Well Women Visits at Any Age
Thinking creatively about access to women’s health care has always been part of the job for Tracie Kirkland, clinical assistant professor in the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work.
Kirkland, a former program coordinator for Johns Hopkins Pepsi Beverages Wellness Center in Mesquite, Texas set up a mobile breast screening unit at the Pepsi plant so women could take advantage of mammography screenings without having to take time off work.
“Seeking windows of opportunity to access health care may not always be in a traditional setting,” Kirkland said.
Accessing routine care may be harder for some women than others, depending on individual circumstances and institutional barriers. Scheduling and attending routine health care visits can help women care for all aspects of their physical and mental health as they age.
According to a 2018 survey by the Kaiser Family Foundation, almost half of millennials don’t have a primary care provider. Finding new ways to meet patients where they are is critical to maintaining women’s health, regardless of age.
“We plan for retirement, but how do we plan to take care of our bodies? Our health is our wealth,” Kirkland said.
What Keeps Women from Seeking Health Care?
Social determinants are environmental factors that affect how people work, live and age throughout the life span. These determinants can also be barriers to accessing care and keep women from finding a primary care provider.
Social determinants that affect women’s abilities to access health care:
Insurance coverage: Women without health care insurance will experience higher out-of-pocket payments to access and receive medical care. About 11 percent of women in the United States are uninsured, compared to 9 percent of all Americans.
Income: Women and girls in families with low income may be unable to afford copays or other fees required to see a provider. In 2017, 11 percent of women lived below the federal poverty line, compared to 8 percent of men.
Geography: People living in areas far from health providers may find it difficult to travel several hours for an appointment. In a 2017 report on social determinants, researchers found that geography contributed to differences in mortality and morbidity related to smoking, obesity, air pollution and several chronic illnesses.
Family obligations: Women who are parents of young children or caregivers for other family members may have to arrange for child care or other forms of assistance in order to make time for health visits. Data from a 2018 caregiving report from Pew Research Center indicates that women spend more time providing child care than men.
Work obligations: Taking leave from work can be a challenge for women who don’t have paid time off. The 2018 Current Population Survey from the Department of Labor shows that 57 percent of women and 71 percent of mothers are in the labor force.
Transportation: In rural communities, women without a car or public transit options may be unable to access a provider. In urban areas, residents might not find care within walking distance or be able to afford costly public transit fares.
Education: An individual’s education can affect their language proficiency, as well as their ability to understand complex medical information. Low educational attainment has been linked to higher rates of morbidity for cardiovascular disease and cervical cancer.
Health literacy: The ability to access, understand and apply health information to daily life can be a challenge for women who may be vulnerable to false information and advertising or may have limited experience with a health care provider. Only 12 percent of American adults have a proficient health literacy.
Where to Find Women’s Health Care Resources
Even after women attend a health care appointment, social determinants can keep them from being able to understand and apply health information to their lifestyles. That includes knowing how to reach a provider for a follow-up conversation or how to fill a prescription at the nearest pharmacy. Providers like nurse practitioners can make use of one-on-one time to guide patients through next steps and counsel them on how to make appointments for other visits or needs.
“Know where to seek out services that may be free of charge, like the public health department or Planned Parenthood, where you can utilize a sliding scale in order to receive services,” Kirkland said. Sliding scale services use a variable cost to determine a fee based on how much the patient can afford to pay.
Providers can also look for innovative ways to reach patients for follow-ups or spread awareness about health information.
“We need to really be savvy in the way that we’re utilizing social media to disseminate information versus our traditional face-to-face visits,” Kirkland said.
Social media can help providers reach captive audiences by promoting health information during specific health awareness months. Patients can also use social media to find locations in their community to access health care and information:
- Places of employment
- Sorority organizations
- Places of worship
- Faith-based employers
- Local and state departments of health
- Local school district
- Publicly funded clinics
- Mobile units
- Planned Parenthood and women’s health clinics
When using any of these venues to access care, it’s important that patients find a way to follow up with a provider or keep in contact.
“Once we create a connection through rapport, we generally are able to keep bringing [patients] back on a regular basis,” Kirkland said. “Depending on what we find in the clinical examination.”
Recommended Health Screenings for Well-Woman Visits
Even when feeling healthy, women have a lot to gain from routine checkups, including screenings for future medical changes, family planning, vaccinations and healthy lifestyle maintenance.
“Do you wait until your car breaks down to have it serviced, or do you maintain it by changing your oil and your tires?” Kirkland said. “Do you wait until your body breaks down, or do you maintain it?”
A well-woman exam is an annual appointment for women throughout the life span. As women age, their health needs evolve, so the visit may include different types of exams or interviews between a patient and provider.
Similar to an annual physical for children, a well-woman visit includes assessments of physical and mental health but also includes conversations about reproductive and sexual health.
An initial visit, often done when women are seeing their provider for a physical for the first time, may just be a one-on-one to discuss what would actually take place in a well-woman visit, Kirkland explained.
Depending on age and health needs, a well-woman exam can look different for each patient.
