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Claus LE, Barton Laws M, Wilson IB, Han D, Saha S, Moore RD, Beach MC. Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand? AIDS Behav 2023; 27:3780-3788. [PMID: 37792233 DOI: 10.1007/s10461-023-04135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 10/05/2023]
Abstract
HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic. We identified and coded episodes of behavior change counseling to determine clinicians' consistency with motivational interviewing (MI) and used multi-level regression to evaluate counseling quality changes with each additional topic. Clinician counseling for at least one behavior was indicated in 92% of visits (mean 2.5/visit). Behavioral topics included antiretroviral medication adherence (80%, n = 163), appointment adherence (54%, n = 110), drug use (46%, n = 95), tobacco use (45%, n = 93), unsafe sex (43%, n = 89), weight management (39%, n = 80), and alcohol use (35%, n = 71). Clinician counseling was most MI-consistent when discussing drug and tobacco use and least consistent for medication and appointment adherence, unsafe sex, and alcohol use. In multilevel analyses, clinician counseling was significantly less MI-consistent (β = - 0.14, 95% CI - 0.29 to - 0.001) with each additional behavior change counseling need. This suggests that HIV ambulatory care be restructured to allocate increased time for patients with greater need for behavior change.
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Affiliation(s)
- Lauren E Claus
- Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21205, USA.
| | | | - Ira B Wilson
- Brown School of Public Health, Providence, RI, USA
| | - Dingfen Han
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Somnath Saha
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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2
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Bard AM, Main DCJ, Haase AM, Whay HR, Reyher KK. Veterinary communication can influence farmer Change Talk and can be modified following brief Motivational Interviewing training. PLoS One 2022; 17:e0265586. [PMID: 36094916 PMCID: PMC9467306 DOI: 10.1371/journal.pone.0265586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
Current veterinary communication skills training often focuses on the strategies necessary to successfully transfer information and promote shared decision making rather than inspiring client motivation to engage in behaviour change(s). One evidence-based communication methodology with a specific focus on enhancing conversations about change is Motivational Interviewing (MI), which is perceived by veterinarians to be highly relevant to their profession. We examined whether veterinarians who experienced brief (4–5 hours) MI training (BMIT) were able to change their communication behaviours to be more MI consistent. Fourteen veterinarians recorded 31 veterinary herd health consultations before (n = 15) and after (n = 16) BMIT to allow pre-post intervention analysis of veterinarian and farmer verbal behaviour. Additionally, using a sequential linguistic analysis of 3885 veterinarian-farmer communication events within these consultations, the influence of veterinarians’ verbal behaviours on farmers’ response language was explored. Analysis of veterinary consultations undertaken before and after BMIT revealed that veterinarians changed their communication style to be more consistent with the MI methodology, including more use of reflection statements, a more empathic and partnership-oriented consultation style and greater emphasis on clients’ own language in favour of change goals. In response, farmers contributed more to the conversation and discussed more herd health-related changes. Sequential linguistic analysis suggested that following a veterinarian emphasising something positive about the farmer (e.g. efforts, strengths), seeking collaboration or emphasising farmer choice, farmers were subsequently more likely to express arguments in favour of change (‘Change Talk’), especially phrases indicative of commitment. This study offers the first evidence of the potential value of a BMIT experience to enhance veterinary communication skills, although conscious and disciplined use of MI principles, strategies and Spirit–an ethos of compassion, acceptance, partnership and evocation—requires longer and more complex training. Further studies examining the longevity and consistency of these verbal behaviour changes following BMIT are required.
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Affiliation(s)
- Alison M. Bard
- University of Bristol Veterinary School, Langford, Bristol, United Kingdom
- * E-mail:
| | - David C. J. Main
- Royal Agricultural University, Cirencester, Gloucestershire, United Kingdom
| | - Anne M. Haase
- Victoria University of Wellington, Faculty of Health, Wellington, New Zealand
| | - Helen R. Whay
- National University of Ireland Galway, Galway, Republic of Ireland
| | - Kristen K. Reyher
- University of Bristol Veterinary School, Langford, Bristol, United Kingdom
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Gwadz M, Cluesman SR, Freeman R, Collins LM, Dorsen C, Hawkins RL, Cleland CM, Wilton L, Ritchie AS, Torbjornsen K, Leonard NR, Martinez BY, Silverman E, Israel K, Kutnick A. Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study. Int J Equity Health 2022; 21:97. [PMID: 35840962 PMCID: PMC9286957 DOI: 10.1186/s12939-022-01699-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants' perspectives on the study's acceptability, feasibility, and impact, and the conceptual model's contribution to these experiences. METHODS Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. RESULTS On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants' experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. CONCLUSIONS The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA. .,Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.
