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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Kyrou D, Vrontaras N, Karamanidou C. Going above and beyond: a qualitative study on the experiences and perspectives of HIV healthcare providers in Greece. BMC Health Serv Res 2021; 21:1358. [PMID: 34930281 PMCID: PMC8686363 DOI: 10.1186/s12913-021-07380-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study concerns the experiences and perceptions of healthcare providers (HCPs) in Greece, as they respond to the changing health and psychosocial needs of people living with HIV (PLHIV) in unfavorable conditions, within a healthcare system encumbered by a decade of austerity measures. Methods To this end, semi-structured interviews were conducted with 20 HCPs in six HIV units throughout Greece. The data were analyzed employing reflexive thematic analysis, under a critical realist approach. Results Three main themes were generated from the analysis of the data: 1) Care Beyond Medicine, 2) Compensating System Barriers Towards Optimized Care and 3) Role Appraisal. According to HCPs’ perspectives, 1) their role extends beyond medicine, as they provide care for vulnerable groups and respond to their psychosocial difficulties. 2) Struggling to overcome structural barriers, HCPs often manage to provide privileged care to PLHIV. 3) In doing so, they become excessively involved. Despite the fulfillment experienced, HCPs often feel invalidated by the hospital setting, and frustrated, when they cannot manage to respond to the pressing needs of PLHIV. Conclusions HCPs are forced to pull together their personal resources in order to coordinate care and respond to PLHIV’s psychosocial difficulties and health issues, as there is no formal model of coordination of care for PLHIV in Greece. Considering these findings, the development of case management protocols and integrated care pathways in Greece is being proposed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07380-6.
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Affiliation(s)
- Dimitrios Kyrou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Road, 57001, Thessaloniki, Greece.
| | - Nikolaos Vrontaras
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Road, 57001, Thessaloniki, Greece
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Road, 57001, Thessaloniki, Greece
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Fauzi A, Anggraini N, Fatkhurohman N. Self-management: A comprehensive approach to improve quality of life among people living with HIV in Indonesia. BELITUNG NURSING JOURNAL 2021; 7:395-401. [PMID: 37496503 PMCID: PMC10367977 DOI: 10.33546/bnj.1554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 08/28/2021] [Indexed: 07/28/2023] Open
Abstract
Background People living with HIV (PLWH) today have to deal with a chronic condition that requires efficient self-management due to increased longevity. Self-management interventions have been shown to improve physical and psychological symptoms as well as clinical results in chronic diseases. However, few studies have investigated the effect of self-management on quality of life (QOL) among PLWH in Indonesia. Objective To examine the effect of a self-management program on QOL among PLWH in Indonesia. Methods This was a quasi-experimental study with a comparison group in a general hospital in Jakarta, Indonesia. Of the 114 recruited PLWH, 57 were assigned to the intervention group and 57 to the comparison group. The self-management group attended a four-week program workshop. The intervention consisted of five sessions: need assessment and goal setting, maintaining a healthy lifestyle, educational participation to increase communication and self-esteem, and evaluation. The comparison group received standard educational material throughout the leaflet regarding HIV prevention. The post-test assessment was conducted immediately after intervention (T1) and two months (T2) after the intervention in both groups. QOL was measured using the World Health Organization Quality of Life (WHOQOL)-HIV brief Bahasa version. The estimations were obtained using fixed-effect regressions. The differences between T0, T1, and T2 for the intervention and comparison groups were evaluated and compared using the DI Differences method (DID). Results The self-management program improved outcomes relative to the comparison group at T1: 1) overall QOL score increased 8.7% (95% CI 0.021-0.149), 2) physical domain saw a modest increased 8.8% (95% CI 0.017-0.125), 3) psychological domain increased 23.5 % (95% CI 0.085-0.689), and 4) environmental domain showed a modest increase of 18.7% (95% CI 0.053-0.371). At T2, the total QOL score and the physical, psychological, and environmental dimensions were significantly improved compared to the comparison group. Conclusion The self-management program appears to improve the QOL of the life of PLWH. Nurses are advised to provide PLWH with self-management training. Future research on self-management intervention would need to be refined further to ensure that each community achieves consistent intervention outcomes.
