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Ribeiro PG, Vitori PVR, Dos Santos MCS, Mazzini YC, Dos Santos-Junior GA, Rocha KSS, Torres TS, Araújo DC. Brazilian Version of the Health Care Provider HIV/AIDS Stigma Scale: Cross-Cultural Adaptation and Psychometric Evaluation Among Healthcare Students. AIDS Behav 2024; 28:2216-2225. [PMID: 38676781 DOI: 10.1007/s10461-024-04350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
We aimed to validate the Health Care Provider HIV/AIDS Stigma Scale (HPASS) among healthcare students in Brazil. The validation process occurred in three phases from August 2022 to July 2023: translation and cross-cultural adaptation; content validity assessment involving four experts; and evaluation of psychometric properties among 553 healthcare students from the Federal University of Espírito Santo. We used exploratory factor analysis and convergent validity for structural validation. The average scale content validity index was 0.90, while the evaluation of validity evidence based on the internal structure indicated a robust explanatory model. Parallel analysis indicated that the scale is composed by two dimensions: "Discrimination/Prejudice" and "Stereotype"; the composite reliability values for these dimensions were 0.96 and 0.85, respectively. The Brazilian version of HPASS has shown to be a simple, reliable, and psychometrically valid measure to quantify HIV stigma among healthcare students who speak Brazilian Portuguese.Resumen El objetivo de este estudio fue validar la "Health Care Provider HIV/AIDS Stigma Scale" (HPASS) entre estudiantes de salud en Brasil. El proceso de validación se llevó a cabo en tres etapas: traducción y adaptación transcultural; evaluación de la validez de contenido; y evaluación de las propiedades psicométricas con estudiantes de salud de la Universidad Federal de Espírito Santo. El índice de validez de contenido promedio de la escala fue de 0.90, mientras que la evaluación de la evidencia de validez basada en la estructura interna indicó un modelo explicativo sólido. El análisis paralelo indicó que la escala está compuesta por dos dimensiones: "Discriminación/Prejuicio" y "Estereotipo". La versión brasileña de HPASS ha demostrado ser una medida simple, confiable y psicométricamente válida para cuantificar el estigma del VIH entre estudiantes de salud que hablan portugués brasileño.
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Affiliation(s)
- Paula Gonçalves Ribeiro
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | - Paulo Vitor Ramos Vitori
- Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | | | - Yohan Cancilheri Mazzini
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | - Genival Araujo Dos Santos-Junior
- Graduate Program in Pharmaceutical Sciences, Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Espírito Santo, ES, Alegre, Brazil
| | - Kérilin Stancine Santos Rocha
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | - Thiago Silva Torres
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Dyego Carlos Araújo
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil.
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Ebrahimi H, Atashzadeh Shoorideh F, Reza Sohrabi M, Ebrahimi M, Hosseini M. An Analysis of Approaches to Reduction of HIV Stigma across the World through educational interventions: A Scoping Review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e06. [PMID: 39083818 PMCID: PMC11290898 DOI: 10.17533/udea.iee.v42n1e06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/05/2023] [Indexed: 08/02/2024]
Abstract
Objective To determinate the educational interventions for reducing the stigma caused by HIV worldwide. Methods This scoping review study analyzed all papers published from early 2000 to the end of 2022 by searching all the scientific databases, Scopus, Web of Science, PubMed, Cochrane, Embase and CINHAL. The quality assessment of the papers was done using the ROBIS tool checklist. Results 31papers were admitted to the scoping review process. Stigma reduction intervention was founded on three parts: Society, health and therapeutic services providers, and the patients who had HIV and their families. The interventions included education on the reduction of fear, and shame, observation of protective standards, conducting tests and treatment at the above levels, as well as the support provided by the society, policymakers, religious leaders and families of patients in economic, psychological and cultural terms, together with the establishment of social centres and organization of campaigns. Conclusion The stigma associated with HIV is a significant obstacle before treatment, life expectancy and living quality of patients. Therefore, the stigma associated with this disease can be reduced, and the living quality of patients can be raised using approaches such as education of healthcare service providers and afflicted people, as well as economic, social, cultural, and psychological support.