| | - Sabrina R Cluesman
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | | | - Linda M Collins
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.,Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | | | - Robert L Hawkins
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Karen Torbjornsen
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.,School of Global Public Health, New York University, New York, NY, USA
| | | | - Elizabeth Silverman
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Khadija Israel
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Alexandra Kutnick
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
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Chiou PY, Hung CC, Chen CY. Sexual Partner Referral for HIV Testing Through Social Networking Platforms: Cross-sectional Study. JMIR Public Health Surveill 2022; 8:e32156. [PMID: 35380540 PMCID: PMC9019628 DOI: 10.2196/32156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/29/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Men who have sex with men (MSM) who undergo voluntary HIV counseling and testing (VCT) often report condomless anal sexual intercourse, having many sexual partners, and being exposed to risky sexual networks. Limited research has discussed the application of motivational interviewing and convenience referral platforms to facilitate the referral of sexual partners for HIV testing among MSM. Objective This study aimed to evaluate the effects of VCT referral by sexual partners through social networking platforms and the test results after elicited interviews with MSM; compare the characteristics and risk behaviors among MSM tested without referral, index subjects, and referred sexual partners; and explore unknown sexual affiliations through visualizing and quantifying the social network graph. Methods This was a cross-sectional study. Purposeful sampling was used to recruit index subjects from a community HIV screening station frequented by MSM in Taipei City on Friday and Saturday nights. Respondent-driven sampling was used to recruit sexual partners. Partner-elicited interviews were conducted by trained staff before VCT to motivate MSM to become index subjects and refer sexual partners via the Line app, or to disclose the accounts and profiles of sexual partners on relevant social networking platforms. Referred sexual partners received rapid HIV testing, and the recruitment process was repeated until leads were exhausted. Results After the interviews, 28.2% (75/266) of MSM were successfully persuaded to become index subjects in the first wave, referring 127 sexual partners via the Line app for rapid HIV testing and disclosing 40 sexual partners. The index subjects and tested sexual partners had more sexual partners (F2=3.83, P=.02), more frequent anal intercourse (F2=10.10, P<.001), and higher percentages of those who had not previously received HIV testing (χ21=6.1, P=.047) compared with MSM tested without referrals. The new HIV-seropositivity rate among tested sexual partners was 2.4%, which was higher than the rate in the other 2 groups. The social network analysis revealed the following 4 types of sexual affiliation: chain, Y, star, and complicated. Among the HIV-negative sexual partners, 26.9% (43/160) had sexual affiliations with HIV-positive nodes, and 40% (10/25) were untested sexual partners with a direct sexual affiliation with an HIV-positive node. Four transmission bridges were found in the network graph. Conclusions Partner-elicited interviews can effectively promote referral for HIV testing and case identification via Line, and can clarify unknown sexual affiliations of MSM to facilitate the development of a tailored prevention program. Social network analysis is needed for an insightful understanding of the different network structures.
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Affiliation(s)
- Piao-Yi Chiou
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Rodriguez VJ, Abbamonte JM, Alcaide ML, Rodriguez Yanes NL, de la Rosa A, Sued O, Cecchini D, Weiss SM, Jones DL. Motivational Interviewing Training for HIV Care Physicians in Argentina: Uptake and Sustainability of an Effective Behavior Change Intervention. AIDS Behav 2021; 25:1675-1687. [PMID: 33245445 DOI: 10.1007/s10461-020-03083-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
Motivational interviewing (MI) utilizes a patient-centered approach to address patient ambivalence about treatment and has been found to improve treatment ART adherence among patients living with HIV disengaged from care. This study examined MI training for clinicians, uptake, and sustainability over time. Clinics (n = 7) with N = 38 physicians were randomized to condition (MI, Enhanced Standard of Care). Physicians completed video- recorded patient consultations at baseline and 6, 12, and 18-month follow-up. MI condition physicians had greater relational and technical scores over time and were more likely to adhere to and sustain MI over time. Overall, physicians found the MI training highly acceptable and were able to sustain their skills. Results illustrate the feasibility of MI training, implementation, and sustainment over 18 months. Findings support previous research in Argentina in which trained physicians found MI useful with challenging patients. Broader implementation of MI among HIV care physicians in Argentina is merited.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
- Department of Psychology, University of Georgia, Athens, USA
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Nicolle L Rodriguez Yanes
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Aileen de la Rosa
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Omar Sued
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB, Buenos Aires, Argentina
| | | | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA.
