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Schwarz SB, Nydegger L, Hill MJ. Hard-to-Reach or Hardly Reached? The "Difficulty" of Engaging Cisgender Black Females in Sexual Health Research. J Racial Ethn Health Disparities 2023; 10:2615-2619. [PMID: 37831365 DOI: 10.1007/s40615-023-01825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/10/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Rather than placing the onus on stigmatized and disenfranchised communities as hard-to-reach in sexual health research, we challenge researchers to recognize and provide outreach to populations who are hardly reached, such as cisgender Black women. We posit that the disparate human immunodeficiency virus (HIV) and sexually transmitted infection (STI) rates experienced by Black women in the USA are due in part to social and structural inequities and lack of researcher outreach within these communities. Social inequities give rise to racial and gender discrimination, which often results in structural barriers that researchers may not acknowledge. Structural barriers include medical mistrust and lack of access to preventative sexual health services, health care, education, and other resources. To achieve health equity, researchers must engage with Black women to understand the unique struggles they face and intervene with non-stigmatizing, culturally appropriate interventions. Interventions must utilize gatekeepers, influencers, community organizations, community advisory boards, and peer support. It is critical that sexual health researchers reach out to those who do not fall under the traditional hard-to-reach category but are hardly reached to counteract the current projection that 1 in 32 Black women will be diagnosed with HIV in their lifetime.
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Affiliation(s)
- Sarah B Schwarz
- Department of Kinesiology & Health Education, College of Education, University of Texas at Austin, 1717 W 6th St Ste 335, Austin, TX, 78703, USA.
| | - Liesl Nydegger
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Mandy J Hill
- Department of Emergency Medicine, Texas Emergency Medicine Research Center, Population Health in Emergency Medicine Section, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), 6431 Fannin JJL 475G, Houston, TX, 77030, USA
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2
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of prevention strategies, logics, and rationales. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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3
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Coulibaly K, Gosselin A, Carillon S, Ravalihasy A, Melchior M, Ridde V, Desgrées du Loû A. Is empowerment in sexual health measurable? A scoping review of definitions and measurement indicators. Health Promot Int 2022; 37:6730779. [PMID: 36173607 DOI: 10.1093/heapro/daac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The concept of empowerment in sexual health is widely used in health promotion. This scoping review aims to identify how it is defined and measured. PubMed, Sage Journals, PsycInfo and the Web of Science are data sources. The inclusion criteria for studies were as follows: (1) an analysis of empowerment in sexual health, (2) quantitative evaluation and (3) publication in a peer-reviewed journal in French or English since January 1996. Data were extracted using a summary table of the definitions and indicators of empowerment in sexual health. Of the 2181 articles found, 29 met the inclusion criteria. Only 4 studies on 29 clearly defined empowerment in sexual health. Five dimensions emerged from the indicators used in the 29 studies in relation to sexual empowerment (social participation, participation in decision making, power to act, sexual health knowledge and gender norms), with two types of indicators: indicators unspecific to sexual health, which can be viewed as empowerment basic skills, and indicators specific to sexual health. Most studies concerned women and focused on individual empowerment, with a lack of measure of collective and structural levels of empowerment. Despite great heterogeneity in the definitions and indicators used, a set of core indicators emerged: participation in decision making, sexual negotiation power and sexual communication skills, knowledge and use of contraceptive methods, and HIV and sexually transmitted infections risk perception. This set could be systematically used in each study based on sexual empowerment concept, completed by supplementary indicators considering the specific context.
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Affiliation(s)
- Karna Coulibaly
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Anne Gosselin
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,French Institute for Demographic Studies (INED), Aubervilliers, France
| | | | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
| | - Maria Melchior
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
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4
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Campbell T, Rutter S, Croston M. HIV at 40: reflections on and development of interdisciplinary working in HIV care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S12. [PMID: 35678810 DOI: 10.12968/bjon.2022.31.11.s8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article reflects on 40 years of HIV and the growing need to work collaboratively to improve outcomes for people living with HIV. It reflects on the history of interdisciplinary working in HIV care in the UK and discusses the development of links between the professions of nursing and clinical psychology. Both professions had contributed to the development of the Standards for Psychological Support for Adults Living with HIV. One of the authors, who was chair of the National HIV Nurses Association, initiated an audit of the use of the standards within UK HIV clinics and invited local British Psychological Society members to participate in the development of the audit process. The audit results identified gaps in the provision of care that led to further close working relationships. In an era of highly effective antiretrovirals that address the medical aspects of HIV care, the focus of care has shifted to the management of psychosocial factors that contribute to poor outcomes in of HIV. Interdisciplinary work and cooperation is the most effective way to address those complex issues.
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Affiliation(s)
- Tomas Campbell
- Clinical Psychologist, Cogito Psychological Services, London
| | - Sarah Rutter
- Clinical Psychologist, Department of Clinical Psychology, North Manchester General Hospital, Manchester
| | - Michelle Croston
- Associate Professor of Nursing, School of Health Sciences, University of Nottingham, Nottingham
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5
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Opara I, Rivera Rodas EI, Garcia-Reid P, Reid RJ. Ethnic Identity, Empowerment, Social Support and Sexual Risk Behaviors Among Black Adolescent Girls: Examining Drug Use as a Mediator. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 39:71-86. [PMID: 35462639 PMCID: PMC9031836 DOI: 10.1007/s10560-020-00706-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Substance abuse and sexual health research tends to overlook the resiliency skills that Black adolescent girls possess. Using a strengths-based lens, this study examines the role of protective factors: (e.g. ethnic identity, social support, and psychological empowerment) on sexual risk behaviors testing drug use as a mediator among a sample of Black adolescent girls. The study uses a sample (N = 340) female adolescents (13-17 years old) who identified as being Black only and reside in a northeastern urban community in New Jersey. Structural equation modeling was employed to test the hypothesized model of the mediating role of drug use on sexual risk behaviors among this sample. Findings revealed that drug use significantly mediated the relationship between social support, ethnic identity, and psychological empowerment on sexual risk behaviors, with high ethnic identity scores having the strongest relationship on low sexual risk behaviors and low levels of drug use. Given the rise of sexually transmitted infections (STIs) in the United States among Black adolescent girls, findings from this study can contribute to development of culturally appropriate and innovative strategies to reduce risky behaviors by promoting social and cultural strengths among Black girls living in urban communities.
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Affiliation(s)
- Ijeoma Opara
- School of Social Welfare, Stony Brook University, Stony Brook, USA
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, USA
| | | | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, USA
| | - Robert J. Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, USA
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6
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of outcomes. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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7
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Opara I, Hill AV, Calhoun A, Francois M, Alves C, Garcia-Reid P, Reid RJ. Sociopolitical control as a mediator between ethnic identity and social support on 30-day drug use among black girls. J Ethn Subst Abuse 2021:1-20. [PMID: 34533434 PMCID: PMC8926931 DOI: 10.1080/15332640.2021.1975007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While Black girls have lower rates of drug use, they face worse health and wellbeing consequences associated with drug use. Understanding which strengths-based factors serve as buffers to limit adverse outcomes related to drug use among Black girls is essential for prevention. This study investigated the mediating role of sociopolitical control on drug use among Black girls (n = 340). Using path analysis, models were tested to include the variables of interest. Sociopolitical control (e.g. leadership competency and policy control) significantly mediated the relationship between ethnic identity and social support on drug use. Implications from this study may consider bolstering empowerment-based strategies in drug use prevention for Black girls.
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Affiliation(s)
- Ijeoma Opara
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | | | - Amanda Calhoun
- Yale University School of Medicine, New Haven, Connecticut
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8
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Ravalihasy A, Rude N, Yazdanpanah Y, Kardas-Sloma L, Desgrées du Loû A, Gosselin A, Ridde V. Development and Validation of an HIV/AIDS Empowerment Scale for Impact Intervention Evaluation. An Example from the MAKASI Intervention. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1955230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrainolo Ravalihasy
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- UMR 1137, Inserm, University of Paris, IAME
- French Collaborative Institute on Migrations, CNRS
| | - Nathalie Rude
- UFR Santé, EA 481 Neurosciences, Université de Franche Comté
| | | | | | - Annabel Desgrées du Loû
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
| | - Anne Gosselin
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- French Collaborative Institute on Migrations, CNRS
- ERES, Social Epidemiology Unit, IPLESP, INSERM S1136
| | - Valéry Ridde
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
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9
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Nugroho A, Erasmus V, Krier SE, Reviagana KP, Laksmono PA, Widihastuti A, Richardus JH. Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen. Health Promot Int 2021; 35:916-924. [PMID: 31504514 PMCID: PMC7585524 DOI: 10.1093/heapro/daz075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study explored clients’ perspective on an outreach approach to promote HIV testing in Indonesia targeting men who have sex with men (MSM) and transgender women (transwomen or waria). Semi-structured qualitative interviews were conducted with 32 individuals (21 MSM and 11 waria) who had received services from outreach workers (OWs) in five cities in Indonesia. Participants in this study reported positive experiences with the outreach approach and perceived OWs as their motivators in accessing HIV testing as well as HIV care and treatment. OWs provided easy-to-understand HIV information. Clients expected OWs to be well-trained and more creative in performing outreach. They perceived that the Internet and social media have helped them considerably to stay in touch with OWs. Yet, they expressed that such virtual contacts could not simply replace the face-to-face contact, especially for waria. Furthermore, clients suggested outreach to be delivered in a more appealing manner, for example through activities that may facilitate clients learning professional or life skills. They also asserted that as an HIV prevention approach, outreach needs to use more positive framing and go beyond HIV and health contents, chiefly for the youth. Future outreach programmes should facilitate OWs in providing tailored services based on the level and type of support that the clients need, and in applying varied proportion and levels of sophistication in the use of online and virtual platforms for outreach.