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Affiliation(s)
- Hamideh Ebrahimi
- 1 Ph.D. Candidate, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Foroozan Atashzadeh Shoorideh
- 2 Ph.D. Professor, Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Sohrabi
- 3 Ph.D. Professor, Department of Community Medicine, Social Determinants of Health Research Center, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Ebrahimi
- 4 M.Sc. Clinical Research Development Unit of Pirooz Hospital, Guilan University of Medical Sciences, Rasht, Guilan.
| | - Meimanat Hosseini
- 5 Ph.D. Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bitektine E, Hintermayer MA, Chen A, Ko A, Rodriguez C. Medical students' perceptions on preparedness and care delivery for patients with autism or intellectual disability. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:37-47. [PMID: 38528903 PMCID: PMC10961132 DOI: 10.36834/cmej.76338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Introduction To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. Methods We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. Results We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. Discussion/Conclusions This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.
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Affiliation(s)
- E Bitektine
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - M A Hintermayer
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
- Montreal Neurological Institute, McGill University, Quebec, Canada
| | - A Chen
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - A Ko
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - C Rodriguez
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Ruprecht K, Dunlop W, Wah E, Phillips C, Martin S. 'A human face and voice': transgender patient-educator and medical student perspectives on gender-diversity teaching. BMC MEDICAL EDUCATION 2023; 23:621. [PMID: 37658319 PMCID: PMC10472656 DOI: 10.1186/s12909-023-04591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) people face many obstacles in accessing health care, including discrimination, institutional bias, and clinician knowledge deficits. We developed a clinical skills and education module on gender-affirming care for pre-clinical medical students, in collaboration with a TGD-led civil society organisation. The module consisted of an educational session followed by preceptor-facilitated small group tutorials, led by TGD patient-educators (n = 22) who used their lived experience to explore medical history-taking and broader issues related to TGD healthcare with students (n = 199). This study aimed to explore the views of students and TGD patient-educators on the structure, delivery and impact of the module. METHODS Analysis of responses of TGD patient-educators and students to the module (2020 and 2021), in post-intervention surveys using open-ended questions for TGD patient-educators (18 responses from 22 educators) and free text comments as part of a quantitative survey for medical students (89 responses). RESULTS Responses from students and patient-educators to the session were highly positive. Students and patient-educators emphasised that the teaching session succeeded through elevating the centrality of shared experience and creating a safe space for learning and teaching. Safety was experienced by patient-educators through the recognition of their own expertise in a medical environment, while students reported a non-judgemental teaching space which allowed them to explore and redress recognised limitations in knowledge and skill. Patient-educators described their motivation to teach as being driven by a sense of responsibility to their community. Preceptor attitudes may function as a barrier to the effectiveness of this teaching, and further attention should be paid to supporting the education of clinical facilitators in TGD health. CONCLUSION The experiences of TGD patient-educators and medical students in this study suggest that this model of teaching could serve as a transferable template for TGD health and the inclusion of other historically marginalised groups in medical education.
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Affiliation(s)
- Ky Ruprecht
- Medical School, Australian National University, Canberra, ACT 2600, Australia
| | - William Dunlop
- Medical School, Australian National University, Canberra, ACT 2600, Australia
| | - Estee Wah
- Medical School, Australian National University, Canberra, ACT 2600, Australia
| | - Christine Phillips
- School of Medicine and Psychology, Australian National University, Canberra, ACT 2600, Australia
| | - Sarah Martin
- School of Medicine and Psychology, Australian National University, Canberra, ACT 2600, Australia.
- Canberra Sexual Health Centre, Canberra Health Services, Yamba Drive, Garran, ACT 2605, Australia.
