A Mixed-Methods Outcome Evaluation of a Mentorship Intervention for Canadian Nurses in HIV Care

Understanding barriers and facilitators to HIV testing in Canada from 2009-2019: A systematic mixed studies review

BACKGROUND

HIV testing is a core pillar of Canada's approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed.

OBJECTIVE

To examine current barriers and facilitators of HIV testing across key populations and jurisdictions in Canada.

METHODS

A systematic mixed studies review of peer-reviewed and grey literature was conducted identifying quantitative and qualitative studies of barriers and facilitators to HIV testing in Canada published from 2009 to 2019. Studies were screened for inclusion and identified barriers and facilitators were extracted. The quality of included studies was assessed and results were summarized.

RESULTS

Forty-three relevant studies were identified. Common barriers emerge across key populations and jurisdictions, including difficulties accessing testing services, fear and stigma surrounding HIV, low risk perception, insufficient patient confidentiality and lack of resources for testing. Innovative practices that could facilitate HIV testing were identified, such as new testing settings (dental care, pharmacies, mobile units, emergency departments), new modalities (oral testing, peer counselling) and personalized sex/gender and age-based interventions and approaches. Key populations also face unique sociocultural, structural and legislative barriers to HIV testing. Many studies identified the need to offer a broad range of testing options and integrate testing within routine healthcare practices.

CONCLUSION

Efforts to improve access to HIV testing should consider barriers and facilitators at the level of the individual, healthcare provider and policy and should focus on the accessibility, inclusivity, convenience and confidentiality of testing services. In addition, testing services must be adapted to the unique needs and contexts of key populations.

Attitudes Toward Caring for People Living with HIV/AIDS: A Cross-Sectional Study of Nursing Faculty in Six Countries

Background:

Since the earliest study about nursing faculty and student attitudes about caring for people living with HIV/AIDS (PLHIV) in 1992, there have been less than 20 additional studies reported in the literature. Yet, PLHIV continues to report stigma and experience discrimination. Nursing faculty attitudes are part of the informal curriculum. Negativity about caring for PLHIV can adversely impact student perceptions as well as their care. Current research in this area is essentially non-existent.

Objective:

To describe the attitudes of the university nursing faculty toward caring for PLHIV; and to identify the relationship between faculty attitudes and explanatory factors such as age, education, religion, nationality, teaching in a clinical setting, years of experience, and university attributes.

Methods:

This was a multicenter cross-sectional study with nonrandomized electronic purposeful sampling. The Healthcare Provider HIV/AIDS Stigma Scale (HPASS) is a 30-item scale with three subscales: Prejudice, stereotype, and discrimination. The English and Spanish versions of the HPASS exhibit stable psychometric properties for cross-cultural research. The HPASS was delivered to university nursing faculty in six countries across three continents.

Results:

A sample of 368 nursing faculty completed the HPASS. The mean composite score was 2.41 (SD = 0.69), six-point scale with lower scores indicating more positive attitudes, with subscale scores: Stereotypes 2.55 (SD = 0.84), discrimination 2.28 (SD = 0.74), and prejudices 2.41 (SD = 0.63). Peruvian faculty had the highest scores while Canadian had the lowest. Significant correlations were observed between attitudes and the three subscales, and between the three subscales and the composite score.

Conclusion:

Attitudes of the nursing faculty toward caring for PLHIV were slightly positive to slightly negative depending on the region and country. Knowledge deficiencies about HIV persist, incorrect beliefs are common, and attitudes appear to be influenced by culture. The correlation between subscales justifies continued research to implement targeted interventions. Education about HIV/AIDS can address knowledge deficits while structured interactions with PLHIV can facilitate experiential learning.