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Rouleau G, Pelletier J, Côté J, Gagnon MP, Martel-Laferrière V, Lévesque R, Fontaine G. Codeveloping a Virtual Patient Simulation to Foster Nurses' Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence. J Med Internet Res 2020; 22:e18225. [PMID: 32672679 PMCID: PMC7391166 DOI: 10.2196/18225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/01/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background Although helping people living with HIV manage their antiretroviral therapy is a core competency of HIV nursing care, no educational intervention has sought to strengthen this competency. Thus, we codeveloped a simulation of a virtual patient (VP) having difficulty adhering to treatment to foster the relational skills that nurses require in such situations. Objective This viewpoint paper aims to describe the codevelopment process and the content of VP simulation, as well as the challenges encountered and the strategies used to overcome them. Methods We use a collaborative and iterative approach to develop the simulation based on qualitative evidence, theoretical approaches (strengths-based nursing, motivational interviewing [MI], and adult learning theories), and expert recommendations. We carried out 2 main phases: (1) planning the simulation development and (2) designing the simulation content, sequence, and format. We created the script as if we were writing a choose-your-own-adventure book. All relational skills (behavior change counseling techniques derived from MI) were integrated into a nurse-patient dialogue. The logic of the simulation is as follows: if the nurse uses techniques consistent with MI (eg, open-ended questions, summarizing), a dialogue is opened up with the VP. If the nurse uses relational skills inconsistent with MI (eg, providing advice without asking for permission), the VP will react accordingly (eg, defensively). Learners have opportunities to assess and reflect on their interventions with the help of quizzes and feedback loops. Results Two main challenges are discussed. The most salient challenge was related to the second phase of the VP simulation development. The first was to start the project with divergent conceptions of how to approach the VP simulation—the simulation company’s perspective of a procedural-type approach versus the clinical team’s vision of a narrative approach. As a broad strategy, we came to a mutual understanding to develop a narrative-type VP simulation. It meshed with our conception of a nurse-patient relationship, the values of strengths-based nursing (a collaborative nurse-patient relationship), and the MI’s counseling style. The second challenge was the complexity in designing realistic relational skills in preprogrammed and simulated nurse-patient dialogue while preserving an immersive learning experience. As a broad strategy, we created a collaborative and work-in-progress writing template as a shared working tool. Conclusions Our experience may be helpful to anyone looking for practical cues and guidance in developing narrative VP simulations. As relational skills are used by all nurses—from novices to experts—and other health care practitioners, focusing on this clinical behavior is a good way to ensure the simulation’s adaptability, sustainability, and efficiency.
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Affiliation(s)
- Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Montréal, QC, Canada.,Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Jérôme Pelletier
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,Université du Québec à Rimouski, Rimouski, QC, Canada
| | - José Côté
- Research Chair in Innovative Nursing Practices, Montréal, QC, Canada.,University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,University Hospital Centre of Quebec, Laval University Research Centre, Quebec, QC, Canada.,Institute of Health and Social Services in Primary Care, Research Centre on Healthcare and Services in Primary Care, Quebec, QC, Canada
| | - Valérie Martel-Laferrière
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Rock Lévesque
- University of Montreal Hospital Centre, Montreal, QC, Canada
| | -
- Please see acknowledgements for a list of collaborators,
| | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada
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Fontaine G, Cossette S, Maheu-Cadotte MA, Mailhot T, Heppell S, Roussy C, Côté J, Gagnon MP, Dubé V. Behavior change counseling training programs for nurses and nursing students: A systematic descriptive review. NURSE EDUCATION TODAY 2019; 82:37-50. [PMID: 31425931 DOI: 10.1016/j.nedt.2019.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/02/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES (1) To systematically review the literature on behavior change counseling (BCC) training programs targeting nurses and nursing students; (2) to characterize these training programs according to their content (i.e., targeted health behavior[s], BCC approaches taught, BCC techniques taught), structure, and modes of delivery. DESIGN A systematic, descriptive literature review. DATA SOURCES PubMed, CINAHL and Embase were searched with no time limitation in August 2018. REVIEW METHODS A systematic, descriptive literature review structured according to Paré et al.'s methodology and the PRISMA guidelines. Primary studies were included if they evaluated a BCC training program with nurses or nursing students. Review authors screened studies, extracted data, and assessed study quality using the MERSQI. Data was synthesized through narrative synthesis, descriptive statistics, and content analysis. RESULTS From a pool of 267 articles, we included 25 articles published between 2003 and 2018. Two studies scored as low quality (8%), 18 as moderate quality (72%), and 5 as high quality (20%). Physical activity (n = 14; 56%) and smoking (n = 11; 44%) were the most frequently targeted health behaviors. Eleven BCC approaches were cited (e.g., motivational interviewing), and 48 BCC techniques were identified (e.g., eliciting and scaling change talk). The median number of training sessions was 3 (interquartile range [IQR] 5), the median training program duration was 3 h (IQR 6.25 h), and median training period was 24.5 days (IQR 110 days). Programs were most often delivered as seminars and workshops. CONCLUSIONS High-quality studies reporting the assessment of BCC training programs with nurses and nursing students are scarce. There was significant heterogeneity in terms of the BCC approaches and techniques taught. Current evidence suggests nurses and nursing students learn BCC mainly through active, realistic practice. However, computer-based training programs are rapidly gaining ground. Further research emphasizing theory-based BCC training programs is warranted.
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Affiliation(s)
- Guillaume Fontaine
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute Research Center, 5000 Belanger Street, S-2490, Montreal H1T 1C8, Quebec, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Marc-André Maheu-Cadotte
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute Research Center, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada
| | - Tanya Mailhot
- Montreal Heart Institute Research Center, Montreal, Quebec, Canada; Department of Pharmacy and Health Systems Sciences, Bouvé College of Health Sciences, Northeastern University, United States of America
| | - Sonia Heppell
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Laval University, Quebec, Quebec, Canada; CHU de Québec Research Center, Quebec, Quebec, Canada
| | - Véronique Dubé
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
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