Understanding the Influence of Bureaucratic Caring on Implementation of Doxycycline Post-Exposure Prophylaxis: A Multiple Case Study

Despite its demonstrated effectiveness, doxycycline post-exposure prophylaxis (doxyPEP) has not been included in local response strategies for STI outbreaks. The challenges surrounding doxyPEP implementation are not fully understood in the southern United States, and further research is needed to implement doxyPEP effectively. Utilizing an embedded multiple-case study design, this study explores how bureaucratic caring influences the implementation of doxycycline post-exposure prophylaxis in two health departments within a larger metropolitan area in southeast Texas. This study applies a relativist perspective with a constructivist approach to explore the research question. Eight clinicians and seven administrators at the two local health departments were asked qualitative questions about their perspectives on how the eight concepts of bureaucratic caring theory (BCT) influenced doxyPEP implementation at their respective agencies. Within-case patterns were identified, and the codes were combined into categories that aligned with the concepts of the BCT framework. Cross-case synthesis was applied to compare and synthesize patterns across cases within each case. The results explain the multifaceted influence of bureaucratic caring on doxyPEP implementation in both agencies. Five themes emerged that align with the BCT concepts: Overarching Acceptance and Moral Gatekeeping, Political Determinants, Clinical Implications, Knowledge Gaps, and Technological (Techno) Optimization and Innovation. This study highlights the complexities of implementing doxyPEP in public health agencies within a larger metropolitan area in southeast Texas. The size and homogeneity of the sample limit the study's generalizability. The focused geography limits transferability. Subsequent research should involve a larger number of participants and a broader geographical scope. From a clinical perspective, public health nurses should become aware of doxyPEP as a biomedical intervention and consider implementing it to address the rising rates of STIs locally and nationwide.

Author dc:creator

• Clack, Kendrick 1982-

Contributors dc:contributor

• Cottrell, Damon
• Swilley, Brenda Ross
• Carney, Anthony
• Mirzaeirafe, Mehri

• Highly active antiretroviral therapy
• Antibiotics
• Nursing models
• Sexually transmitted diseases
• Nursing

Language dc:language

English

Handle dc:identifier.uri

https://hdl.handle.net/11274/17428

OAI identifier oai:identifier

oai:tdl-ir.tdl.org:11274/17428