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Affiliation(s)
- Adi Nugroho
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,School of Public Health, Faculty of Medicine, Lambung Mangkurat University, Banjarbaru, Indonesia.,GWL-INA Network, Jakarta, Indonesia
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kusnindyah P Reviagana
- School of Public Health, Faculty of Medicine, Lambung Mangkurat University, Banjarbaru, Indonesia
| | | | | | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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The Co-Evolution of Network Structure and PrEP Adoption among a Large Cohort of PrEP Peer Leaders: Implications for Intervention Evaluation and Community Capacity-Building. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116051. [PMID: 34199829 PMCID: PMC8200056 DOI: 10.3390/ijerph18116051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
Background: Peer leader interventions are effective strategies for promoting prevention behaviors in communities at risk for HIV, yet little is known about their effects on the social and behavioral dynamics of peer leaders themselves. Methods: Using data from PrEP Chicago, an RCT PrEP for prevention intervention for young Black MSM (YBMSM), we apply stochastic actor-based models to longitudinally model the impact of study participation on the online friendship and PrEP adoption dynamics among a network of peer leaders (n = 174) and a network of control group counterparts (n = 166). Results: Peer leaders assigned to the same leadership training workshop were more likely to form new Facebook friendships with one another, whereas control participants assigned to the same attention control workshop were no more or less likely to form new friendships. Further, peer leaders with greater PrEP intentions and those living with HIV were more active in forming new friendships with other peer leaders, effects not found in the control network. PrEP adoption was not influenced by network dynamics in either group. Conclusions: The implications of these findings are discussed through the lens of community-capacity building and the role that peer leader interventions and the networks they engage can impact public health.
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11
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Shoker K, Doornekamp L, Horjus B, Wagener MN, Aron GI, Goeijenbier M, van Gorp ECM. Empowering Dutch and Surinamese children to prevent viral infections: implications from an international education module. Health Promot Int 2021; 36:1566-1577. [PMID: 33604664 DOI: 10.1093/heapro/daaa153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Viral infections have a large share in human morbidity and mortality. Next to vaccinations and hygiene measures, health education plays a role in preventing infections. Social scientists argue that empowerment should be included in health education, as increasing knowledge is insufficient to achieve sustainable behaviour change. Within the international education module 'Viruskenner', primary school students learn how to prevent virus infections by identifying health risks and developing interventions. This qualitative formative study explored to what extent Viruskenner creates conditions in which empowerment processes can arise and take place in the Netherlands and Suriname. Indicators of empowerment, as defined in the literature and placed in the attitude, social influence, and self-efficacy model, were assessed during semi-structured interviews (n = 24) with students, parents, teachers and facilitators. We conclude that Viruskenner is successful in creating conditions for empowerment processes to arise and take place, specifically in attitude and self-efficacy. According to interviewees, the module raised students' motivation, skills and confidence to take action to improve health behaviour. Educators played a stimulating role in the participatory setting in both countries, while content relevance and community involvement differed between the Netherlands and Suriname. These outcomes could improve this module and possibly other health education programmes.
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Affiliation(s)
- Kifah Shoker
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura Doornekamp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bob Horjus
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marlies N Wagener
- Center of Expertise Innovations in Care, Rotterdam University of Applied Science, Rotterdam, The Netherlands
| | - Georgina I Aron
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Stone TJ, Brangan E, Chappell A, Harrison V, Horwood J. Telephone outreach by community workers to improve uptake of NHS Health Checks in more deprived localities and minority ethnic groups: a qualitative investigation of implementation. J Public Health (Oxf) 2020; 42:e198-e206. [PMID: 31188440 DOI: 10.1093/pubmed/fdz063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND NHS Health Checks is a national cardiovascular risk assessment and management programme in England. To improve equity of uptake in more deprived, and Black, Asian and minority ethnic (BAME) communities, a novel telephone outreach intervention was developed. The outreach call included an invitation to an NHS Health Check appointment, lifestyle questions, and signposting to lifestyle services. We examined the experiences of staff delivering the intervention. METHODS Thematic analysis of semi-structured interviews with 10 community Telephone Outreach Workers (TOWs) making outreach calls, and 5 Primary Care Practice (PCP) staff they liaised with. Normalization Process Theory was used to examine intervention implementation. RESULTS Telephone outreach was perceived as effective in engaging patients in NHS Health Checks and could reduce related administration burdens on PCPs. Successful implementation was dependent on support from participating PCPs, and tensions between the intervention and other PCP priorities were identified. Some PCP staff lacked clarity regarding the intervention aim and this could reduce the potential to capitalize on TOWs' specialist skills. CONCLUSIONS To maximize the potential of telephone outreach to impact equity, purposeful recruitment and training of TOWs is vital, along with support and integration of TOWs, and the telephone outreach intervention, in participating PCPs.
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Affiliation(s)
- T J Stone
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - E Brangan
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - A Chappell
- Public Health, Bristol City Council, City Hall, Bristol, UK
| | - V Harrison
- Public Health, Bristol City Council, City Hall, Bristol, UK
| | - J Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
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Lardier DT, Opara I, Reid RJ, Garcia-Reid P. The Role of Empowerment-Based Protective Factors on Substance Use Among Youth of Color. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2020; 37:271-285. [PMID: 34732976 PMCID: PMC8562725 DOI: 10.1007/s10560-020-00659-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Youth of color continue to be disproportionately affected by the consequences of engaging in high rates of daily substance use. Racial-ethnic minority adolescents are often viewed through a deficit lens. There is limited research that examines the strengths of these young people and their communities as a prevention strategy to lower rates of drug use. Using an empowerment-based framework, this study examines the role of intrapersonal and cognitive psychological empowerment, community civic engagement, and ethnic identity on 30-day drug use among a sample of youth of color (N=383; 53.1% Female; 75% Hispanic), between 14 and 18 years of age, from a northeastern urban community. Structural equation modeling was used to test indirect and direct associations between constructs. Results revealed that both intrapersonal and cognitive psychological empowerment were associated with lower rates of 30-day substance use mediated by ethnic identity and community civic engagement. Findings from this study contribute to the social work field by highlighting the importance of strengths-based approaches to improving health outcomes and decreasing risky behaviors such as drug use among youth of color.
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Affiliation(s)
- David T. Lardier
- Department of Individual, Family, and Community Education, Family and Child Studies Program, The University of New Mexico, Albuquerque, NM 87131, USA
- Department of Psychiatry and Behavioral Sciences, The University of New Mexico School of Medicine, The University of New Mexico, Albuquerque, NM 87131, USA
| | - Ijeoma Opara
- School of Social Welfare, Stony Brook University, Stony Brook, NY, USA
| | - Robert J. Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
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Effect of health intervention integration within women's self-help groups on collectivization and healthy practices around reproductive, maternal, neonatal and child health in rural India. PLoS One 2018; 13:e0202562. [PMID: 30138397 PMCID: PMC6107172 DOI: 10.1371/journal.pone.0202562] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluates an eight-session behavior change health intervention with women's self-help groups (SHGs) aimed to promote healthy maternal and newborn practices among the more socially and economically marginalized groups. METHODS Using a pre-post quasi-experimental design, a total of 545 SHGs were divided into two groups: a control group, which received the usual microcredit intervention; and an intervention group, which received additional participatory training around maternal, neonatal, and child health issues. Women members of SHGs who had a live birth in the 12 months preceding the survey were surveyed on demographics, practices around maternal, neonatal and child health (MNCH), and collectivization. Outcome effects were assessed using difference-in-difference (DID) methods. RESULTS Women from the SHGs with health intervention, relative to controls over time (time 1 to time 2), were more likely to: use contraceptive methods (DID: 9 percentage points [pp], p<0.001), have institutional delivery (DID: 9pp, p<0.05), practice skin-to-skin care (DID: 17pp, p<0.05), delay bathing for 3 or more days (DID: 19pp, p<0.001), initiate timely breastfeeding (DID: 21pp, p<0.001), exclusively breastfeed the child (DID: 27pp, p<0.001), and provide age-appropriate immunization (DID: 9pp, p<0.001). Additionally, women from the SHGs with health intervention when compared to the control group over time were more likely to report: collective efficacy (DID: 17pp, p<0.001), support through accompanying SHG members for antenatal care (DID: 8pp, p<0.05), receive a visit from SHG member within 2 days post-delivery (DID: 32pp, p<0.001), and receive reproductive, maternal, neonatal and child health information from an SHG member (DID: 45pp, p<0.001). CONCLUSION Findings demonstrate that structured participatory communication on MNCH with women's groups improve positive health practices. In addition, SHGs can reach a substantial proportion of women while providing an avenue for pregnant women and young mothers to be assisted by others in learning and practicing healthy behaviors, thus building social cohesion on health.
