Using focus groups to develop a culturally sensitive videotape intervention for HIV-positive women

Educational technologies and practices for prevention of vertical HIV transmission

OBJECTIVE

to assess available evidence on educational technologies and practices for prevention of vertical HIV transmission.

METHOD

LILACS, PubMed, Scopus, BDENF, between April and May 2016, with the descriptors: "Vertical Transmission of Infectious Disease", "HIV", "Health Education" and "Technology".

RESULTS

there are 16 articles published between 2000 and 2014, mostly Brazilian and African, Cross-sectional and with low level of evidence. The studies covered the use of hard technologies, through video, radio and telephone, and soft, emphasizing, in particular, counseling.

CONCLUSION

the studies recognize the importance of educational activities as a tool for health promotion in the context of vertical HIV transmission, despite reporting the need for constant training of professionals and urgency in the renewal of educational concepts and practices. Therefore, it is recommended to expand and consolidate health counseling and emphasize the role of nurses as an important actor in this setting.

Identifying Key Elements to Inform the Development of an HIV Health Behavior Maintenance Intervention

PURPOSE

To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors.

DESIGN

Focused, in-depth individual and group interviews.

SETTING

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC.

PARTICIPANTS

A total of 42 individuals who had participated in The Positive Life Workshop-an HIV self-management intervention adapted and implemented by the NYC DOHMH.

METHOD

Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data.

RESULTS

Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others.

CONCLUSION

Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.

A focus group for caregivers of hospice patients with severe dyspnea

The use of focus groups has grown in all aspects of our society, including the areas of politics and business. More recently, clinical research investigators have begun using focus groups to acquire important information from potential study subjects, such as patients and caregivers. Researchers use focus groups to help them design and test data collection measures, assess responses to proposed interventions, and obtain guidance on recruitment and retention methods for clinical trials. This report explains the basic requirements and methods for conducting focus groups. The authors conducted a focus group study based on six former caregivers of hospice patients with severe dyspnea. The paper describes the results of this study and illustrates how caregivers assisted in evaluating potential interventions for dyspnea, which will be tested in a future clinical trial. Subsequently, the researchers used the focus group data to adapt the guided-imagery intervention to the lifestyle and culture of the study subjects and their caregivers.

Enhancing Research With Migrant Women Through Focus Groups

Recent systematic reviews of measurement strategies have identified a striking lack of data to support the validity of most questionnaires used with multiethnic, migrant populations. In the context of two ongoing research studies examining the reproductive health needs of migrant women in Canada, cultural validation was required for proposed study questionnaires and protocols in a total of 13 languages. Multilingual, multiethnic women with various migrant profiles were recruited from the community to review research materials in a series of focus groups. Recommendations by these women were made in relation to consent and interpretation procedures, development of trust in research, home visits after birth, approaches to sensitive topics, inclusion of discrimination as a research variable, and reimbursement of participants. Preliminary work applying focus-group methods to mixed ethno-cultural groups yielded valuable information on appropriateness of planned research.

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥ 30 kg/m(2) and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Women frequently stated a GWG goal >20 lbs. Women described a body image not in line with clinical recommendations ("200 pounds is not that big."). They avoided the term "obese". They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of "exercise" varied. Family members could help, but generational differences posed challenges. Most had to "encourage myself" and "do this for me and the baby". Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: an exploratory study with Somali mothers in the USA

The objective of this study was to explore Somali mothers' beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers.

The Events in Care Screening Questionnaire (ECSQ): a new tool to identify needs and concerns of people with HIV/AIDS

The purpose of this paper is to present validation data on the Events in Care Screening Questionnaire (ECSQ), which was designed to identify the needs and concerns of people living with HIV/AIDS (PLWHA) in nine specific domains: adherence to medical instructions; medical problems; specialty and inpatient hospital care; preventive health care and screening and behavioral health; sexual risk behavior; family planning; psychological symptoms; substance use; and life circumstances and demands. The ECSQ is the anchor for a more comprehensive measure called "The Dynamics of Care," and was administered in the context of a longitudinal study to evaluate New York State's HIV Special Needs Plan (HIV SNP), a Medicaid managed care model for PLWHA. Participants in the study, which began in March 2003 and closed recruitment in January 2007, were NYC PLWHA who were enrolled in either a Medicaid HIV SNP or Fee-For-Service plan. Participants were recruited through HIV SNP enrollment lists, direct on-site recruitment, and fliers. The specific event domains covered in the ECSQ were selected based on the purpose of the HIV SNP and the literature describing the needs and challenges that PLWHA face. Analyses are based on data from 628 study respondents over two times points. Results suggest that the concerns identified by PLWHA were largely consistent with their health care situation, heath status, risk behavior, and personal characteristics. Findings presented here lend support for the construct validity of the ECSQ and demonstrate its value as a starting point for inquiring more fully about the experiences of patients and improving the care they receive.

A Concept Analysis of Cultural Sensitivity

Cultural sensitivity is used ubiquitously, yet different meanings are constructed. An improved understanding of the term as described within health care and in general would enhance nurses' understanding and communication with professionals and clients. To uncover the current meaning of cultural sensitivity, a concept analysis was performed. Findings included the attributes of knowledge, consideration, understanding, respect, and tailoring. Necessary antecedents were diversity, awareness, and an encounter. The consequences were effective communication, effective intervention, and satisfaction. A definition of cultural sensitivity was proposed. Providers may benefit from recognizing and addressing the identified antecedents and attributes to obtain the positive consequences of employing cultural sensitivity.

Development and evaluation of a childbirth education programme for Malawian women

AIM

This paper is a report of a study to develop and evaluate a childbirth educational programme for Malawian women.

