186 Rehabilitation Nursing • Vol. 34, No. 5 • September/October 2009 Rehabilitation NURSING C O N T I N U I N G E D U C A T I O N APN Knowledge, Self-Efficacy, and Practices in Providing Women’s Healthcare Services to Women with Disabilities Cheryl A. Lehman, PhD BC RN CRRN It is widely recognized that access to preventive women’s healthcare services such as breast and cer- vical cancer screening is of utmost importance to all women (American Cancer Society, 2005; Agency for Healthcare Research and Quality, 2008). Although women who have disabilities are living longer and healthier lives (Jans & Stoddard, 1999), access to preventive services continues to be a critical barrier to care (Association of State and Territorial Health Officials [ASTHO], 2003; Becker, Stuifbergen, & Tinkle, 1997; Iezzoni, McCarthy, Davis, & Siebens, 2000; Nosek & Howland, 1997). Women with disabilities who live in the United States face many barriers in the healthcare system. They are more likely to be poor, unemployed, and lack adequate health insurance. Some facilities pres- ent physical barriers such as a lack of accessible trans- portation or wheelchair access. In addition, many healthcare providers lack the necessary knowledge to provide basic services to women with disabilities, and attitudes toward people with disabilities may inter- fere with provision of care. There also are additional related costs for care providers, such as costs of exami- nation tables that rise and lower, wheelchair scales, and accessible mammography machines (ASTHO, 2003; Becker et al., 1997; Iezzoni et al., 2000; Nosek & Howland, 1997). Women with disabilities have the same need for gy- necological healthcare as women without disabilities, yet they are less likely to receive these services from their healthcare provider (ASTHO, 2003; Becker et al., 1997; Iezzoni et al., 2000; Nosek & Howland, 1997). Women with disabilities are also more likely to have difficulty finding an accessible doctor’s office or transportation and even encounter more difficulty getting onto an ex- amination table (Nosek & Howland; Nosek et al., 1995). In one study, more than 50% of women with disabilities reported that their hospital could not accommodate their childbirth due to architectural barriers (Nosek, Rintala, Young, Foley, & Dunn, 1996). Women with disabilities are less likely to receive sex education than their male counterparts (Becker et al.). One study of women with acquired or congenital disabilities found that more than 50% had received information about contraception, but women with paralysis, obvious physical deformity, and severely impaired motor function were not offered this information (Nosek et al., 1995). Not every woman with a disability has the same gynecological and reproductive healthcare needs, and not every disability can be treated in the same way. Women with spinal cord injury, for example, require special consideration of the relationship between the autonomic nervous system and the reproductive sys- tem. Intercourse, menstruation, and labor and delivery all can cause autonomic dysreflexia, a life-threatening elevation of blood pressure, in women with spinal cord injuries above the T5 level (Zejdlik, 1992). In some populations, mobility and range of motion can affect care providers’ abilities to carry out an examination. This especially may occur when working with elder- ly women and women with traumatic brain injury, cerebral palsy, or stroke. Other women with mobility or range-of-motion issues may require special educa- tion and guidance on self-care during menstruation, Women with disabilities require the same gynecological and reproductive healthcare services as women without disabilities, yet they often experience difficulty obtaining them. Advanced practice nurses (APNs) increasingly provide primary care services that include women’s health care, yet their influence on this population has not been systematically examined. This study examined the practices, environments, knowledge, and self-efficacy of APNs in Texas regarding provision of women’s health care to women with disabilities. The study’s respondents are 744 women who replied to a mailed survey. The results reveal that while nurses do not lack knowledge, work environments do not support competent care of women with disabilities and practices do not always follow national guidelines. Predictors of self-efficacy in provision of health care to women with disabilities were status as a women’s health nurse practitioner, previous rehabilitation experience, high knowledge scores, and a working environment perceived as accessible. Until changes are made in APN education and environmental barriers are addressed, APNs may not be able to provide optimal women’s healthcare services to women with disabilities. KEY WORDS access to health care advanced practice nurse women with disabilities women’s health care