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15
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Pettifor A, Lippman SA, Gottert A, Suchindran CM, Selin A, Peacock D, Maman S, Rebombo D, Twine R, Gómez‐Olivé FX, Tollman S, Kahn K, MacPhail C. Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa. J Int AIDS Soc 2018; 21:e25134. [PMID: 29972287 PMCID: PMC6058206 DOI: 10.1002/jia2.25134] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Community mobilization (CM) is increasingly recognized as critical to generating changes in social norms and behaviours needed to achieve reductions in HIV. We conducted a CM intervention to modify negative gender norms, particularly among men, in order to reduce associated HIV risk. METHODS Twenty two villages in the Agincourt Health and Socio-Demographic Surveillance Site in rural Mpumalanga, South Africa were randomized to either a theory-based, gender transformative, CM intervention or no intervention. Two cross-sectional, population-based surveys were conducted in 2012 (pre-intervention, n = 600 women; n = 581 men) and 2014 (post-intervention, n = 600 women; n = 575 men) among adults ages 18 to 35 years. We used an intent-to-treat (ITT) approach using survey regression cluster-adjusted standard errors to determine the intervention effect by trial arm on gender norms, measured using the Gender Equitable Mens Scale (GEMS), and secondary behavioural outcomes. RESULTS Among men, there was a significant 2.7 point increase (Beta Coefficient 95% CI: 0.62, 4.78, p = 0.01) in GEMS between those in intervention compared to control communities. We did not observe a significant difference in GEMS scores for women by trial arm. Among men and women in intervention communities, we did not observe significant differences in perpetration of intimate partner violence (IPV), condom use at last sex or hazardous drinking compared to control communities. The number of sex partners in the past 12 months (AOR 0.29, 95% CI 0.11 to 0.77) were significantly lower in women in intervention communities compared to control communities and IPV victimization was lower among women in intervention communities, but the reduction was not statistically significant (AOR 0.53, 95% CI 0.24 to 1.16). CONCLUSION Community mobilization can reduce negative gender norms among men and has the potential to create environments that are more supportive of preventing IPV and reducing HIV risk behaviour. Nevertheless, we did not observe that changes in attitudes towards gender norms resulted in desired changes in risk behaviours suggesting that more time may be necessary to change behaviour or that the intervention may need to address behaviours more directly. CLINICAL TRIALS NUMBER ClinicalTrials.gov NCT02129530.
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Affiliation(s)
- Audrey Pettifor
- Department of EpidemiologyUniversity of North Carolina Gillings School of Global Public HealthChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for AIDS Prevention Studies (CAPS)Department of MedicineUniversity of California at San FranciscoSan FranciscoCAUSA
| | - Ann Gottert
- Population CouncilHIV and AIDS programWashingtonDCUSA
| | - Chirayath M Suchindran
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Department of BiostatisticsUniversity of North Carolina Gillings School of Global Public HealthChapel HillNCUSA
| | - Amanda Selin
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Dean Peacock
- Sonke Gender JusticeCape TownSouth Africa
- School of Public HealthDivision of Social and Behavioural ScienceUniversity of Cape TownCape TownSouth Africa
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina Gillings School of Global Public HealthChapel HillNC
| | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Francesc Xavier Gómez‐Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Epidemiology and Global Health UnitDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Epidemiology and Global Health UnitDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Safarnejad A, Groot W, Pavlova M. Study design and the estimation of the size of key populations at risk of HIV: lessons from Viet Nam. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:7. [PMID: 29382390 PMCID: PMC5791336 DOI: 10.1186/s12914-018-0141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/03/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Estimation of the size of populations at risk of HIV is a key activity in the surveillance of the HIV epidemic. The existing framework for considering future research needs may provide decision-makers with a basis for a fair process of deciding on the methods of the estimation of the size of key populations at risk of HIV. This study explores the extent to which stakeholders involved with population size estimation agree with this framework, and thus, the study updates the framework. METHODS We conducted 16 in-depth interviews with key informants from city and provincial governments, NGOs, research institutes, and the community of people at risk of HIV. Transcripts were analyzed and reviewed for significant statements pertaining to criteria. Variations and agreement around criteria were analyzed, and emerging criteria were validated against the existing framework. RESULTS Eleven themes emerged which are relevant to the estimation of the size of populations at risk of HIV in Viet Nam. Findings on missing criteria, inclusive participation, community perspectives and conflicting weight and direction of criteria provide insights for an improved framework for the prioritization of population size estimation methods. CONCLUSIONS The findings suggest that the exclusion of community members from decision-making on population size estimation methods in Viet Nam may affect the validity, use, and efficiency of the evidence generated. However, a wider group of decision-makers, including community members among others, may introduce diverse definitions, weight and direction of criteria. Although findings here may not apply to every country with a transitioning economy or to every emerging epidemic, the principles of fair decision-making, value of community participation in decision-making and the expected challenges faced, merit consideration in every situation.
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Affiliation(s)
- Ali Safarnejad
- Maastricht University, Maastricht Graduate School of Governance, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Gibbs A, Jewkes R, Karim F, Marofi F, Corboz J. Understanding how Afghan women utilise a gender transformative and economic empowerment intervention: A qualitative study. Glob Public Health 2018; 13:1702-1712. [PMID: 29353530 DOI: 10.1080/17441692.2018.1427276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The processes through which women's economic empowerment interventions are envisaged to improve women's health are strongly embedded in notions of building women's agency and autonomy. Yet despite the ubiquity of such interventions, there remains incredibly little qualitative work exploring how women actually utilise interventions to reshape their lives and wellbeing. Drawing on 9 focus groups discussions among 52 women who participated in the Women for Women International intervention in Afghanistan, an economic strengthening and social empowerment intervention, we explore processes of change. Data showed women learnt new skills around numeracy and animal husbandry; they perceived themselves to have become more respected within the household setting; they invested cash they received for intervention attendance in businesses, primarily their husband's or family's, and saved cash. Women did not, however, report their relationships to have been radically restructured. Rather women described incremental changes in their relationships within their household and used what they gained from the intervention to secure and sustain this. This conceptualisation of agency and empowerment reflects approaches to understanding agency, which move away from 'action-oriented' understandings, to ones that recognise 'distributed agency' as pathways to change through interventions.