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Burnier I, Northrop G, Fotsing S. Nomenclature of real patients in health professional education by role and engagement: a narrative literature review. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:69-76. [PMID: 36310908 PMCID: PMC9588179 DOI: 10.36834/cmej.72429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
RESEARCH PROBLEM Real patients living with a disease and engaged in the education of healthcare professionals are referred to by different terms. To address this, A.Towle proposed a draft taxonomy. OBJECTIVE Our objective is to extract from the literature the definitions given for the following terms: (1) patient educator, (2) patient instructor, (3) patient mentor, (4) partner patient, (5) patient teacher, (6) Volunteer Patient in order to clearly identify their roles and level of engagement. METHODS The literature search was carried out in Medline, CINAHL, PsychInfo and Eric by adding medical education or healthcare professional to our previously identified keywords to ensure that it is indeed literature dealing with real patients' involvement in the education of healthcare professionals. RESULTS Certain terms refer to real and simulated patients. Roles are more or less well described but may refer to multiple terms. The notion of engagement is discussed, but not specifically. CONCLUSION Explicitly defining the terms used according to the task descriptions and level of engagement would help contribute to Towle's taxonomy. Real patients would thus feel more legitimately involved in health professional education.
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Affiliation(s)
- Isabelle Burnier
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Grace Northrop
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Salomon Fotsing
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
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Namer Y, Drüke F, Razum O. Transformative Encounters: A Narrative Review of Involving People Living With HIV/AIDS in Public Health Teaching. Public Health Rev 2022; 43:1604570. [PMID: 35813031 PMCID: PMC9258193 DOI: 10.3389/phrs.2022.1604570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: To collate the experiences of involvement of people living with HIV/AIDS (PLWHA) in academic public health teaching to inform future public health education models involving people affected by long-term effects of other pandemics. Our goal is to describe interventions in a way that makes them accessible to potential public health teachers hoping to adapt patient involvement paradigms in their teaching of chronic illness brought on by infectious diseases. Methods: Narrative review based on a literature search in PubMed and Google Scholar up to September 2021. Fifteen articles that contained a description of a health educational intervention on HIV/AIDS that actively involved PLWHA were included. Results: Interventions either involved PLWHA as teachers and program/curriculum developers or incorporated experiential elements in which students have genuine contact with PLWHA. Creating safe spaces, recognizing PLWHA as experts, relating to each other differently were common transformative elements. Conclusion: Involving PLWHA in public health teaching have transformative and empowering outcomes, both for PLWHA and for learners. This finding should inform new teaching programs that will address the long-term effects of other pandemics such as COVID-19.
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Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Research Institute Social Cohesion, Bielefeld, Germany
- *Correspondence: Yudit Namer,
| | - Florian Drüke
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Research Institute Social Cohesion, Bielefeld, Germany
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Schlaudecker J, Zamudio O, Goodnow K, Pallerla H, Regan S. Using Patient Voice to Personalize the Opioid Epidemic: An Evaluation of 2 Educational Interventions. J Patient Exp 2021; 7:964-968. [PMID: 33457529 PMCID: PMC7786768 DOI: 10.1177/2374373520948401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite rising opioid fatalities, attitudes remain indifferent toward those with opioid use disorder (OUD). Utilizing patient voice may be one way to move providers to action. We included persons with OUD in 2 educational sessions as an important tool of attitude change. Post-session surveys demonstrate increased compassion, deeper understanding of challenges, and positive change in attitude. Inclusion of patient voice was identified as the most useful feature of both educational sessions. Four themes emerged: value of patient voice; change in attitude; barriers to change; and enhanced provider role. Future educational sessions should include the voice of persons living with OUD.
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Affiliation(s)
- Jeffrey Schlaudecker
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA.,The Christ Hospital/University of Cincinnati Family Medicine Residency, Cincinnati, OH, USA
| | - Olivia Zamudio
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Keesha Goodnow
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Harini Pallerla
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Saundra Regan
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
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Leyva-Moral JM, Dominguez-Cancino KA, Edwards JE, Moriña-Soler D, Cesario SK, Guevara-Vasquez GM, Feijoo-Cid M, Palmieri PA. Attitudes Toward Caring for People Living with HIV/AIDS: A Cross-Sectional Study of Nursing Faculty in Six Countries. Open AIDS J 2020. [DOI: 10.2174/1874613602014010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Since the earliest study about nursing faculty and student attitudes about caring for people living with HIV/AIDS (PLHIV) in 1992, there have been less than 20 additional studies reported in the literature. Yet, PLHIV continues to report stigma and experience discrimination. Nursing faculty attitudes are part of the informal curriculum. Negativity about caring for PLHIV can adversely impact student perceptions as well as their care. Current research in this area is essentially non-existent.
