might likewise be markers for medicinal services looking for practices. This is why it is important to provide regular distribution of educational material about sexual health and safety measures for preventing re-infection. Poor, uninsured, minority patients may be less inclined to look for restorative forethought or to look for consideration later than their more prosperous, safeguarded, nonminority partners do. Case in point, women of higher SES may be more inclined to have routine examinations, and subsequently, the discovery of asymptomatic cases in this gathering may predisposition reporting of chlamydia upward. Overall, after the foundation of facilitated screening, reconnaissance and wellbeing training for chlamydia, this STD, in time, may get to be more focused inside center organizations where access to STD administrations is constrained.

Background

Chlamydia is a sexually transmitted disease caused by the bacteria Chlamydia trachomatis (Hocking et al., 2013). According to research and statistics, Chlamydia is one of the most prevalent sexually transmitted diseases throughout the country, and more predominant in women between the ages of 13 to 24, compared to men in the same age range. (Hocking et al., 2013).More than 1.4 million new instances of chlamydia were reported in the United States in 2012, and an expected 456.7 in 100,000 individuals right now convey the infection. (CDC, 2014). The malady is spread through a trade of organic liquids, regularly happening through sexual action, and side effects incorporate unusual vaginal or penile release, smoldering sensation amid pee, bleeding, and rectal and testicular agony. (Somani, Bhullar, Workowski, Farshy, & Black, 2000). Women and men less than 25 years old face the most astounding danger of disease (Somani et al., 2000; Geisler, Lensing, Press, & Hook, 2013). On the off chance that left untreated, chlamydia contamination can spread all through the regenerative framework and cause more extreme, issues, for example, provocative sickness, epididymis, and conception disappointment (Wang et al., 2005).

A more critical look at the Pinellas County, Florida with a populace of 929, 048 demonstrate a record 101, 872 instances of STDs all through 2012. That year additionally recorded 1,029 instances of Gonorrhea, 3,812 instances of infection of Chlamydia in the province. Gonorrhea positions as the sixth illness and Chlamydia positions as the fourth infection in Pinellas County among 67 districts. Females age fifteen through twenty-nine; rate the most astounding in the district. Adolescents and those in their initial twenties are at the most elevated danger for STD and numerous reasons incorporate different sex partners, drugs, and vulnerability. The 15-29 years old age group has demonstrated over the previous year of 2012, that they had the most noteworthy rate of reported Std. The instances of Chlamydia, female sexual orientation between these ages totaled up to 77,851 cases. These insights are focused around a ten-year perception from 2003 to 2012 (www.doh.state.fl.us)

The Pinellas County gives screening ($20 for every test), guiding, treatment and notification to partner services, to individuals that are contaminated with or associated with being infected with sexually transmitted diseases. This segment incorporates reconnaissance with research centers and other human services suppliers to guarantee quick reporting, treatment and mediation administrations. Different segments incorporate rapid response teams in order to search for and guarantee that people infected, including their partners, and others will obtained the most adequate intervention and treatment. Other services includes the notifications of at-risks cases that are in close proximity to public health jurisdictions, and outreach screenings.(DOH, n.d). Regardless of the above intercessions, there is persistent consistent climb for treatments that are repeated for Chlamydia disease in the STDs facilities all through the region consistently.A non-invasive, FDA-approved, urine-based nucleic acid test, Gen-Probe APTIMA Combo 2 Assay, is used to test for chlamydia and gonorrhea. The sensitivity and specificity of the Gen-Probe urine-based chlamydia test are 95.9% and 98.2%, respectively according to the Centers of Disease Control and Prevention (CDC, 2014).

Chlamydia can be easily cured through proper treatment (Ison, 2012). As bacteria cause chlamydia, the disease is most commonly treated with antibiotics (Hocking et al., 2013). The CDC recommends either taken orally 1 gram of azithromycin or 100 milligrams orally twice a day of doxycycline for seven days as co-equal therapies for uncomplicated chlamydia. Another focus would be to explore the demographic predictors of failure for chlamydia treatment of doxycycline and azithromycin. Additionally to research the clinical parameters that distinguishes those that are susceptible to repeated infection. However, not much is known about these types of infections, and the continuity of failures from treatments which leads to an increase rate for reinfection throughout the county.