ASSESSMENTS
- Blood pressure
- Heart rate
- Height
- Weight
IMMUNIZATIONS
- Hepatitis B
- Tetanus, diphtheria and pertussis (Tdap)
- Human papillomavirus (HPV)
- Influenza (annually)
- Chickenpox
- Meningococcal (A, B, C, W, Y)
HEALTH SCREENINGS AND EXAMS
- Physical
- Vision
- Hearing
- Sexually transmitted infections (STIs)
CONSULTATION
- Drug and alcohol consumption
- Vaping and tobacco use
- Driving and seatbelt safety
- Menstrual cycle
- Gender identity
- Sexual identity and activity
- Mental health
- Body image
- Exercise and nutrition
- International travel
ASSESSMENTS
- Blood pressure
- Cholesterol
- Heart rate
- Height
- Weight
IMMUNIZATIONS
- HPV
- Influenza
- Tetanus
HEALTH SCREENINGS AND EXAMS
- Cervical cancer
- Pelvic exam
- Pap smear
- STIs
- Breast exam/mammogram
- Vision
- Pre-diabetes
CONSULTATION
- Family planning and contraception
- Pre- and post-natal care
- Drug and alcohol consumption
- Vaping and tobacco use
- Menstrual cycle
- Gender identity
- Sexual identity and activity
- Mental health
- Body image
- Exercise and nutrition
- International travel
ASSESSMENTS
- Blood pressure
- Cholesterol
- Heart rate
- Weight
IMMUNIZATIONS
- Influenza
- Tetanus
HEALTH SCREENINGS AND EXAMS
- Cervical cancer
- Pelvic exam
- Pap smear
- Breast exam/mammogram
- Vision
- Hearing
- Diabetes
- Colorectal cancer
CONSULTATION
- Drug and alcohol consumption
- Vaping and tobacco use
- Menstrual cycle
- Gender identity
- Sexual identity and activity
- Mental health
- Body image
- Exercise and nutrition
- Dietary supplement intake
- Cardiovascular health
- International travel
- Hearing/vision loss
- Family relationships
- Occupational hazards
ASSESSMENTS
- Blood pressure
- Cholesterol
- Heart rate
- Weight
IMMUNIZATIONS
- Influenza
- Tetanus
- Measles, mumps, rubella
- Varicella
- Zoster (shingles)
- HPV
- Hepatitis (A and B)
- Meningococcal (A, B, C, W, Y)
- Pneumococcal (conjugate and polysaccharide)
HEALTH SCREENINGS AND EXAMS
- Cervical cancer
- STIs
- Diabetes
- Osteoporosis
- Lung cancer
- Breast exam/mammogram
- Colorectal cancer
- Vision
CONSULTATION
- Drug and alcohol consumption
- Vaping and tobacco use
- Menstruation/menopause
- Mental health
- Body image
- Exercise and nutrition
- Dietary supplement intake
- Cardiovascular health
- International travel
- Hearing/vision loss
- Family relationships
- Stroke Prevention
- Sun exposure
- Incontinence
When Should Women Seek Reproductive and Sexual Health Care?
Women don’t have to be planning a family to need reproductive health screenings and care. They should start seeking care at the age of menarche — which is when they begin having menstrual cycles — or when they start having sexual partners. “It depends individually on their desire to be intimate, and where they are in terms of maturation,” Kirkland said.
Reproductive and sexual health care are not synonymous. People of any age, gender or sexual identity can engage in sexual activity without a desire to reproduce. Birth control pills may be used for a variety of reasons unrelated to family planning. Therefore, it’s important for patients and providers to candidly discuss sexual health and reproductive plans.
Reproductive and Sexual Health Screenings:
STI and HIV testing: This screening can be a physical exam or a consultation from a provider to discuss sexual activity and test for sexually transmitted infections. The best time to get tested is before being active with a new sexual partner, and it can be done as often as a patient desires.
Breast exam: This is a physical exam that is done routinely on patients even if they have no other signs of developing breast cancer. Any abnormalities can be further tested with a mammogram, which is an X-ray screening for tumors that can’t be felt with a breast exam.
Pelvic exam: This is a physical examination of reproductive organs and is used to screen for ovarian cancer or other abnormalities that can develop as women age. The provider will inform the patient if they need to return for additional testing.
Menstrual health: A provider will ask about the regularity of a patient’s menstrual cycle, contraceptive use and any abnormalities with pain, bleeding or mood.
Pap smear: This is a physical exam during which a provider collects cells from the cervix to test for cervical cancer. This exam can also help find cells caused by HPV and is recommended every few years for women between the ages of 21 and 65.
Literacy about sexual health can be pivotal to women’s ability to control and plan for their future. Being able to afford contraception is one thing, but maintaining a treatment plan can be an issue — particularly when there is a lack of understanding about different types of contraception, their efficacy and how to use them. The more that providers can empower patients about seeking and understanding health information, the more meaningfully women can be engaged in their decision-making and health care.
Additional Resources for Women’s Health Care
- Health and Wellness: Planned Parenthood
- Women’s Healthcare: A Clinical Journal for NPs
- Women’s Health: MedlinePlus
- National Women’s Health Network
- National LGBT Health Education Center
Legal Disclaimer: Please note that this article is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided.
Posted courtesy of Nursing@USC, the online FNP program from the University of Southern California
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