Predictors of Nurse Practitioners' Adherence to Menstrual Cycle–Related Practice Recommendations in Pediatric Primary Care

Purpose The menstrual cycle is an important but often neglected indicator of the overall health of menstruating adolescents. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) offer menstrual cycle-related practice recommendations for providers caring for this population. About a quarter of primary care in the United States is provided by nurse practitioners (NPs); yet, factors influencing their adherence to these practice recommendations remain underexamined. We explored factors that predicted NPs' reported adherence to ACOG/AAP menstrual cycle-related recommendations when providing primary care to children and adolescents.Methods A national cross-sectional sample of U.S. NPs was recruited for an online survey. We used hierarchical multiple linear regression to assess the ability of sociodemographic characteristics, knowledge, attitudes, subjective norms, and external barriers to predict practice adherence.Results NPs from all 50 states (N = 886) participated (Mage = 46 years; 92% female; 80% White, non-Hispanic; 71% family NPs). Holding significant sociodemographic characteristics constant, NPs' attitudes, subjective norms, and external barriers collectively predicted nearly 40% of the variation in their reported adherence to the menstrual cycle-related recommendations of ACOG/AAP. NPs' attitudes had the most explanatory power for practice adherence.Discussion Although NPs in this sample reported that they often adhered to ACOG/AAP menstrual cycle-related recommendations, strengthening NPs' positive attitudes and organizational norms may increase adherence to menstrual cycle-related recommendations. Stronger, more consistent messaging about best practices from professional societies and within NP curricula may improve NPs' attention to and support for adolescents' menstrual and overall health.