Objective:
To describe the attitudes of the university nursing faculty toward caring for PLHIV; and to identify the relationship between faculty attitudes and explanatory factors such as age, education, religion, nationality, teaching in a clinical setting, years of experience, and university attributes.
Methods:
This was a multicenter cross-sectional study with nonrandomized electronic purposeful sampling. The Healthcare Provider HIV/AIDS Stigma Scale (HPASS) is a 30-item scale with three subscales: Prejudice, stereotype, and discrimination. The English and Spanish versions of the HPASS exhibit stable psychometric properties for cross-cultural research. The HPASS was delivered to university nursing faculty in six countries across three continents.
Results:
A sample of 368 nursing faculty completed the HPASS. The mean composite score was 2.41 (SD = 0.69), six-point scale with lower scores indicating more positive attitudes, with subscale scores: Stereotypes 2.55 (SD = 0.84), discrimination 2.28 (SD = 0.74), and prejudices 2.41 (SD = 0.63). Peruvian faculty had the highest scores while Canadian had the lowest. Significant correlations were observed between attitudes and the three subscales, and between the three subscales and the composite score.
Conclusion:
Attitudes of the nursing faculty toward caring for PLHIV were slightly positive to slightly negative depending on the region and country. Knowledge deficiencies about HIV persist, incorrect beliefs are common, and attitudes appear to be influenced by culture. The correlation between subscales justifies continued research to implement targeted interventions. Education about HIV/AIDS can address knowledge deficits while structured interactions with PLHIV can facilitate experiential learning.
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Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open 2020; 10:e037217. [PMID: 32718925 PMCID: PMC7389514 DOI: 10.1136/bmjopen-2020-037217] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To identify the scope of active patient involvement in medical education, addressing the current knowledge gaps relating to rationale and motivation for involvement, recruitment and preparation, roles, learning outcomes and key procedural contributors. METHODS The authors performed a systematic search of the PubMed database of publications between 2003 and 2018. Original studies in which patients take on active roles in the development, delivery or evaluation of undergraduate medical education and written in English were eligible for inclusion. Included studies' references were searched for additional articles. Quality of papers was assessed using the Mixed Methods Appraisal Tool. RESULTS 49 articles were included in the review. Drivers for patient involvement included policy requirements and patients' own motivations to contribute to society and learning. Patients were engaged in a variety of educational settings in and outside of the hospital. The vast majority of studies describe patients taking on the role of a patient teacher and formative assessor. More recent studies suggest that patients are increasingly involved in course and curriculum development, student selection and summative assessment. The new body of empirical evidence shows the wide range of learning objectives was pursued through patient participation, including competencies as professional, communicator, collaborator, leader and health advocate, but not scholar. Measures to support sustainable patient involvement included longitudinal institutional incorporation, patient recruitment and/or training, resource support and clear commitment by faculty. The importance and advantages of patient involvement were highlighted by students, faculty and patients themselves; however, organisations must continue to consider, monitor and take steps to mitigate any potential harms to patients and students. DISCUSSION This systematic review provides new knowledge and practical insights to physicians and faculty on how to incorporate active patient involvement in their institutions and daily practice, and provides suggested action points to patient organisations wishing to engage in medical education.
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Leyva-Moral JM, Dominguez-Cancino KA, Guevara-Vasquez GM, Edwards JE, Palmieri PA. Faculty Attitudes About Caring for People Living With HIV/AIDS: A Comparative Study. J Nurs Educ 2020; 58:712-717. [PMID: 31794038 DOI: 10.3928/01484834-20191120-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV. METHOD The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru. RESULTS The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest. CONCLUSION Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion. [J Nurs Educ. 2019;58(12):712-717.].