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Affiliation(s)
- Andrew Gibbs
- a Gender and Health Research Unit , South African Medical Research Council , Pretoria , South Africa
| | - Rachel Jewkes
- a Gender and Health Research Unit , South African Medical Research Council , Pretoria , South Africa
| | - Fazal Karim
- b Women for Women International , Kabul , Afghanistan
| | - Frozan Marofi
- b Women for Women International , Kabul , Afghanistan
| | - Julienne Corboz
- c What Works to Prevent Violence Against Women and Girls? Global Programme , Pretoria , South Africa
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18
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Mubyazi GM, Mushi AK, Shayo E, Mdira K, Ikingura J, Mutagwaba D, Malecela M, Njunwa KJ. Local Primary Health Care Committees and Community-Based Health Workers in Mkuranga District, Tanzania:. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/09735070.2007.11886298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Godfrey M. Mubyazi
- Amani Medical Research Centre, P.O Box 81 Muheza, Tanzania
- National Institute for Medical Research (NIMR), Headquarters, P.O. Box 9653 Dar Es Salaam, Tanzania
| | - Adiel K. Mushi
- Amani Medical Research Centre, P.O Box 81 Muheza, Tanzania
| | | | - Kassembe Mdira
- Amani Medical Research Centre, P.O Box 81 Muheza, Tanzania
| | - Joyce Ikingura
- National Institute for Medical Research (NIMR), Headquarters, P.O. Box 9653 Dar Es Salaam, Tanzania
| | | | - Mwele Malecela
- Amani Medical Research Centre, P.O Box 81 Muheza, Tanzania
| | - Kato J. Njunwa
- Amani Medical Research Centre, P.O Box 81 Muheza, Tanzania
- Kigali Health Institute, Rwanda
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19
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Young LE, Schumm P, Alon L, Bouris A, Ferreira M, Hill B, Khanna AS, Valente TW, Schneider JA. PrEP Chicago: A randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men. Clin Trials 2017; 15:44-52. [PMID: 28862483 DOI: 10.1177/1740774517730012] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS Advances in biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) represent a new opportunity for reducing HIV incidence among young Black men who have sex with men, for whom the number of new HIV infections continues to rise. However, studies have documented low rates of PrEP uptake in this community. Research suggests that the peer networks of young Black men who have sex with men play important roles in their sexual health decisions. PrEP Chicago is a randomized controlled trial network intervention designed to increase PrEP uptake among young Black men who have sex with men living in Chicago. The aims of this study are twofold. Aim 1 is to estimate the effectiveness of a peer change agent intervention for (1) increasing the number of referrals made to a PrEP information line, (2) increasing the rate of PrEP adoption among non-participant peers, and (3) increasing PrEP knowledge, attitudes, and intentions among participants. Aim 2 is to determine the individual and network variables that explain peer change agent effectiveness. METHODS PrEP Chicago is a social network intervention that utilizes the influence of peer change agents to link young Black men who have sex with men in Chicago to PrEP. Young Black men who have sex with men were recruited using respondent-driven sampling. Once screened for eligibility, participants were randomly assigned to either one of two treatment sequences: (1) intervention treatment in Year 1 followed by a minimal contact attention control in Year 2 or (2) the minimal contact attention control in Year 1 followed by treatment in Year 2. The treatment consists of a PrEP/peer change agent training workshop followed by booster calls for 12 months. The attention control consists of a sex diary activity designed to help participants assess sexual risk. Psychosocial, sexual health, and network data are collected from all participants at baseline and at 12- and 24-month follow-ups. RESULTS In total, 423 participants aged 18-35 have been enrolled (more than 100% target enrollment) and have completed baseline data collection. A majority of participants in both intervention and control groups reported having heard of PrEP before enrolling in the study, yet also reported having had no current or prior experience taking PrEP. Statistical analyses await completion of Year 1 of the trial in March 2018. CONCLUSION PrEP Chicago addresses a gap in HIV prevention research and intervention design by utilizing the existing social networks among young Black men who have sex with men as mechanisms for information diffusion, behavioral influence, social support, and empowerment. Therefore, interventions that leverage peer influence processes to facilitate PrEP uptake are promising strategies to improve sexual health engagement and overcome disparities in outcomes among this at-risk population.
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Affiliation(s)
- Lindsay E Young
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Phil Schumm
- 3 Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Leigh Alon
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Alida Bouris
- 2 Chicago Center for HIV Elimination, Chicago, IL, USA.,4 School of Social Service Administration, The University of Chicago, Chicago, IL, USA
| | - Matthew Ferreira
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Brandon Hill
- 1 The University of Chicago Medicine, Chicago, IL, USA.,5 Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Thomas W Valente
- 6 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - John A Schneider
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA.,3 Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
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20
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Lippman SA, Pettifor A, Rebombo D, Julien A, Wagner RG, Kang Dufour MS, Kabudula CW, Neilands TB, Twine R, Gottert A, Gómez-Olivé FX, Tollman SM, Sanne I, Peacock D, Kahn K. Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial. Implement Sci 2017; 12:9. [PMID: 28095904 PMCID: PMC5240325 DOI: 10.1186/s13012-016-0541-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/27/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND HIV transmission can be decreased substantially by reducing the burden of undiagnosed HIV infection and expanding early and consistent use of antiretroviral therapy (ART). Treatment as prevention (TasP) has been proposed as key to ending the HIV epidemic. To activate TasP in high prevalence countries, like South Africa, communities must be motivated to know their status, engage in care, and remain in care. Community mobilization (CM) has the potential to significantly increase uptake testing, linkage to and retention in care by addressing the primary social barriers to engagement with HIV care-including poor understanding of HIV care; fear and stigma associated with infection, clinic attendance and disclosure; lack of social support; and gender norms that deter men from accessing care. METHODS/DESIGN Using a cluster randomized trial design, we are implementing a 3-year-theory-based CM intervention and comparing gains in HIV testing, linkage, and retention in care among individuals residing in 8 intervention communities to that of individuals residing in 7 control communities. Eligible communities include 15 villages within a health and demographic surveillance site (HDSS) in rural Mpumalanga, South Africa, that were not exposed to previous CM efforts. CM activities conducted in the 8 intervention villages map onto six mobilization domains that comprise the key components for community mobilization around HIV prevention. To evaluate the intervention, we will link a clinic-based electronic clinical tracking system in all area clinics to the HDSS longitudinal census data, thus creating an open, population-based cohort with over 30,000 18-49-year-old residents. We will estimate the marginal effect of the intervention on individual outcomes using generalized estimating equations. In addition, we will evaluate CM processes by conducting baseline and endline surveys among a random sample of 1200 community residents at each time point to monitor intervention exposure and community level change using validated measures of CM. DISCUSSION Given the known importance of community social factors with regard to uptake of testing and HIV care, and the lack of rigorously evaluated community-level interventions effective in improving testing uptake, linkage and retention, the proposed study will yield much needed data to understand the potential of CM to improve the prevention and care cascade. Further, our work in developing a CM framework and domain measures will permit validation of a CM conceptual framework and process, which should prove valuable for community programming in Africa. TRIAL REGISTRATION NCT02197793 Registered July 21, 2014.
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Affiliation(s)
- Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, CA, USA.
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, 27599, NC, USA
| | - Dumisani Rebombo
- Sonke Gender Justice, 4th Floor Westminster House, 122 Longmarket Street, 8001, Cape Town, South Africa
| | - Aimée Julien
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, 27599, NC, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Sweden
| | - Mi-Suk Kang Dufour
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, CA, USA
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, CA, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Ann Gottert
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, 27599, NC, USA
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Helen Joseph Hospital, Perth Road, Westdene, 2092, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice, 4th Floor Westminster House, 122 Longmarket Street, 8001, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Falmouth Rd, Observatory 7925, Cape Town, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Sweden
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Lippman SA, Neilands TB, MacPhail C, Peacock D, Maman S, Rebombo D, Twine R, Selin A, Leslie HH, Kahn K, Pettifor A. Community Mobilization for HIV Testing Uptake: Results From a Community Randomized Trial of a Theory-Based Intervention in Rural South Africa. J Acquir Immune Defic Syndr 2017; 74 Suppl 1:S44-S51. [PMID: 27930611 PMCID: PMC5147031 DOI: 10.1097/qai.0000000000001207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV testing uptake in South Africa is below optimal levels. Community mobilization (CM) may increase and sustain demand for HIV testing, however, little rigorous evidence exists regarding the effect of CM interventions on HIV testing and the mechanisms of action. METHODS We implemented a theory-driven CM intervention in 11 of 22 randomly-selected villages in rural Mpumalanga Province. Cross-sectional surveys including a community mobilization measure were conducted before (n = 1181) and after (n = 1175) a 2-year intervention (2012-2014). We assessed community-level intervention effects on reported HIV testing using multilevel logistic models. We used structural equation models to explore individual-level effects, specifically whether intervention assignment and individual intervention exposure were associated with HIV testing through community mobilization. RESULTS Reported testing increased equally in both control and intervention sites: the intervention effect was null in primary analyses. However, the hypothesized pathway, CM, was associated with higher HIV testing in the intervention communities. Every standard deviation increase in village CM score was associated with increased odds of reported HIV testing in intervention village participants (odds ratio: 2.6, P = <0.001) but not control village participants (odds ratio: 1.2, P = 0.53). Structural equation models demonstrate that the intervention affected HIV testing uptake through the individual intervention exposure received and higher personal mobilization scores. CONCLUSIONS There was no evidence of community-wide gains in HIV testing due to the intervention. However, a significant intervention effect on HIV testing was noted in residents who were personally exposed to the intervention and who evidenced higher community mobilization. Research is needed to understand whether CM interventions can be diffused within communities over time.