BACKGROUND

Providing parent education is integral to the midwife's role. Malawian midwives face a challenge in fulfilling this role, with no existing childbirth education programme to facilitate this process.

METHOD

A mixed method approach was used for this three-phase study. In Phase 1, childbirth information needs of Malawian women were determined from literature and interviews with midwives. In Phase 2, a structured childbirth education programme was developed. In Phase 3, a quasi-experimental design using sequential sampling was conducted to evaluate the education programme. Participants were pregnant women who attended antenatal clinics in 2002, with 104 in the control group and 105 in the intervention group. Changes in childbirth knowledge were determined over a 6-week period.

FINDINGS

The childbirth education programme included information, teaching strategies and a schedule for implementation for content relevant to the antenatal, labour and birth and postnatal time periods. Results revealed no significant difference in knowledge in the control group between pretest and post-test scores. For the intervention group, however, an overall significant increase in knowledge across all time periods was demonstrated (P < 0.01).

CONCLUSION

A childbirth education programme, developed for the Malawian context, was associated with important increases in maternal knowledge about antenatal, labour and birth and postnatal topics. The findings have implications for midwives in other developing countries and offer an example of a midwifery-led initiative to provide formal childbirth education to these vulnerable women.

Hearing consumer voices: planning HIV/sexually transmitted infection prevention in alcohol detoxification

The literature has provided ample evidence that individuals abusing or dependent upon alcohol are at high risk for contracting HIV and other sexually transmitted infections (STIs). Despite the documented need of this vulnerable group for targeted HIV/STI prevention efforts, no prior research has explored the efficacy and feasibility of HIV/STI prevention for individuals in alcohol detoxification. The current study sought the voices of consumers of such services to get their guidance about successful and necessary features of HIV/STI prevention programs targeted to their needs. Two focus groups conducted yielded exceptionally helpful information. Consumers clearly want to be educated about HIV/STI, seeing this as crucial to their physical well-being and safety. They voiced preferences for nonjudgmental counselors who meet with them on an individual basis in contexts that protect consumer privacy. A clear set of guidelines emerged for an intervention structure that, if carefully honored, has strong likelihood of success in protecting individuals in alcohol detoxification from HIV/STI.

Development and assessment of an innovative culturally sensitive educational videotape to improve adherence to highly active antiretroviral therapy in Soweto, South Africa

The increasing availability of antiretroviral medication (ARV) therapy in the face of limited chronic medication-taking experience among resource-poor South Africans has raised concerns about adequate adherence to these medications. We hypothesized that a culturally sensitive audiovisual patient education program would be of substantial and measurable benefit in increasing patient understanding of the concepts of ARV resistance risk and medication-taking skills. To identify potential barriers to adherence and successful strategies to promote adherence, 6 focus groups with health care providers and HIV-positive adherence counselors were held, resulting in the production of a 17-minute culturally sensitive educational videotape. Basic drug-taking concepts and practical advice on how to improve adherence were presented in the videotape. Thirty-four HIV-positive patients (including 11 ARV-naive patients and 23 ARV-experienced patients) were shown the educational videotape, and their knowledge about medication taking was evaluated by a 24-point pre- and postvideotape questionnaire. On average, the 34 patients gained 2.2 knowledge points (P = 0.021). ARV-naive patients had an average improvement of 3.0 points (P = 0.0028), with most significant gains in the areas of understanding medication-taking strategies and side effects. These preliminary findings indicate that a culturally sensitive educational videotape can improve medication-taking knowledge in South Africa and that further study of the potential efficacy of using media technology to improve individuals' adherence to ARV therapy is warranted.

Classifying the findings in qualitative studies

A key task in conducting research integration studies is determining what features to account for in the research reports eligible for inclusion. In the course of a methodological project, the authors found a remarkable uniformity in the way findings were produced and presented, no matter what the stated or implied frame of reference or method. They describe a typology of findings, which they developed to bypass the discrepancy between method claims and the actual use of methods, and efforts to ascertain its utility and reliability. The authors propose that the findings in journal reports of qualitative studies in the health domain can be classified on a continuum of data transformation as no finding, topical survey, thematic survey, conceptual/thematic description, or interpretive explanation.

Incorporating patients' views and experiences of life with IBS in the development of an evidence based self-help guidebook

To become active partners in chronic illness management, patients need relevant information which clearly explains treatment choices. This paper describes a method of producing information to feed into production of a guidebook for people with irritable bowel syndrome (IBS). Users were involved throughout the development process. Five focus groups were held involving 23 people with IBS out of 147 who responded to a newspaper article asking for help with a study of self-care in IBS. Qualitative analysis of transcripts from these meetings formed the basis of guidebook development. Patients described their experiences, coping strategies, experiences of the healthcare system, treatments and social consequences of the condition. Medical literature searches were made to find answers to identified areas of information need. The book includes direct quotes from patients describing their own experiences. Guided and practical ways of support are required for people with IBS who want to self-manage their condition.

Context-based advocacy for HIV-positive women making reproductive decisions

As the number of HIV-positive women of childbearing age continues to rise, and treatments available to manage HIV become more accessible, the issue of HIV-positive women's reproductive decision making is gaining importance for nurses in AIDS care. Nurses and other health professionals care for these women as they decide whether to bear children. The decision whether to have children is complex and influenced by a number of individual and societal factors, creating an ethical tension between the interests of HIV-positive women and those of society. This article proposes a six-step, context-based advocacy process for nurses and other health professionals who interact with HIV-positive women of childbearing age. The advocacy process described is grounded in a review of literature on HIV/AIDS, factors influencing HIV-positive women's reproductive choices, and nursing advocacy. The proposed advocacy process enables nurses to support women's self-determination and decision making in a way that is informative and empowering.