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Nyblade L, Addo NA, Atuahene K, Alsoufi N, Gyamera E, Jacinthe S, Leonard M, Mingkwan P, Stewart C, Vormawor R, Kraemer JD. Results from a difference-in-differences evaluation of health facility HIV and key population stigma-reduction interventions in Ghana. J Int AIDS Soc 2020; 23:e25483. [PMID: 32329153 PMCID: PMC7180216 DOI: 10.1002/jia2.25483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. METHODS We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). RESULTS We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. CONCLUSIONS These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.
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Affiliation(s)
- Laura Nyblade
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Nii A Addo
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | | | - Emma Gyamera
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | - Madeline Leonard
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
| | - Pia Mingkwan
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Christin Stewart
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | | | - John D Kraemer
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
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Allen B, Harocopos A, Chernick R. Substance Use Stigma, Primary Care, and the New York State Prescription Drug Monitoring Program. Behav Med 2020; 46:52-62. [PMID: 30726167 DOI: 10.1080/08964289.2018.1555129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prescription drug monitoring programs (PDMPs) are databases that track controlled substances at the provider, patient, and pharmacy levels. While these databases are widely available at the state level throughout the United States, several jurisdictions in recent years have mandated the use of these systems by health care providers. This study explores the implementation of mandatory PDMP technology in primary care practice and the effects on treatment of people with possible substance use disorders. Findings are based on 53 in-depth interviews with primary care providers in New York City, collected shortly following the passage of legislation mandating use of a PDMP by health care providers in New York State. Findings suggest that use of the PDMP highlighted tensions between provider stigma toward substance use disorders and the clinical care of people who use drugs, challenging their stereotypes and biases. The parallel clinical and law enforcement purposes of PDMP technology placed providers in dual roles as clinicians and enforcers and encouraged the punitive treatment of patients. Finally, PDMP technology standardized the clinical assessment process toward a "diagnosis first" approach, consistent with prior scholarship on the implementation of emerging medical technologies.
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Affiliation(s)
- Bennett Allen
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Queens, NY, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Queens, NY, USA
| | - Rachel Chernick
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Queens, NY, USA
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Allen B, Nolan ML, Paone D. Underutilization of medications to treat opioid use disorder: What role does stigma play? Subst Abus 2019; 40:459-465. [DOI: 10.1080/08897077.2019.1640833] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Bennett Allen
- aNew York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment Queens, Queens, New York, USA
| | - Michelle L. Nolan
- aNew York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment Queens, Queens, New York, USA
| | - Denise Paone
- aNew York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment Queens, Queens, New York, USA
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Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, Mitchell EMH, Nelson LRE, Sapag JC, Siraprapasiri T, Turan J, Wouters E. Stigma in health facilities: why it matters and how we can change it. BMC Med 2019; 17:25. [PMID: 30764806 PMCID: PMC6376713 DOI: 10.1186/s12916-019-1256-2] [Citation(s) in RCA: 355] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
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Affiliation(s)
- Laura Nyblade
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Melissa A. Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, 2103 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
| | - Kayla Giger
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, Zambart, P.O. Box 50697, Lusaka, Zambia
| | - Maria L. Ekstrand
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549 USA
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, India
| | - Roger Mc Lean
- Health Economics Unit, Centre for Health Economics, Faculty of Social Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Ellen M. H. Mitchell
- International Institute for Social Studies, Erasmus University, Kortenaerkade 12, 2518 AX The Hague, Netherlands
| | - La Ron E. Nelson
- University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, M5T 1B8 Canada
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Ontario, Canada
| | - Taweesap Siraprapasiri
- Department of Disease Control, Ministry of Public Health of the Government of Thailand, Tivanond Road, Nonthaburi, 11000 Thailand
| | - Janet Turan
- Department of Health Care Organization and Policy, Maternal and Child Health Concentration, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
- Behavioral and Community Sciences Core, UAB Center for AIDS Research (CFAR), Birmingham, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, B-2000 Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, PO Box 399, Bloemfontein, 9300 South Africa
