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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/229165
Atenció Infermera a les Infeccions de Transmissió Sexual a la Catalunya Central: Coneixements, Comportament Sexual i Factors Associats en Persones ateses
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El Virus de la Immunodeficiència Humana (VIH) i altres Infeccions de Transmissió Sexual (ITS) continuen representant un repte important per a la salut pública mundial, amb un augment sostingut de casos tant en poblacions tradicionalment considerades de risc com en col·lectius heterosexuals. Aquest increment es vincula a múltiples factors com el desconeixement, l’estigma i els hàbits de risc, així com a la manca de formació del personal sanitari. En aquest context, les Infermeres de Pràctica Avançada (IPA) tenen un paper clau oferint una atenció integral i personalitzada que millora el diagnòstic precoç, redueix l’estigma i facilita l'accés a l'atenció especialitzada.
Objectius: Aquesta tesi té com a objectiu general analitzar els factors associats al comportament de risc sexual i el nivell de coneixement sobre les ITS en les persones que acudeixen a una consulta infermera especialitzada en VIH/ITS d’un hospital d’aguts de la Catalunya Central. Com a objectius específics, s´incloen analitzar l’evidència científica existent sobre els factors de risc en homes, classificar-los segons el Model Precede-Proceed, i explorar la influència de variables sociodemogràfiques, clíniques, conductuals, de suport social i d’estigma. També es busca determinar i examinar el nivell de coneixement sobre VIH, ITS, hepatitis, Profilaxi Pre Exposició (PrEP) i Profilaxi Post Post Exposició (PEP) en funció d’aquests factors i segons l’orientació sexual de la població atesa.
Metodologia: Es van utilitzar diferents metodologies per respondre a cada un dels objectius: a) Es va realitzar una revisió integradora (RI) mitjançant una cerca bibliogràfica a les bases de dades PubMed, WoS, CINAHL i Cochrane per analitzar l'evidència científica existent sobre els factors associats al comportament de risc sexual en relació amb l' augment d´ITS i classificar-los seguint el Model Precede-Proceed. b) Es va dur a terme un estudi observacional, transversal i unicèntric en un hospital de Catalunya amb una mostra de 259 pacients reclutats consecutivament entre novembre de 2021 i juliol de 2022; mitjançant una enquesta basada en el qüestionari European Men to Men Internet Survey (EMIS) i anàlisi estadística bivariada i multivariada.
Resultats / Discussió: En la RI es van identificar 151 articles publicats entre 2015 i 2021, en anglès i castellà. Els factors associats al comportament de risc es van classificar segons les categories del Model Precede-Proceed: Factors predisponents (consum de drogues, alcohol, múltiples parelles sexuals, diagnòstic previ d’ITS, orientació sexual i ús de la PEP); facilitadors (pràctiques sexuals sense protecció i intercanvi de xeringues); reforçadors del canvi de conducta (diagnòstic precoç, ús de la PrEP i intervencions educatives o programes de salut sexual).
Aquests factors es van analitzar posteriorment a l´estudi observacional. Es van considerar variables sociodemogràfiques i culturals com l’edat, país d’origen, situació laboral, nivell d’ingressos i estudis. La mitjana d’edat era de 52 anys. El 66% dels participants eren heterosexuals, el 25.5% homosexuals i el 8.5% bisexuals o altres. Els participants homosexuals van mostrar un coneixement més gran sobre VIH (69.7%), mentre que un 93% dels heterosexuals desconeixien què era la PrEP i la PEP. Els factors associats a un menor coneixement preventiu van ser: orientació heterosexual, edat superior als 40 anys, ser dona, nivell educatiu i d’ingressos baix, situació d’atur, consum de substàncies, ús escàs d’internet, poques parelles sexuals, no utilitzar pràctiques de sexe segur i menor integració social.
Conclusió: La disminució de la prevalença d’ITS i VIH només serà possible si es coneixen i aborden els factors associats als comportaments de risc. És fonamental que els professionals sanitaris integrin aquesta informació per millorar les intervencions educatives i adaptar-les a les característiques de cada grup poblacional. Cal reforçar l’educació sexual, especialment en poblacions heterosexuals, dones, persones grans i col·lectius bisexuals o altres; desmitificar la transmissió del VIH; fomentar l’ús de la PrEP i la PEP, i reduir l’estigma. Només així es podran dissenyar estratègies educatives inclusives, efectives i contextualitzades que contribueixin a la disminució de les ITS i millorin la salut sexual comunitària.