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Affiliation(s)
- Sheri A. Lippman
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
| | - Catherine MacPhail
- School of Health, University of New England, Armidale, New South Wales, Australia
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Cape Town, South Africa
- School of Public Health, University of Cape Town, South Africa
| | - Suzanne Maman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dumisani Rebombo
- Sonke Gender Justice, Cape Town, South Africa
- School of Public Health, University of Cape Town, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amanda Selin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hannah H. Leslie
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and
| | - Kathleen Kahn
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Urada LA, Simmons J, Wong B, Tsuyuki K, Condino-Enrera G, Hernandez LI, Simbulan NP, Raj A. A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study. Int J Public Health 2016; 61:945-957. [PMID: 27600733 DOI: 10.1007/s00038-016-0875-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study evaluated a brief human rights-focused HIV community mobilization intervention for sex workers in the Philippines, a country with one of the fastest rising number of HIV cases worldwide. METHODS Five single-session group interventions to reduce sexual risk and increase HIV testing among 86 sex workers in Manila were evaluated with pre-post-test data via Wilcoxon's signed-ranks and Mann-Whitney tests. The 4-h intervention, Kapihan (August-November, 2013), integrated human rights with HIV skill-building. Demographic data, violence/trafficking victimization, human rights knowledge, and intentions to HIV test and treat were collected. RESULTS Participants were median aged 23; female (69 %); had children (55; 22 % had 3+ children); used drugs (past 3 months: 16 %); sexually/physically abused by clients (66 %); 20 % street sex workers ever took an HIV test. Pre-post-test scores significantly improved in knowledge of HIV (z = -8.895, p < 0.001), reproductive health (z = -3.850, p < 0.001), human rights (z = -4.391, p < 0.001), ethical rights of research participants (z = -5.081, p < 0.001), and intentions to HIV test (z = -4.868, p < 0.001). CONCLUSIONS Integrating human rights into HIV interventions may empower sex workers to address their health and human rights and test for HIV.
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Affiliation(s)
- Lianne A Urada
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA. .,College of Health and Human Services, School of Social Work, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Janie Simmons
- National Development and Research Institutes, Inc., 71 W 23rd St, New York, NY, 10010, USA
| | - Betty Wong
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Kiyomi Tsuyuki
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Gerlita Condino-Enrera
- Woodwater Center for Healing, 8 Nicanor Reyes St, Loyola Heights, Quezon City, Philippines
| | - Laufred I Hernandez
- Department of Behavioral Sciences, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Nymia Pimentel Simbulan
- College of Arts and Science and College of Public Health, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Anita Raj
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
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MacPhail C, Campbell C. Evaluating HIV/STD Interventions in Developing Countries: Do Current Indicators Do Justice to Advances in Intervention Approaches? SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124639902900401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV continues to spread unabated in many developing countries. Here we consider the interventions that are currently in place and critically discuss the methods that are being used to evaluate them as reported in the published literature. In recent years there has been a move away from highly individual-oriented interventions towards more participatory approaches that emphasise techniques such as community-led peer education and group discussions. However, this move towards more community orientated intervention techniques has not been matched by the development of evaluation methods with which to capture and explain the community and social changes which are often necessary preconditions for health-enhancing behaviour change. Evaluation research continues to rely on quantitative methodologies that fail to elucidate the complex changes that the newer interventions seek to promote within target communities. In addition, these methods of evaluation tend to rely on the use of highly individualistic and quantitative biomedical indicators such as HIV/STD rates, or knowledge, attitude, perception and behaviour (KAPB) survey questionnaires. We argue that such approaches are inadequate for the task of tracking and measuring important determinants of programme success such as psycho-social changes, features of the community-intervention interface and the degree of trust and identification with which members of target communities regard particular interventions. Rigorously conducted qualitative process evaluations taking account of the above factors could make a key contribution to the development of more successful HIV-prevention interventions.
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Affiliation(s)
- Catherine MacPhail
- CSIR Mining Technology, P.O. Box 91230, Auckland Park 2006, South Africa
| | - Catherine Campbell
- Department of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, Britain
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Policing practices as a structural determinant for HIV among sex workers: a systematic review of empirical findings. J Int AIDS Soc 2016; 19:20883. [PMID: 27435716 PMCID: PMC4951541 DOI: 10.7448/ias.19.4.20883] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/13/2016] [Accepted: 04/24/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Sex workers are disproportionately infected with HIV worldwide. Significant focus has been placed on understanding the structural determinants of HIV and designing related interventions. Although there is growing international evidence that policing is an important structural HIV determinant among sex workers, the evidence has not been systematically reviewed. Methods We conducted a systematic review of quantitative studies to examine the effects of policing on HIV and STI infection and HIV-related outcomes (condom use; syringe use; number of clients; HIV/STI testing and access) among cis and trans women sex workers. Databases included PubMed, Embase, Scopus, Sociological Abstracts, Popline, Global Health (OVID), Web of Science, IBSS, IndMed and WHOLIS. We searched for studies that included police practices as an exposure for HIV or STI infection or HIV-related outcomes. Results Of the 137 peer-reviewed articles identified for full text review, 14 were included, representing sex workers' experiences with police across five settings. Arrest was the most commonly explored measure with between 6 and 45% of sex workers reporting having ever been arrested. Sexual coercion was observed between 3 and 37% of the time and police extortion between 12 and 28% across studies. Half the studies used a single measure to capture police behaviours. Studies predominantly focused on “extra-legal policing practices,” with insufficient attention to the role of “legal enforcement activities”. All studies found an association between police behaviours and HIV or STI infection, or a related risk behaviour. Conclusions The review points to a small body of evidence that confirms policing practices as an important structural HIV determinant for sex workers, but studies lack generalizability with respect to identifying those police behaviours most relevant to women's HIV risk environment.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Public health has either implicitly or explicitly drawn upon a range of psychological theories. This paper identifies four areas where the application of such theory could be developed, health communication, environmental initiatives, the negotiation of behaviour and participation and empowerment. Recommendations are made regarding content, sources and recipient characteristics that can be used to develop targeted health communication campaigns. Psychology also has a role to play in informing structural approaches to prevention. To facilitate this, a framework which focuses on cues, reinforcer and barriers and an understanding of how behaviour is achieved through negotiation and interaction is outlined. Finally we highlight a role for psychology in approaches that focus on participation and empowerment in relation to health.
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Miller RL, Bedney BJ, Guenther-Grey C. Assessing Organizational Capacity to Deliver HIV Prevention Services Collaboratively: Tales from the Field. HEALTH EDUCATION & BEHAVIOR 2016; 30:582-600. [PMID: 14582599 DOI: 10.1177/1090198103255327] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Collaborative efforts between university researchers and community entities such as citizen coalitions and community-based organizations to provide health prevention programs are widespread. The authors describe their attempt to develop and implement a method for assessing whether community organizations had the organizational capacity to collaborate in a national study to prevent HIV infection among young men who have sex with men and what, if any, needs these institutions had for organizational capacity development assistance. The Feasibility, Evaluation Ability, and Sustainability Assessment (FEASA) combines qualitative methods for collecting data (interviews, organizational records, observations) from multiple sources to document an organization's capacity to provide HIV prevention services and its capacity-development needs. The authors describe experiences piloting FEASA in 13 communities and the benefits of using a systematic approach to partnership development.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, University of Illinois at Chicago, 60607-7137, USA.
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Etz KE, Arroyo JA. Small Sample Research: Considerations Beyond Statistical Power. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:1033-6. [PMID: 26281902 DOI: 10.1007/s11121-015-0585-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Small sample research presents a challenge to current standards of design and analytic approaches and the underlying notions of what constitutes good prevention science. Yet, small sample research is critically important as the research questions posed in small samples often represent serious health concerns in vulnerable and underrepresented populations. This commentary considers the Special Section on small sample research and also highlights additional challenges that arise in small sample research not considered in the Special Section, including generalizability, determining what constitutes knowledge, and ensuring that research designs match community desires. It also points to opportunities afforded by small sample research, such as a focus on and increased understanding of context and the emphasis it may place on alternatives to the randomized clinical trial. The commentary urges the development and adoption of innovative strategies to conduct research with small samples.
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Affiliation(s)
- Kathleen E Etz
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD, 20852, USA.
| | - Judith A Arroyo
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, MD, 20852, USA
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Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions. AIDS Behav 2016; 20:1275-83. [PMID: 26499335 DOI: 10.1007/s10461-015-1230-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010-2013). Lippman and colleagues' Social Cohesion Scale measured SWs' connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20-29, range 4-45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95-0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.