Significance

This study is important because it will help fill a significant gap by examining the county-specific STDs clients’ data throughout 2013 to 2014 regarding re-infection rates and indicators contributing to the need for repeat treatment for Chlamydia within the Pinellas County, Florida. It will also provide an information about Chlamydia repeaters that will allow STD programs to better understand this portion of the clinic population. Additionally, information on STD repeater intervention feasibility in an STD clinic will be useful to STD programs, clinic staff, and researchers. Furthermore, understanding these rates is critical for identifying environmental underpinnings of chlamydia infection, as well as failure to contemporary treatments within this particular county. By correlatingthis data with demographic and lifestyle factors, the study may provide information about genetic and modifiablerisk factors for treatment resistance (West et al., 2014). Finally, Chlamydia is one of the most costly diseases in the United States, reaching nearly $16 billion each year to treat (CDC, 2014). By identifying the demographics, environmental, and genetic underpinnings of this disease may prove useful for developing more efficacious and, targeted treatments, ultimately reducing STDs cost in the county by a considerable amount.

Methodology

Participants:

Pinellas County, which is one of the most populated counties in Florida, is the setting of the study. Therefore, participants were residents of this particular county.  Participants selected were those who have tested positive and received treatment (with either Doxycycline 7grams or Zithromax 1gram) for Chlamydia more than once from January 2013 through June 2014. Participants were between the ages of 15 to 29 years old; otherwise, they could not be included in the study. Participants included 150 males and 150 females, respectively. Prior to the selection of the participants, the study will be thoroughly explained to the subjects and informed concerned signatures were taking before it began.

Sampling frame

The primary sampling technique used is the purposive sampling. This non-probability sampling method refers to sampling with specific criteria in mind (Shi, 2008). As such, the researcher surveyed 300 residents who have had repeat treatment for Chlamydia infection in the Pinellas County STD clinics from January 2013 to June 2014. The criteria was 150 males and 150 females. The respondents of the survey had to be residing in the Pinellas County, Florida. Nevertheless, a simple random sampling were also conducted so that every unit among the sample have an equal probability of being included in the sample (Shi, 2008).

Another secondary data source that may prove to be useful is The Florida Health Department’s (FHD) comparison of sexually transmitted disease rates (STD, 2014). This department maintains accurate yearly records of common STDs by county, as well as demographic analyses of specific STD cases (e.g., prevalence by gender and age). Data collected for the FHD is believed to be reliable, as well as the most accurate source of information available regarding Chlamydia infections in specific counties within Florida. Due to its breakdown of demographic variables, this data source will be helpful in identifying contributors to repeat treatments. By combining information from the FHD with rates of treatment resistance or relapse, a predictive risk model could be developed explaining the relationship between key variables and repeat treatments (Shoukri&Cihon, 2010; Polgar & Thomas, 2013). The ability to examine trends in data across large sample sizes, such as those included within the FHD’s report, will significantly increase the statistical power achieved when analyzing results, thus, greatly increasing the external validity and generalizability of this study to the larger population (Cohen, 2013; Cresswell, 2013). Specifically, these results will allow conclusions to be made about contributors to repeat treatment for Chlamydia infection in both Pinellas County, Florida and other counties throughout the country (Falasinnu et al., 2014).Using already established studies can provide limitations in which includes inaccurate data, or data that is biased towards the conclusions wanted by the authors. It is better to conduct a study based on real-time data, however, the implications to do so require many protocols, and other procedures in order to conduct a study. .