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Peer-led Self-management Interventions and Adherence to Antiretroviral Therapy Among People Living with HIV: A Systematic Review. AIDS Behav 2020; 24:998-1022. [PMID: 31598801 DOI: 10.1007/s10461-019-02690-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adherence to antiretroviral therapy (ART) is essential to reduce morbidity and mortality among people living with HIV (PLWH). However, adherence remains suboptimal, and PLWH may benefit from more self-management support to address the complexities of chronic illness. Our objective was to identify the impact of peer-led self-management interventions on adherence and patient-reported outcomes (PROs) among PLWH. We searched MEDLINE, PubMed, Embase, PsycINFO, and CINAHL for English language publications from 1996 to March 2018, and included controlled intervention studies. Additional articles were handsearched, risk of bias assessed, and narrative syntheses outlined. Thirteen studies met inclusion criteria. Findings demonstrate unclear effectiveness for peer-led self-management interventions improving ART adherence; however evidence was limited with only seven studies measuring this outcome and some risk of bias. Many PROs were measured, with limited consistent findings. Future research is needed to strengthen the evidence regarding effects of peer-led self-management interventions on adherence and PROs among PLWH.
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How the delivery of HIV care in Canada aligns with the Chronic Care Model: A qualitative study. PLoS One 2019; 14:e0220516. [PMID: 31348801 PMCID: PMC6660092 DOI: 10.1371/journal.pone.0220516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
With the advent of continuous antiretroviral therapy, HIV has become a complex chronic, rather than acute, condition. The Chronic Care Model (CCM) provides an integrated approach to the delivery of care for people with chronic conditions that could therefore be applied to the delivery of care for people living with HIV. Our objective was to assess the alignment of HIV care settings with the CCM. We conducted a mixed methods study to explore structures, organization and care processes of Canadian HIV care settings. The quantitative results of phase one are published elsewhere. For phase two, we conducted semi-structured interviews with key informants from 12 HIV care settings across Canada. Irrespective of composition of the care setting or its location, HIV care in Canada is well aligned with several components of the CCM, most prominently in the areas of linkage to community resources and delivery system design with inter-professional team-based care. We propose the need for improvements in the availability of electronic clinical information systems and self-management support services to support better care delivery and health outcomes among people living with HIV in Canada.
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de la Rubia JM, Andrade GPC, Yépez ACT, Guerra VML, López JAP, Sagarduy JLY. Validation study of a scale for assessing three personality functional dimensions among Venezuelan HIV-positive patients. Psychol Res Behav Manag 2018; 11:459-470. [PMID: 30349412 PMCID: PMC6190635 DOI: 10.2147/prbm.s152038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Personality has been recognized as a key variable in the prediction of treatment adherence and health care behaviors in patients living with chronic diseases. Purpose In order to contribute to the prediction of treatment-adherence behaviors among HIV-positive patients, this study aimed to test the metric properties of the 12-item Stress-Related Situations Scale (SRSS-12), which assesses four interactive styles of personality related to stressful situations when receiving treatment for a chronic disease. Patients and methods This cross-sectional study was performed with a nonprobability sampling between May and June 2016. The SRSS-12 was fulfilled by 186 out of 400 HIV-positive patients receiving attention through the regional program for HIV -sexually transmitted diseases control in the State of Lara, Venezuela (sample proportion =0.465). The participants were young adults (X=34.9 years), predominantly men (80.1%), and single (76.3%). Data analysis included exploratory factor analysis and confirmatory factor analysis, assessment of internal consistency, and description of distributions. Results The exploratory factor analysis yielded a three-factor structure: Tolerance to Frustration and Ambiguity, Follow-up of Instructions and Impulsivity, and Decision Making. Through confirmatory factor analysis, this model showed an acceptable fit to the data. The three factors showed convergent and discriminant validity and internal consistency from acceptable to high. The factor scores did not follow a normal distribution. Conclusions The three-factor model for the SRSS-12 showed validity and internal consistency among Venezuelan HIV-positive patients. Scaled scores for factors can be developed using percentile scores.