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Riley R, Coghill N, Montgomery A, Feder G, Horwood J. The provision of NHS health checks in a community setting: an ethnographic account. BMC Health Serv Res 2015; 15:546. [PMID: 26651487 PMCID: PMC4676171 DOI: 10.1186/s12913-015-1209-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/03/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The UK National Health Service Health Checks programme aims to reduce avoidable cardiovascular deaths, disability and health inequalities in England. However, due to the reported lower uptake of screening in specific black and minority ethnic communities who are recognised as being more at risk of cardiovascular disease, there are concerns that NHS Health Checks may increase inequalities in health. This study aimed to examine the feasibility and acceptability of community outreach NHS Health Checks targeted at the Afro-Caribbean community. METHODS This paper reports findings from an ethnographic study including direct observation of four outreach events in four different community venues in inner-city Bristol, England and follow up semi-structured interviews with attendees (n = 16) and staff (n = 4). Interviews and field notes were transcribed, anonymized and analysed thematically using a process of constant comparison. RESULTS Analysis revealed the value of community assets (community engagement workers, churches, and community centres) to publicise the event and engage community members. People were motivated to attend for preventative reasons, often prompted by familial experience of cardiovascular disease. Attendees valued outreach NHS Health Checks, reinforcing or prompting some to make healthy lifestyle changes. The NHS Health Check provided an opportunity for attendees to raise other health concerns with health staff and to discuss their test results with peers. For some participants, the communication of test results, risk and lifestyle information was confusing and unwelcome. The findings additionally highlight the need to ensure community venues are fit for purpose in terms of assuring confidentiality. CONCLUSIONS Outreach events provide evidence of how local health partnerships (family practice staff and health trainers) and community assets, including informal networks, can enhance the delivery of outreach NHS Health Checks and in promoting the health of targeted communities. To deliver NHS Health Checks effectively, the location and timing of events needs to be carefully considered and staff need to be provided with the appropriate training to ensure patients are supported and enabled to make lifestyle changes.
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Affiliation(s)
- Ruth Riley
- The Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - Nikki Coghill
- The Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Gene Feder
- The Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - Jeremy Horwood
- The Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
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Gibbs A, Willan S, Jama-Shai N, Washington L, Jewkes R. 'Eh! I felt I was sabotaged!': facilitators' understandings of success in a participatory HIV and IPV prevention intervention in urban South Africa. HEALTH EDUCATION RESEARCH 2015; 30:985-995. [PMID: 26590246 PMCID: PMC4654179 DOI: 10.1093/her/cyv059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 10/17/2015] [Indexed: 06/05/2023]
Abstract
Participatory approaches to behaviour change dominate HIV- and intimate partner violence prevention interventions. Research has identified multiple challenges in the delivery of these. In this article, we focus on how facilitators conceptualize successful facilitation and how these understandings may undermine dialogue and critical consciousness, through a case study of facilitators engaged in the delivery of Stepping Stones and Creating Futures and ten focus-group discussions held with facilitators. All facilitators continually emphasized the importance of discussion and active engagement by participants. However, other understandings of successful facilitation also emerged, including group management--particularly securing high levels of attendance; ensuring answers provided by participants were 'right'; being active facilitators; and achieving behaviour change. These in various ways potentially undermined dialogue and the emergence of critical thinking. We locate these different understandings of success as located in the wider context of conceptualizations of autonomy and structure; historical experiences of work and education; and the ongoing tension between the requirements of rigorous research and those of participatory interventions. We suggest a new approach to training and support for facilitators is required if participatory interventions are to be delivered at scale, as they must be.
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Affiliation(s)
- Andrew Gibbs
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa,
| | - Samantha Willan
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa, Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa, and
| | - Nwabisa Jama-Shai
- Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa, and
| | | | - Rachel Jewkes
- Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa, and
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Pettifor A, Lippman SA, Selin AM, Peacock D, Gottert A, Maman S, Rebombo D, Suchindran CM, Twine R, Lancaster K, Daniel T, Gómez-Olivé FX, Kahn K, MacPhail C. A cluster randomized-controlled trial of a community mobilization intervention to change gender norms and reduce HIV risk in rural South Africa: study design and intervention. BMC Public Health 2015; 15:752. [PMID: 26245910 PMCID: PMC4527273 DOI: 10.1186/s12889-015-2048-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/10/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Community mobilization (CM) interventions show promise in changing gender norms and preventing HIV, but few have been based on a defined mobilization model or rigorously evaluated. The purpose of this paper is to describe the intervention design and implementation and present baseline findings of a Cluster Randomized Controlled Trial (RCT) of a two-year, theory-based CM intervention that aimed to change gender norms and reduce HIV risk in rural Mpumalanga province, South Africa. METHODS Community Mobilizers and volunteer Community Action Teams (CATs) implemented two-day workshops, a range of outreach activities, and leadership engagement meetings. All activities were mapped onto six theorized mobilization domains. The intervention is being evaluated by a randomized design in 22 communities (11 receive intervention). Cross-sectional, population-based surveys were conducted with approximately 1,200 adults ages 18-35 years at baseline and endline about two years later. CONCLUSIONS This is among the first community RCTs to evaluate a gender transformative intervention to change norms and HIV risk using a theory-based, defined mobilization model, which should increase the potential for impact on desired outcomes and be useful for future scale-up if proven effective. TRIAL REGISTRATION ClinicalTrials.gov NCT02129530.
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Affiliation(s)
- Audrey Pettifor
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
- Honorary appointments at MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and Wits Reproductive Health and HIV Institute (WHRI), University of the Witwatersrand, Johannesburg, South Africa.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sheri A Lippman
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Amanda M Selin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ann Gottert
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Chirayath M Suchindran
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn Lancaster
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Honorary appointments at MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and Wits Reproductive Health and HIV Institute (WHRI), University of the Witwatersrand, Johannesburg, South Africa
- CRN for Mental Health and Wellbeing, University of New England, Armidale, NSW, Australia
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On the road to HIV/AIDS competence in the household: building a health-enabling environment for people living with HIV/AIDS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3264-92. [PMID: 25794189 PMCID: PMC4377963 DOI: 10.3390/ijerph120303264] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 11/24/2022]
Abstract
When aiming to provide chronic disease care within the context of human resource shortages, we should not only consider the responsibility of the individual person living with HIV/AIDS (PLWHA) but also the capacity of the social environment to actively encourage a lifestyle that fosters health. In this social environment, extensive efforts are thus required to increase HIV/AIDS knowledge, reduce stigma, stimulate HIV testing, improve health care-seeking behavior, and encourage safe sexual practices—described in the literature as the need for AIDS competence. In accordance with socio-ecological theory, one cannot restrict the research focus to communities, as AIDS competence studies should also incorporate the intermediate household level. In responding to this research need, the aim of this article is to conceptualize an “HIV/AIDS competent household” based on qualitative interviews and focus group discussions conducted in a township on the outskirts of Cape Town, South Africa. Our results show that a household’s supportive response to disclosure allows a patient to live openly as HIV positive in the household concerned. This may mark the start of the road to HIV/AIDS competence in the household, meaning the PLWHA receives sustainable support throughout the care continuum and positive living becomes the norm for the PLWHA and his or her household. A feedback loop might also be created in which other household members are encouraged to be tested and to disclose their status, which is an important step towards a sustainable response to HIV/AIDS-related challenges. Despite the fact that this road to HIV/AIDS competence at the household level is fragile and prone to various barriers, this article shows that the household has the potential to be a health-enabling environment for PLWHA.
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Frumence G, Emmelin M, Eriksson M, Kwesigabo G, Killewo J, Moyo S, Nystrom L. Access to social capital and risk of HIV infection in Bukoba urban district, Kagera region, Tanzania. ACTA ACUST UNITED AC 2014; 72:38. [PMID: 25671111 PMCID: PMC4322460 DOI: 10.1186/2049-3258-72-38] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 07/12/2014] [Indexed: 11/17/2022]
Abstract
Background Kagera is one of the 22 regions of Tanzania mainland, which has witnessed a decline in HIV prevalence during the past two decades; decreasing from 24% in 1987 to 4.7 in 2009 in the urban district of Bukoba. Access to social capital, both structural and cognitive, might have played a role in this development. The aim was to examine the association between individual structural and cognitive social capital and socio-economic characteristics and the likelihood of being HIV infected. Methods We conducted a population-based cross-sectional study of 3586 participants, of which 3423 (95%) agreed to test for HIV following pre-test counseling. The HIV testing was performed using enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Multiple logistic regression analysis was applied to estimate the impact of socio-economic factors, individual structural and cognitive social capital and HIV sero-status. Results Individuals who had access to low levels of both structural and cognitive individual social capital were four and three times more likely to be HIV positive compared to individuals who had access to high levels. The associations remained statistically significant for both individual structural and cognitive social capital after adjusting for potential confounding factors such as age, sex, marital status, occupation, level of education and wealth index (OR =8.6, CI: 5.7-13.0 and OR =2.4, CI: 1.6-3.5 for individual structural and cognitive social capital respectively). For both women and men access to high levels of individual structural and cognitive social capital decreased the risk of being HIV infected. This study confirms previous qualitative studies indicating that access to structural and cognitive social capital is protective to HIV infection. Conclusions We suggest that policy makers and programme managers of HIV interventions may consider strengthening and facilitating access to social capital as a way of promoting HIV preventive information and interventions in order to reduce new HIV infections in Tanzania.