Method chosen and why

The research strategy to be used is exploratory research because it aims to know more about the phenomenon of indicators contributing to the need for repeat treatment for Chlamydia infection in Pinellas County from 2013 to 2014. The research will be exploratory in which would allow the study to view the problem using an exploratory and descriptive perspective. This method is generally preferred because it enables the research to control what is happening to view new perspectives. Additionally it assesses phenomena and ask questions under a new insight. This study in conducting exploratory research will utilize the principle elements that includes analyzing existing data, and conducting literature search.  (Hennekens, et al 1987) The research will operate within the descriptive cross-sectional design, as I will be collecting data from one population or subgroup within the population at a given point in time using a convenience sample (Hulley et al., 2001)  The advantages of this method would allow the research to focus on the depth and breadth of the primary aims of the study. Additionally, it explores the topic, and increases the validity of the research by decreasing the perplexing variables. The survey method, also known as the questionnaire method, were used in gathering the data at the Pinellas County. Surveys are the most common form of research method for collection of primary data.

One of the essential focuses is to describe the frequency count of the same event, while also assessing the distribution of the variables on the specific issues, and additional data on the population. Using a descriptive survey conducted on the population, is significant in comprehended the target audience, as well as helping to determine the correlation between the variable relationships. Using to collect data, a structured questionnaire will be utilized. The Strength of the survey is that the large sample means it can be 95 percent sure that the respondents will answer the same way within a few percent error. The number of responses was large enough to assured that the results for the county were statistically valid. The limitation was that, self-reporting could only provide information about past or likely actions. Responses may not describe how people will actually act in a given situation.

Since this research involved human subjects, an approval was sought from the health department ethics review board and the county medical director for collection of the secondary data from the STD clinics. I gave the county assurance that the data will be confidentially protected and seek their permission in case of publishing the data. The Strength of the survey is that the large sample means I can be 95 percent sure that the respondents will answer the same way within a few percent error. The number of responses was large enough to assured that the results for the county were statistically valid. The limitation was that, self-reporting could only provide information about past or likely actions. Responses may not describe how people will actually act in a given situation. Since this research involved human subjects, an approval was sought from the health department ethics review board and the county medical director for collection of the secondary data from the STD clinics. I gave the county assurance that the data will be confidentially protected and seek their permission in case of publishing the data

Conclusion

In the US, there has been randomized trials that have identified the causes and the clinical management of failures from treatment. (Regan, Wilson, and Hocking, 2013: Chesson, Sternberg, Leichilter, and Aral 2010) Researchers, however, are presently uncertain as to how individuals become resistant to treatment. As stable antibiotic strains have not be collected in human trials. (Kretzschema, Schmid, Low, and Heijne 2011). There has been isolated human samples in which exhibited resistance; however, it has been determined that that these strains have lost in vitro their resistance phenotype (Sandoz, Rockey 2011; O’Neil et al 2013). Therefore, there is not much that is known about the geographic implication of Chlamydia. This is ill-fated, due to the prevalence throughout the country, in which is impacted by the environmental factors, like children that are impacted by their regions, in which plays a vital part in identifying the most efficacious prevent and treatment methods. (Horner 2012; Regan et al. 2013)

Generally most repeat infections are considered to be re-infections from the exposure of their infected partner, there has been evidence that has emerged in which suggests that the failure of treatments of azithromycin could be accounted for this increase. This of course has led to contentious debates between the scientific and medical fields. (Horner, 2012) It is believed that 7.9% percent or repeat infections are contributed to females. (Batteiger et al 2010) The research by Battieger, attempted to differentiate between failure of treatment and reinfection by conducted questionnaires based on sexual behavior. Additionally it included the tool of genotyping as a way in which to pinpoint causes of reinfection. These studies however, were based solely on self-reported data of unreliable sexual behavior. Repeat chlamydia infections are common following treatment. Several studies have reported high chlamydia repeat infection rates among young women tested again post-treatment. If the reported infections that have been repeated are indication of reinfections, these repeat infections, then this is of serious public health concern because the risk of developing PID considerably increases with each subsequent chlamydia infection.

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