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J Adv Nurs. 2013 Nov;69(11):2413-22. doi: 10.1111/jan.12108. Epub 2013 Feb 28.

The application of Kingdon's Multiple Streams Theory for human papillomavirus-related anal intraepithelial neoplasia.

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  • 1University of California San Francisco - School of Nursing, Community Health Systems, California, USA.



This paper presents a discussion of the advantages and disadvantages of redefining human papillomavirus-related anal intraepithelial neoplasia as a problem of sexually active people by using Kingdon's Multiple Streams Theory to examine possible policy solutions for increasing anal cancer screening.


Human papillomavirus is the most common sexually transmitted infection worldwide. Anal cancer associated with human papillomavirus infections is increasing in incidence in both men and women. The prevalence of anal cancer does not decrease with age.


Pubmed was searched for articles and internet references from 1995-2012.


Although a large body of literature suggests that human papillomavirus-related anal intraepithelial neoplasia is a problem, no effective policy solutions have emerged. However, as almost the entire sexually active population is exposed to human papillomavirus, it should be thought of as every person's problem. This suggests that human papillomavirus-related anal intraepithelial neoplasia calls for different types of problem definitions and policy solutions to address the disease. The issue of anal cancer is typically defined as a problem of HIV-positive individuals.


Nurses are focused on improving patient outcomes. We play a key role in helping to identify problems, moving problems onto policymaker's agendas, and influencing the creation of new healthcare policies.


Human papillomavirus-related anal intraepithelial neoplasia demands attention and the development of national level policies to ensure public health and safety. Kingdon's Multiple Streams Theory has provided a pragmatic framework to evaluate the problem.

© 2013 Blackwell Publishing Ltd.


HIV; HPV; HRA; Nursing practice; anal cancer; policy

[PubMed - indexed for MEDLINE]
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