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Affiliation(s)
- Gasto Frumence
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, PO Box 65454, Dar es Salaam, Tanzania
| | - Maria Emmelin
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, SE-205 02 Sweden
| | - Malin Eriksson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE-901 85 Sweden
| | - Gideon Kwesigabo
- Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Sabrina Moyo
- Department of Microbiology, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Lennarth Nystrom
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE-901 85 Sweden
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Reid RJ, Garcia-Reid P, Forenza B, Eckert C, Carrier M, Drag S. Let Our Voices Be Heard: Urban Minority Adolescents Share Their Perspectives regarding Substance Abuse and HIV/AIDS Prevention Messages. Am J Health Promot 2014; 29:107-14. [DOI: 10.4278/ajhp.130117-qual-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. This study explored the substance abuse and human immunodeficiency virus prevention needs of urban minority adolescents. Design. Six 1-hour focus groups. Setting. Two high schools and two community-based organizations located in the city of Paterson, New Jersey. Participants. The sample included 41 African-American and Latino youth, ranging in ages from 13 to 18 years. Method. Data were collected through six focus group interviews. Each group discussion was audio-recorded and transcribed. Qualitative software was then used to facilitate the processes of thematic analysis, until emergent themes transcended the data. To bolster the rigor and confirmability of analysis, additional researchers coded stratified selections of transcript. Results. Study participants were able to identify the environmental threats and structural deficits impacting their city. Few of the youth were able to recognize substance abuse and HIV/AIDS prevention messages in their immediate surroundings. Additionally, most participants indicated that prevention messages must be delivered in authentic ways from relatable sources in order to resonate with their audience. Conclusion. Our findings emphasize the importance of infusing the adolescents' voices into the design and implementation of health promotion messages, which could serve to increase their receptivity and responsiveness, and the overall resonance of the interventions.
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Brawner BM. A multilevel understanding of HIV/AIDS disease burden among African American women. J Obstet Gynecol Neonatal Nurs 2014; 43:633-643. [PMID: 25139057 DOI: 10.1111/1552-6909.12481] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 01/22/2023] Open
Abstract
Disproportionate HIV/AIDS rates among African American women have been examined extensively, primarily from an individual-centered focus. Beyond individual behaviors, factors such as the hyperincarceration of African American men and geographically concentrated disadvantage may better explain inequitable disease burden. In this article I propose a conceptual model of individual, social, and structural factors that influence HIV transmission among African American women. The model can be used to develop comprehensive assessments and guide prevention programs in African American communities.
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A cross-site intervention in Chinese rural migrants enhances HIV/AIDS knowledge, attitude and behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4528-43. [PMID: 24762671 PMCID: PMC4024984 DOI: 10.3390/ijerph110404528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 11/26/2022]
Abstract
Background: With the influx of rural migrants into urban areas, the spread of HIV has increased significantly in Shaanxi Province (China). Migrant workers are at high risk of HIV infection due to social conditions and hardships (isolation, separation, marginalization, barriers to services, etc.). Objective: We explored the efficacy of a HIV/AIDS prevention and control program for rural migrants in Shaanxi Province, administered at both rural and urban sites. Methods: Guidance concerning HIV/AIDS prevention was given to the experimental group (266 migrants) for 1 year by the center of disease control, community health agencies and family planning department. The intervention was conducted according to the HIV/AIDS Prevention Management Manual for Rural Migrants. A control group of migrants only received general population intervention. The impact of the intervention was evaluated by administering HIV/AIDS knowledge, attitudes and sexual behavior (KAB) questionnaires after 6 and 12 months. Results: In the experimental group; 6 months of intervention achieved improvements in HIV/AIDS related knowledge. After 12 months; HIV/AIDS-related knowledge reached near maximal scores. Attitude and most behaviors scores were significantly improved. Moreover; the experimental group showed significant differences in HIV-AIDS knowledge; attitude and most behavior compared with the control group. Conclusions: The systematic long-term cross-site HIV/AIDS prevention in both rural and urban areas is a highly effective method to improve HIV/AIDS KAB among rural migrants.
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Albarracin J, Chancay J, Hinrichs D, Sanchez L. Empowerment and Condom Use Among Mexican and Mexican American Women in Illinois. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2014. [DOI: 10.1177/0739986314528462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study used a survey of 218 Mexican women living in Illinois to test if measures of women’s empowerment in the economic, sociocultural, interpersonal/relational, and political dimensions influenced condom use. Our findings revealed that sociocultural and political forms of empowerment were significantly correlated with condom use. More specifically, women who were allowed to leave the house to visit friends without their husband/partner’s permission, had a cell phone, worked for or contributed to a political campaign, participated in a public meeting, and voted were more likely to use condoms with their husband or partners than other women. In addition, women who were younger and completed the survey in English were also more likely to use condoms. However, neither women’s economic nor interpersonal empowerment in their romantic relationship influenced condom use. Thus, women’s general empowerment may be a crucial preamble to safe sex.
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Tetra Dewi FS, Stenlund H, Marlinawati VU, Öhman A, Weinehall L. A community intervention for behaviour modification: an experience to control cardiovascular diseases in Yogyakarta, Indonesia. BMC Public Health 2013; 13:1043. [PMID: 24188684 PMCID: PMC3840649 DOI: 10.1186/1471-2458-13-1043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable Disease (NCD) is increasingly burdening developing countries including Indonesia. However only a few intervention studies on NCD control in developing countries are reported. This study aims to report experiences from the development of a community-based pilot intervention to prevent cardiovascular disease (CVD), as initial part of a future extended PRORIVA program (Program to Reduce Cardiovascular Disease Risk Factors in Yogyakarta, Indonesia) in an urban area within Jogjakarta, Indonesia. METHODS The study is quasi-experimental and based on a mixed design involving both quantitative and qualitative methods. Four communities were selected as intervention areas and one community was selected as a referent area. A community-empowerment approach was utilized to motivate community to develop health promotion activities. Data on knowledge and attitudes with regard to CVD risk factors, smoking, physical inactivity, and fruit and vegetable were collected using the WHO STEPwise questionnaire. 980 people in the intervention areas and 151 people in the referent area participated in the pre-test. In the post-test 883 respondents were re-measured from the intervention areas and 144 respondents from the referent area. The qualitative data were collected using written meeting records (80), facilitator reports (5), free-listing (112) and in-depth interviews (4). Those data were analysed to contribute a deeper understanding of how the population perceived the intervention. RESULTS Frequency and participation rates of activities were higher in the low socioeconomic status (SES) communities than in the high SES communities (40 and 13 activities respectively). The proportion of having high knowledge increased significantly from 56% to 70% among men in the intervention communities. The qualitative study shows that respondents thought PRORIVA improved their awareness of CVD and encouraged them to experiment healthier behaviours. PRORIVA was perceived as a useful program and was expected for the continuation. Citizens of low SES communities thought PRORIVA was a "cheerful" program. CONCLUSION A community-empowerment approach can encourage community participation which in turn may improve the citizen's knowledge of the danger impact of CVD. Thus, a bottom-up approach may improve citizens' acceptance of a program, and be a feasible way to prevent and control CVD in urban communities within a low income country.
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Affiliation(s)
- Fatwa Sari Tetra Dewi
- Public Health Division, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
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Yadav D, Ramanathan S, Goswami P, Ramakrishnan L, Saggurti N, Sen S, George B, Paranjape R. Role of community group exposure in reducing sexually transmitted infection-related risk among female sex workers in India. PLoS One 2013; 8:e78361. [PMID: 24205210 PMCID: PMC3813446 DOI: 10.1371/journal.pone.0078361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022] Open
Abstract
Background Empowering female sex workers (FSWs) to address structural barriers and forming community groups (CGs) through community mobilization are seen as essential components of HIV prevention programs in India. Taking the membership of a CG as an exposure intervention, we hypothesized whether participation in a CG lead to reduced sexually transmitted infections (STIs) and increased treatment-seeking behavior among FSWs in three selected states of India — Andhra Pradesh, Maharashtra and Tamil Nadu. Methods and Findings The propensity score matching (PSM) approach examined the effect of CG membership, as against no membership, on STI-related risk, described as selected outcome measures — presence of any STI, self-reported STI symptoms, and treatment-seeking behavior among FSWs. A cross sectional bio-behavioral survey was administered in 2009–2010 and covered 7,806 FSWs through two-stage probability-based conventional and time location cluster sampling in 23 administrative districts of Andhra Pradesh, Maharashtra and Tamil Nadu. Only 2,939 FSWs were reported to be members of a CG and among them 4.5% had any STIs. A majority of FSWs were aged above 24 years (86.4%), had ever been married (73%), operated from a public place for solicitation (81.5%), and had ever received HIV test results (75.6%). The average effect of CG exposure was reduction in STI prevalence by 4%, while self-reported STI symptom treatment-seeking behavior increased by 13.7%. Conclusion FSWs who were exposed to a CG were at a substantially lower risk of STIs than those who were unexposed. The FSWs exposed to a CG had a higher chance of seeking STI treatment from public and private health facilities. Collectivization related challenges must be overcome to provide access to tailored STI prevention and care services.