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Sharma M, Pinto A, Kumagai AK. In Reply to Abudu. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:816-817. [PMID: 29846223 DOI: 10.1097/acm.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Malika Sharma
- Medical director, Casey House, Toronto, Ontario, Canada; . Assistant professor, Department of Family and Community Medicine, Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, and clinician-scientist, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Professor and vice chair of education, Department of Medicine, University of Toronto, and FM Hill Chair in Humanism Education, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Sharma M. 'Can the patient speak?': postcolonialism and patient involvement in undergraduate and postgraduate medical education. MEDICAL EDUCATION 2018; 52:471-479. [PMID: 29349892 DOI: 10.1111/medu.13501] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 05/14/2023]
Abstract
CONTEXT Patients are increasingly being engaged in providing feedback and consultation to health care institutions, and in the training of health care professionals. Such involvement has the potential to disrupt traditional doctor-patient power dynamics in significant ways that have not been theorised in the medical literature. Critical theories can help us understand how power flows when patients are engaged in the training of medical students. METHODS This paper applies postcolonial theory to the involvement of patients in the development and delivery of medical education. First, I review and summarise the literature around patient involvement in medical education. Subsequently, I highlight how postcolonial frameworks have been applied to medical education more broadly, extrapolating from the literature to apply a postcolonial lens to the area of patient engagement in medical education. CONCLUSION Concepts from postcolonial theory can help medical educators think differently about how patients can be engaged in the medical education project in ways that are meaningful and non-tokenistic. Specifically, the positioning of the patient as 'subaltern' can provide channels of resistance against traditional power asymmetries. This has curricular and methodological implications for medical education research in the area of patient engagement.
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Affiliation(s)
- Malika Sharma
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
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Resources to address stigma related to sexuality, substance use and sexually transmitted and blood-borne infections. ACTA ACUST UNITED AC 2018; 44:62-67. [PMID: 29770101 DOI: 10.14745/ccdr.v44i02a05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Stigma is widely recognized as a significant barrier to the prevention, management and treatment of sexually transmitted and blood-borne infections (STBBIs) in Canada. Despite major advances in STBBI prevention and treatment, and global efforts to reduce stigma, people living with or affected by STBBIs continue to experience stigma within health and social service settings in Canada. Objective To describe the development, content and evaluation of knowledge translation resources and training workshops designed to equip health and social service professionals with the knowledge and skills needed to provide more respectful and inclusive sexual health, harm reduction and STBBI services. Methods After conducting a literature review, environmental scan and key informant interviews, and developing a conceptual framework, the Canadian Public Health Association (CPHA) developed four knowledge translation resources and three training workshops in partnership with a number of community-based organizations and experts. The resources were drafted and reviewed by both service providers and individuals affected by STBBIs. The workshops were developed, piloted and then evaluated using post-workshop questionnaires. Results The four resources developed were a self-assessment tool related to STBBIs and stigma; a service provider discussion guide to facilitate respectful and inclusive discussions on issues related to sexuality, substance use and STBBIs; a toolkit focused on stigma reduction, privacy, confidentiality and the criminalization of HIV non-disclosure; and an organizational assessment tool related to STBBIs and stigma for health and social service settings. These knowledge translation resources were subsequently integrated into the content of three face-to-face trainings that were piloted and evaluated across the country. Post-workshop evaluation had an overall 85% response rate; 88% of participants noted increased awareness of various forms of stigma, 87% noted increased comfort discussing sexuality, substance use and harm reduction with their clients/patients, 90% reported increased awareness of organizational strategies to reduce stigma, and 93% reported being able to integrate workshop learnings into practice. In addition, there was strong support for professional development on issues related to STBBI stigma reduction. Conclusion These knowledge translation resources and training workshops represent a comprehensive set of tools developed in Canada that service providers can use to help reduce stigma when caring for clients/patients with STBBIs and related conditions. Evaluation indicates there is a strong willingness among health and social service providers to engage in educational opportunities in this area and that participation in the training workshops led to increased awareness and a willingness to adopt best practices.
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