Exploring Sexual History Taken in One Health Center: A Focused Ethnography

Sexual history taking is the clinical practice of collecting information about patients’ sexual health. Despite the availability of guidelines for conducting a sexual history, variability in the documentation of sexual histories exists. In addition to documentation, the literature on sexual histories is limited to their content, barriers to collecting them, and interventions to improve their documentation and health care providers’ comfort and confidence in taking them. Additionally, the methods used to explore sexual history taking have been homogeneous. Absent from this literature is an in-depth understanding of the contextual factors affecting the collection of sexual history data as well as how health care providers evaluate and use sexual history data. To address these gaps in the literature, a focused ethnography of one health center was conducted. Guided by the theoretical perspectives of symbolic interactionism and the theory of culture care diversity and universality, data were collected primarily through passive observations of health care encounters between patients and health care providers and through individual interviews with health care providers. Over the course of approximately eight months of fieldwork, no specific sexual history taking was observed during health care encounters; this was likely influenced by the characteristics of the patients, communication between patients and health care providers, the prioritization of patients’ basic needs, and time constraints imposed upon encounters. By using a methodology not previously employed to study sexual history taking, this study adds to the evidence that sexual history taking may not routinely occur in a primary care practice setting. Given that the organization studied serves many patients who are homeless and who have concomitant mental health and opioid dependence concerns, the findings illuminate areas for future inquiry into a patient population at risk for adverse sexual health outcomes, and reinforces the need for routine sexual history taking. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Christine K. Bradway Subject Categories Nursing | Quantitative, Qualitative, Comparative, and Historical Methodologies This dissertation is available at ScholarlyCommons: http://repository.upenn. edu/edissertations/2032 EXPLORING SEXUAL HISTORY TAKING IN ONE HEALTH CENTER: A FOCUSED ETHNOGRAPHY Timothy Joseph Sowicz A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2016 Supervisor of Dissertation ______________________________ Christine K. Bradway, Associate Professor of Gerontological Nursing Graduate Group Chairperson ______________________________ Eileen V. Lake, Jessie M. Scott Endowed Term Chair in Nursing and Health Policy Dissertation Committee Christine K. Bradway, Associate Professor of Gerontological Nursing Julie A. Fairman, Nightingale Professor of Nursing Sarah Hope Kagan, Lucy Walker Honorary Term Professor of Gerontological Nursing EXPLORING SEXUAL HISTORY TAKING IN ONE HEALTH CENTER: A FOCUSED ETHNORAPHY COPYRIGHT 2016 Timothy Joseph Sowicz This work is licensed under the Creative Commons AttributionNonCommercial-ShareAlike 3.0 License To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/3.0/us/