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Affiliation(s)
- Diwakar Yadav
- FHI 360, Green Park Extension, New Delhi, India
- * E-mail:
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Lippman SA, Maman S, MacPhail C, Twine R, Peacock D, Kahn K, Pettifor A. Conceptualizing community mobilization for HIV prevention: implications for HIV prevention programming in the African context. PLoS One 2013; 8:e78208. [PMID: 24147121 PMCID: PMC3795620 DOI: 10.1371/journal.pone.0078208] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 09/17/2013] [Indexed: 01/15/2023] Open
Abstract
Introduction Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation. Objectives We aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting. Method We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge. Results CM domains include: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks. Conclusions To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of specific domains is required, they provide an extremely valuable organizational tool to guide CM programming and evaluation of critically needed mobilizing initiatives in Southern Africa.
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Affiliation(s)
- Sheri A. Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Suzanne Maman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Catherine MacPhail
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Collaborative Research Network, University of New England, Armidale, New South Wales, Australia
| | - Rhian Twine
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice Network, Cape Town, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Weeks MR, Abbott M, Hilario H, Radda K, Medina Z, Prince M, Li J, Kaplan C. Structural issues affecting creation of a community action and advocacy board. HEALTH EDUCATION RESEARCH 2013; 28:375-91. [PMID: 23660461 PMCID: PMC3649213 DOI: 10.1093/her/cyt051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 03/24/2013] [Indexed: 05/20/2023]
Abstract
The most effective woman-initiated method to prevent HIV/sexually transmitted infections is the female condom (FC). Yet, FCs are often difficult to find and denigrated or ignored by community health and service providers. Evidence increasingly supports the need to develop and test theoretically driven, multilevel interventions using a community-empowerment framework to promote FCs in a sustained way. We conducted a study in a midsized northeastern US city (2009-2013) designed to create, mobilize and build capacity of a community group to develop and implement multilevel interventions to increase availability, accessibility and support for FCs in their city. The Community Action and Advocacy Board (CAAB) designed and piloted interventions concurrently targeting community, organizational and individual levels. Ethnographic observation of the CAAB training and intervention planning and pilot implementation sessions documented the process, preliminary successes, challenges and limitations of this model. The CAAB demonstrated ability to conceptualize, plan and initiate multilevel community change. However, challenges in group decision-making and limitations in members' availability or personal capacity constrained CAAB processes and intervention implementation. Lessons from this experience could inform similar efforts to mobilize, engage and build capacity of community coalitions to increase access to and support for FCs and other novel effective prevention options for at-risk women.
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Affiliation(s)
- M R Weeks
- Institute for Community Research, 2 Hartford Sq. W., Ste. 100, Hartford, CT 06106, USA and Planned Parenthood of Southern New England, 345 Whitney Ave., New Haven, CT 06511, USA.
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Tucker A, de Swardt G, Struthers H, McIntyre J. Understanding the needs of township men who have sex with men (MSM) health outreach workers: exploring the interplay between volunteer training, social capital and critical consciousness. AIDS Behav 2013; 17 Suppl 1:S33-42. [PMID: 22903420 DOI: 10.1007/s10461-012-0287-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article considers the complex ways volunteer outreach workers can frame their engagement with a community-based HIV prevention programme for South African township MSM. Drawing on research conducted during the Ukwazana programme in Cape Town it begins by exploring limitations towards MSM participation with programme facilitators (namely previous feelings of mistrust and community homophobia) and strategies developed to offset these concerns. It then considers how great care must also be taken to appreciate how volunteers from marginalised groups can frame training as a key condition for participation. To understand this it is therefore necessary for facilitators to acknowledge a number of additional concerns. These include community status, a lack of bonding social capital between volunteers and a highly developed from of critical consciousness by volunteers regarding HIV prevention possibilities. This article therefore suggests that effort to initially engage marginalised communities must also be met with effort to understand the complex ways volunteers relate to other MSM and to each other.
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Dengue Knowledge and Preventive Practices among Rural Residents in Samar Province, Philippines. ACTA ACUST UNITED AC 2013. [DOI: 10.12691/ajphr-1-2-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Busza J, Walker D, Hairston A, Gable A, Pitter C, Lee S, Katirayi L, Simiyu R, Mpofu D. Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review. J Int AIDS Soc 2012; 15 Suppl 2:17373. [PMID: 22789640 PMCID: PMC3499910 DOI: 10.7448/ias.15.4.17373] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/16/2012] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain. METHODS First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries. RESULTS Our review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women's groups and home-based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as "community mobilization" remain poorly defined. CONCLUSIONS Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence-based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community-based interventions.
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Affiliation(s)
- Joanna Busza
- Department of Population Studies, London School of Hygiene & Tropical Medicine, London, UK.
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Tedrow VA, Zelaya CE, Kennedy CE, Morin SF, Khumalo-Sakutukwa G, Sweat MD, Celentano DD. No "magic bullet": exploring community mobilization strategies used in a multi-site community based randomized controlled trial: Project Accept (HPTN 043). AIDS Behav 2012; 16:1217-26. [PMID: 21822627 DOI: 10.1007/s10461-011-0009-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As community-level interventions become more common in HIV prevention, processes such as community mobilization (CM) are increasingly utilized in public health programs and research. Project Accept, a multi-site community randomized controlled trial, is testing the hypothesis that CM coupled with community-based mobile voluntary counseling and testing and post-test support services will alter community norms and reduce the incidence of HIV. By using a multiple-case study approach, this qualitative study identifies seven major community mobilization strategies used in Project Accept, including stakeholder buy-in, formation of community coalitions, community engagement, community participation, raising community awareness, involvement of leaders, and partnership building, and describes three key elements of mobilization success.
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Affiliation(s)
- Virginia A Tedrow
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street/Room E5037, Baltimore, MD 21205, USA.
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Findings from Encontros: a multilevel STI/HIV intervention to increase condom use, reduce STI, and change the social environment among sex workers in Brazil. Sex Transm Dis 2012; 39:209-16. [PMID: 22337108 DOI: 10.1097/olq.0b013e31823b1937] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infection (STI)/HIV prevention programs, which do not modify social structural contexts that contribute to risk of STI/HIV may fail to bring about improvements in health, particularly among groups who experience discrimination and exclusion from public life. We conducted a multilevel intervention with sex workers, including improved clinical care and community-mobilizing strategies to modify social structural factors that shape sexual behavior, to improve condom use and reduce incident STI. METHODS We followed 420 sex workers participating in the Encontros intervention in Corumbá, Brazil, between 2003 and 2005. We estimated the effect of the intervention on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting by comparing those who actively engaged in the intervention activities (exposed) with those who were less engaged (unexposed). We also determined the association of participation on reported social cohesion and participation in networks. RESULTS Exposed participants had significantly higher odds of reporting consistent condom use with regular clients (odds ratio [OR]: 1.9, 95% confidence interval:1.1-3.3) and nonsignificantly increased odds with both new clients (OR: 1.6, 0.9-2.8) and nonpaying partners (OR: 1.5, 0.9-1.5). The odds of an incident STI were nonsignificantly reduced for exposed participants compared with unexposed (OR: 0.46, 0.2-1.3). Participation was significantly associated with increased perceived cohesion and participation in networks. CONCLUSION This prospective study provides evidence that multilevel interventions with mobilizing strategies to modify aspects of the social environment can improve condom use, reduce STIs, and increase social cohesion and participation in networks among sex workers.
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Baelden D, Van Audenhove L, Vergnani T. Using new technologies for stimulating interpersonal communication on HIV and AIDS. TELEMATICS AND INFORMATICS 2012. [DOI: 10.1016/j.tele.2011.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sánchez J, Silva-Suarez G, Serna CA, De La Rosa M. The Latino Migrant Worker HIV Prevention Program: building a community partnership through a community health worker training program. FAMILY & COMMUNITY HEALTH 2012; 35:139-46. [PMID: 22367261 PMCID: PMC5636189 DOI: 10.1097/fch.0b013e3182465153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There is limited information on the impact of the HIV/AIDS epidemic on Latino migrant workers (LMWs), although available data indicate that this community is being disproportionally affected. The need for prevention programs that address the specific needs of LMWs is becoming well recognized. HIV prevention interventions that train and employ community health workers are a culturally appropriate way to address the issues of community trust and capacity building in this community. This article describes the Latino Migrant Worker HIV Prevention Program and its efforts to train and engage community health workers in the prevention of HIV among LMWs in South Florida.
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Affiliation(s)
- Jesús Sánchez
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida 33328, USA.
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Trickett EJ, Rowe HL. Emerging Ecological Approaches to Prevention, Health Promotion, and Public Health in the School Context: Next Steps From a Community Psychology Perspective. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2012. [DOI: 10.1080/10474412.2011.649651] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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