Natalie LeBlanc, PhD, MPH, RN, BSN
Assistant Professor - University of Rochester
Presented at Awards Luncheon - Saturday, November 20th at 11:30AM
Dr. Leblanc’s 17-year career in public health, nursing, and health research investigates the ecological, cultural, and systemic factors (social determinants of health) that influence health and wellness outcomes. As a former public health specialist, she is able to critically assess health issues from both public health and clinical perspectives - globally and domestically. As a nurse research scientist, she seeks to address and investigate determinants of health disparity and assets within these factors that can be leveraged toward achieving health equity to inform intervention implementation. Her work aims acknowledge the role of racism and anti-Black stigma and violence on sexual health inequities; and to discern assets in the health and community settings to promote sexual health, specifically HIV prevention and engagement across the HIV care continuum.
Dr. Leblanc’s program of research pursues three lines of inquiry:
1. health providers (e.g, physicians, nurses, social workers) perspectives, praxis and processes in sexual health promotion, specifically couple-centered approaches in HIV prevention and across the HIV care continuum;
2. couple-centered HIV prevention and interpersonal relationship factors (e.g. couples/partners, provider/patient) that can be leveraged to promote sexual health equity;
3. context of vulnerability to adverse sexual health outcomes (primarily HIV prevention, transmission and treatment) among marginalized populations such as: same-sex male couples, Black couples, women of color, and non-heteronormative populations such as men of color who have sex with men.
Dr. Leblanc primarily uses multi-method qualitative/quantitative approaches to inquiry. Her focus is on qualitative description, content and thematic analytic approaches, qualitative dyadic data collection and analysis, and observational techniques; she has also led and collaborated on projects that utilize: 1) synthesis approaches (metasynthesis and meta-analysis) continuum; and 2) descriptive and advanced statistical techniques.
Sexual Health Conversations Among Black Heterosexual/opposite-sex (BHOS) Couples In New York State
Oral Presentation - Date & Time TBD
Background Sexual health communication between partners is pivotal for healthy relationships. Some couples’ may avoid conversations about sensitive topics (i.e. HIV/STI testing, sexual pleasure) to avoid relationship discord. Others may lack communication skills and want assistance in facilitating sexual health conversations. Among US Black persons particularly, socio-cultural norms and experiences of racial trauma may impede sexual health communication. Yet US Black culture is allocentric, an attribute that may facilitate such communication. Methods To characterize Black heterosexually-identified couples’ sexual health communication, we conducted a cross-sectional, multi-method project from October 2018 to May 2019. We enrolled a convenience sample of 28 self-defined couples from 3 New York State jurisdictions. Eligible partners who consented, individually completed an online quantitative survey then engaged in an in-person, joint, dyadic in-depth interview. The survey captured individuals’ preferences for sexual health outcomes, communal communication strategies and relationship power. Descriptive statistics characterized the sample’s sexual health communication. A thematic analysis was employed to identify joint perspectives regarding sexual agreements, overall/sexual health promotion, motivation and norms for sexual health conversations, communication patterns and relevant themes. Results Participants were on average 43 years old and ranged in relationship length (1 – 22 years). Quantitative dyadic analysis revealed most couples had congruent preferences regarding extra-dyadic sex, use of condoms, and perceived their relationship power to be equitable. Qualitative dyadic analysis revealed the following thematic categories: power dynamics, motivation for sexual health conversations, and general health promotion. Couples who exhibited an equitable power dynamic (N=18) had an open communication pattern during the interviews, and conveyed harmonious attitudes toward sexual health by endorsing sexual agreements and ongoing sexual health conversations throughout their relationship. Other couples (N=7 couples) had a skewed power dynamic in which one partner was more vocal but the other partner remained engaged. Such couples endorsed intermittent sexual health conversations to address particular issues as they arose. Equitable and skewed couples were motivated by seeking relationship transparency and approached shared decision making as a practice. A few cases (N=2 couples) had one partner emitting a domineering presence at key points or during the entire interview with the other partner minimally engaged. Conclusion Findings indicate that couples possess varied communication patterns and power dynamics that operate in tandem with motivations for sexual health conversations and subsequent sexual health promotion. Equitable and skewed communication patterns are relationship assets that can be leveraged to optimize sexual health. Other communication patterns warrant investigation to identify needs for intervention development.
Making Meaning and Operationalizing Sexual Health Promotion among Health Care Providers in Western New York State
Poster Presentation - Date & Time TBD
Background Determinants of sexual health promotion (SHP) in the clinical environment include healthcare provider (HCP) perspective and practice, and healthcare micro and macro environments. Sexual health is often focused on disease prevention and not considered an intrinsic component of overall well-being. In the context of persistent STIs and growing resistance to standard treatments in tandem to pervasive threats to sexual health, it is necessary to understand HCPs conceptualization and practice of SHP in the clinical setting. Methods We conducted a qualitative interpretive description study in small urban areas throughout Western New York State, US – a region experiencing increasing STI rates. Semi-structured in-depth interviews were conducted with 28 HCPs practicing in women’s/reproductive health and family/adolescent health. HCPs were recruited (October 2019 - February 2021) using a purposive sampling modality from public and private, community clinic or hospital settings. HCPs predominately identified as white, female, ranged in years of practice (1-30 years) and were diverse: primarily nurse practitioners (N=12), physicians (N=7), physician assistant (N=3) and other (i.e. medical assistants, registered nurse; N=5). The interview guide asked: 1) What does the term sexual health mean to you?, and 2) Describe your experiences discussing sexual health with patients? Results For many HCPs, the meaning of sexual health utilized a disease prevention framework (HIV/STI screening, PrEP). For a subset of HCPs, meaning also entailed contraception, preconception and conception health. Others contrived a more traditional meaning to include sexual functioning and satisfaction, and partner considerations. A broader conceptualization included: HIV/STI prevention, reproductive health, sexual functioning/satisfaction, and transgender care. Patient education, provider communication and the healthcare environment were components in SHP. Reported ease of patient engagement was commensurate with years of experience and subsequent HCP knowledge and comfort. Experienced HCPs reported strategies that allowed for fluid and open sexual health conversations, whereas other HCP without expansive experience utilized a more structured conversational approach. Operationalizing SHP could be characterized as passive reactive or active due to HCP practice or characteristics, and the practice setting. Passive reactive entailed HIV/STI screening prompted by chief complaints, symptomology, or as a component of routinized care (i.e. EMR prompts). Active operationalization primarily existed within primary care settings (i.e family, adolescent health) whereby HCPs utilized a comprehensive conceptualization of SHP and were forthcoming in patient engagement. Closing HCP meaning making and practice are essential for SHP. Healthcare environment characteristics however require intervention to leverage and/or address HCP factors to facilitate sexual health promotion.