[eng] The Human Immunodeficiency Virus (HIV) and other Sexually Transmitted Infections (STIs) continue to represent a major global public health challenge, with a sustained increase in cases both in populations traditionally considered at risk and in heterosexual groups. This increase is linked to multiple factors such as lack of knowledge, stigma, and risky habits, as well as insufficient training of healthcare personnel. In this context, Advanced Practice Nurses (APNs) play a key role by offering comprehensive and personalized care that improves early diagnosis, reduces stigma, and facilitates access to specialized care. Objectives: This thesis aims primarily to analyze the factors associated with risky sexual behavior and the level of knowledge about STIs among individuals attending a specialized nursing consultation for HIV/STIs in an acute care hospital in Central Catalonia. Specific objectives include reviewing the existing scientific evidence on risk factors in men, classifying them according to the Precede-Proceed Model, and exploring the influence of sociodemographic, clinical, behavioral, social support, and stigma-related variables. It also seeks to determine and examine the level of knowledge about HIV, STIs, hepatitis, Pre-Exposure Prophylaxis (PrEP), and Post-Exposure Prophylaxis (PEP) based on these factors and according to the sexual orientation of the population served. Methodology: Different methodologies were used to address each of the objectives. An integrative review (IR) was carried out through a bibliographic search in the PubMed, WoS, CINAHL, and Cochrane databases to analyse the existing scientific evidence on the factors associated with risky sexual behaviour in relation to the increase in STIs and to classify them according to the Precede-Proceed Model. In addition, a cross-sectional, observational, and single-centre study was conducted in a hospital in Catalonia with a sample of 259 patients consecutively recruited between November 2021 and July 2022, using a survey based on the European Men to Men Internet Survey (EMIS) questionnaire and conducting bivariate and multivariate statistical analyses. Results / Discussion: In the IR, 151 articles published between 2015 and 2021 in English and Spanish were identified. The factors associated with risky behaviour were classified according to the categories of the Precede-Proceed Model: predisposing factors (drug and alcohol use, multiple sexual partners, prior STI diagnosis, sexual orientation, and PEP use); enabling factors (unprotected sexual practices and needle sharing); and reinforcing factors for behaviour change (early diagnosis, PrEP use, and educational or sexual health programs). These factors were later analysed in the observational study. Sociodemographic and cultural variables were considered, such as age, country of origin, employment status, income level, and education. The average age was 52 years. Sixty-six percent of participants were heterosexual, 25.5% homosexual, and 8.5% bisexual or other. Homosexual participants showed a greater knowledge of HIV (69.7%), while 93% of heterosexuals were unaware of what PrEP and PEP were. The factors associated with lower preventive knowledge included heterosexual orientation, age over 40, being a woman, lower educational and income levels, unemployment, substance use, limited internet use, few sexual partners, not practicing safer sex, and lower social integration. Conclusion: The reduction in the prevalence of STIs and HIV will only be possible if the factors associated with risky behaviours are identified and addressed. It is essential that healthcare professionals integrate this information to improve educational interventions and adapt them to the characteristics of each population group. It is necessary to strengthen sexual education, especially among heterosexual populations, women, older individuals, and bisexual or other groups; to demystify HIV transmission; to promote the use of PrEP and PEP; and to reduce stigma. Only in this way will it be possible to design inclusive, effective, and contextualized educational strategies that contribute to reducing STIs and improving community sexual health.
[eng] The Human Immunodeficiency Virus (HIV) and other Sexually Transmitted Infections (STIs) continue to represent a major global public health challenge, with a sustained increase in cases both in populations traditionally considered at risk and in heterosexual groups. This increase is linked to multiple factors such as lack of knowledge, stigma, and risky habits, as well as insufficient training of healthcare personnel. In this context, Advanced Practice Nurses (APNs) play a key role by offering comprehensive and personalized care that improves early diagnosis, reduces stigma, and facilitates access to specialized care. Objectives: This thesis aims primarily to analyze the factors associated with risky sexual behavior and the level of knowledge about STIs among individuals attending a specialized nursing consultation for HIV/STIs in an acute care hospital in Central Catalonia. Specific objectives include reviewing the existing scientific evidence on risk factors in men, classifying them according to the Precede-Proceed Model, and exploring the influence of sociodemographic, clinical, behavioral, social support, and stigma-related variables. It also seeks to determine and examine the level of knowledge about HIV, STIs, hepatitis, Pre-Exposure Prophylaxis (PrEP), and Post-Exposure Prophylaxis (PEP) based on these factors and according to the sexual orientation of the population served. Methodology: Different methodologies were used to address each of the objectives. An integrative review (IR) was carried out through a bibliographic search in the PubMed, WoS, CINAHL, and Cochrane databases to analyse the existing scientific evidence on the factors associated with risky sexual behaviour in relation to the increase in STIs and to classify them according to the Precede-Proceed Model. In addition, a cross-sectional, observational, and single-centre study was conducted in a hospital in Catalonia with a sample of 259 patients consecutively recruited between November 2021 and July 2022, using a survey based on the European Men to Men Internet Survey (EMIS) questionnaire and conducting bivariate and multivariate statistical analyses. Results / Discussion: In the IR, 151 articles published between 2015 and 2021 in English and Spanish were identified. The factors associated with risky behaviour were classified according to the categories of the Precede-Proceed Model: predisposing factors (drug and alcohol use, multiple sexual partners, prior STI diagnosis, sexual orientation, and PEP use); enabling factors (unprotected sexual practices and needle sharing); and reinforcing factors for behaviour change (early diagnosis, PrEP use, and educational or sexual health programs). These factors were later analysed in the observational study. Sociodemographic and cultural variables were considered, such as age, country of origin, employment status, income level, and education. The average age was 52 years. Sixty-six percent of participants were heterosexual, 25.5% homosexual, and 8.5% bisexual or other. Homosexual participants showed a greater knowledge of HIV (69.7%), while 93% of heterosexuals were unaware of what PrEP and PEP were. The factors associated with lower preventive knowledge included heterosexual orientation, age over 40, being a woman, lower educational and income levels, unemployment, substance use, limited internet use, few sexual partners, not practicing safer sex, and lower social integration. Conclusion: The reduction in the prevalence of STIs and HIV will only be possible if the factors associated with risky behaviours are identified and addressed. It is essential that healthcare professionals integrate this information to improve educational interventions and adapt them to the characteristics of each population group. It is necessary to strengthen sexual education, especially among heterosexual populations, women, older individuals, and bisexual or other groups; to demystify HIV transmission; to promote the use of PrEP and PEP; and to reduce stigma. Only in this way will it be possible to design inclusive, effective, and contextualized educational strategies that contribute to reducing STIs and improving community sexual health.
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LAO LÓPEZ, Cristina-eva. Atenció Infermera a les Infeccions de Transmissió Sexual a la Catalunya Central: Coneixements, Comportament Sexual i Factors Associats en Persones ateses. [consulta: 6 de maig de 2026]. [Disponible a: https://hdl.handle.net/2445/229165]