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Affiliation(s)
- José Moral de la Rubia
- Faculty of Psychology, Autonomous University of Nuevo Leon, Monterrey, Nuevo Leon, Mexico,
| | | | | | | | | | - José Luis Ybarra Sagarduy
- Unit of Social Work and Sciences for Human Development, Autonomous University of Tamaulipas, Ciudad Victoria, Tamaulipas, Mexico
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Nkhoma K, Norton C, Sabin C, Winston A, Merlin J, Harding R. Self-management Interventions for Pain and Physical Symptoms Among People Living With HIV: A Systematic Review of the Evidence. J Acquir Immune Defic Syndr 2018; 79:206-225. [DOI: 10.1097/qai.0000000000001785] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Philbin MM, Tanner AE, Ma A, Chambers BD, Ware S, Kinnard EN, Hussen SA, Lee S, Fortenberry JD. Adolescent and Adult HIV Providers' Definitions of HIV-Infected Youths' Successful Transition to Adult Care in the United States. AIDS Patient Care STDS 2017; 31:421-427. [PMID: 28981334 PMCID: PMC5650713 DOI: 10.1089/apc.2017.0131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Brittany D. Chambers
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Elizabeth N. Kinnard
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Sophia A. Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Sonia Lee
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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O'Brien KK, Bayoumi AM, Solomon P, Tang A, Murzin K, Chan Carusone S, Zobeiry M, Nayar A, Davis AM. Evaluating a community-based exercise intervention with adults living with HIV: protocol for an interrupted time series study. BMJ Open 2016; 6:e013618. [PMID: 27798038 PMCID: PMC5073553 DOI: 10.1136/bmjopen-2016-013618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH). METHODS AND ANALYSIS We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0-8 months), participants will be monitored bimonthly. In the intervention phase (8-14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14-22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto HIV/AIDS Research Ethics Board. Knowledge translation will occur with stakeholders in the form of presentations and publications in open access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02794415; Pre-results.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kate Murzin
- Realize (formally known as the Canadian Working Group on HIV and Rehabilitation (CWGHR)), Toronto, Ontario, Canada
| | | | - Mehdi Zobeiry
- Toronto Central Grosvenor Street YMCA, Toronto, Ontario, Canada
| | - Ayesha Nayar
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Health Care and Outcomes, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Jacobsson J, Timpka T. Classification of Prevention in Sports Medicine and Epidemiology. Sports Med 2015; 45:1483-7. [DOI: 10.1007/s40279-015-0368-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kvale EA, Meneses K, Demark-Wahnefried W, Bakitas M, Ritchie C. Formative research in the development of a care transition intervention in breast cancer survivors. Eur J Oncol Nurs 2015; 19:329-35. [DOI: 10.1016/j.ejon.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/13/2014] [Accepted: 01/22/2015] [Indexed: 10/23/2022]
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Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69 Suppl 1:S80-91. [PMID: 25867783 DOI: 10.1097/qai.0000000000000570] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). METHODS PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. RESULTS Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants. CONCLUSIONS Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.
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Dahlström Ö, Jacobsson J, Timpka T. Overcoming the organization-practice barrier in sports injury prevention: A nonhierarchical organizational model. Scand J Med Sci Sports 2014; 25:e414-22. [DOI: 10.1111/sms.12327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ö. Dahlström
- Department of Behavioural Sciences and Learning; Linköping University; Linköping Sweden
| | - J. Jacobsson
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - T. Timpka
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Adherence to antiretroviral medications for HIV pre-exposure prophylaxis: lessons learned from trials and treatment studies. Am J Prev Med 2013; 44:S91-8. [PMID: 23253769 DOI: 10.1016/j.amepre.2012.09.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/09/2012] [Accepted: 09/19/2012] [Indexed: 11/23/2022]
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Smith DK, Dearing JW, Sanchez T, Goldschmidt RH. Introducing wicked issues for HIV pre-exposure prophylaxis implementation in the U.S. Am J Prev Med 2013; 44:S59-62. [PMID: 23253763 DOI: 10.1016/j.amepre.2012.09.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/05/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
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Warren MJ, Bass ES. From efficacy to impact: an advocate's agenda for HIV pre-exposure prophylaxis implementation. Am J Prev Med 2013; 44:S167-70. [PMID: 23253762 DOI: 10.1016/j.amepre.2012.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 09/27/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Mitchell J Warren
- AVAC: Global Advocacy for HIV Prevention, New York, New York 10027, USA.
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