Assessing the impact of mentorship on nurses' and midwives' knowledge and self-efficacy in managing postpartum hemorrhage

Background Despite medical technology advancement, postpartum hemorrhage remains the top universal cause of maternal mortality. Factors note the inconsistency in recognition and timely treatment of women experiencing it, which suggests healthcare professionals' mentorship about postpartum hemorrhage. Methods The study recruited 141 nurses and midwives and used instruments adapted to knowledge and self-efficacy to assess the impact of mentorship on nurses' and midwives' knowledge and self-efficacy in managing postpartum hemorrhage. Results There was an increase in knowledge from 68% prior to mentorship up to 87% and self-efficacy from 6.9 to 9.5 average score out of 10. Knowledge and self-efficacy correlated moderately positive at pre-mentorship (r=0.214) and strongly positive at post-mentorship (r=0.585). The number of mentorship visits attended was associated with post-mentorship knowledge scores (r=0.539) and post-mentorship self-efficacy (r=0.623). Conclusions Mentorship about management of postpartum hemorrhage increases nurses' and midwives' knowledge and self-efficacy in managing postpartum hemorrhage.

Design and Psychometrics of the Mentoring Questionnaire among Bachelor's Degree Students in Nursing

BACKGROUND

Regarding the importance of mentoring in nursing and lack of attention to this issue, as well as the lack of a suitable questionnaire to assess mentoring, this study was carried out to design and analyze psychometric properties of mentoring among bachelor's degree students in nursing.

MATERIALS AND METHODS

In a mixed method study, the validity and reliability of the Mentoring Questionnaire were measured after designing it. The study sample included all undergraduate nursing students of one of the nursing schools in Tehran, Iran. In the qualitative phase, item generation, face, and content validity were performed. In the quantitative phase, construct validity and reliability were performed. The Cronbach's alpha coefficient and Interclass Correlation Coefficient (ICC) test were exploited for data analysis and reliability assessment, respectively.

RESULTS

The number of items designed for the Mentoring questionnaire was twenty. Finally, the Mentoring Questionnaire was designed with 16 items. The Cronbach's alpha coefficient of the Mentoring Questionnaire was 0.96. In addition, the results of the ICC showed the high reliability of the Mentoring Questionnaire (ICC = 0.99). The indices derived from Exploratory Factor Analysis (EFA) revealed that the Mentoring Questionnaire had appropriate construct validity.

CONCLUSIONS

Given the results of this study, as well as the importance of mentoring measurement among nursing students and the lack of access to a valid questionnaire, it can be concluded that the Mentoring Questionnaire is a useful tool for bachelor's degree nursing students.

Where and how does physical therapy fit? Integrating physical therapy into interprofessional HIV care

Purpose: To investigate the role of physical therapy in HIV care from the perspective of people living with HIV and health care professionals with expertise in HIV care. Methods: We conducted a qualitative descriptive study using semistructured interviews (with health care professionals) and focus groups (with people living with HIV). We purposively sampled health care professionals and recruited people living with HIV in collaboration with an HIV-specialty hospital. We asked participants about their knowledge of and experiences with physical therapy, and perceptions of the physical therapy role in interprofessional HIV care. We analyzed data using content analytical techniques. Results: Thirteen people living with HIV and 12 health care professionals conceptualized physical therapy as positively influencing independence and social participation, and as a valuable ally in interprofessional collaboration. The Framework of Physical Therapy Role in HIV Care consists of two components: (1) multidimensional and client-centered roles of physical therapy addressing physical, psychological and social health domains; and (2) contextual factors important to consider for the role of physical therapy: aging, episodic nature of HIV, multimorbidity, competing priorities, continuity of care, stigma, resource security and social isolation. The interaction between contextual factors and health domains can influence the role of physical therapy. Conclusion: The role of physical therapy in HIV is multidimensional and client-centered. This Framework can be used by rehabilitation professionals working with people living with HIV. Implications for Rehabilitation Participants living with HIV in this study experienced physical therapy as a means of addressing rehabilitation goals that positively influenced physical health and social participation. The role of physical therapy in HIV care is multidimensional and client-centered and can address health challenges in physical, social and psychological health domains. The presence and interaction of contextual factors including aging, episodic nature of HIV, multimorbidity, competing priorities, continuity of care, stigma, resource security and social isolation are important for clinicians to consider in order to optimize healthcare for people living with HIV. The Framework describing the role of physical therapy in HIV care can be used by rehabilitation professionals to help inform their approach for providing client-centered HIV care.

Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care

We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations.