Vaginal Douching in Latina Women and Adolescents

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.