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Somba M, Kaaya S, Siril H, Oljemark K, Ainebyona D, McAdam E, Todd J, Andrew I, McAdam K, Simwinga A, Mleli N, Makongwa S, Haberlen S, Fawzi MCS. Barriers and Facilitators to Effective Implementation of the NAMWEZA Intervention in Dar es Salaam, Tanzania. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:940-949. [PMID: 33797666 DOI: 10.1007/s11121-021-01230-x] [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] [Accepted: 03/21/2021] [Indexed: 11/26/2022]
Abstract
The NAMWEZA intervention was implemented, using a ten-session group format, to build skills targeting psychosocial vulnerabilities and enhancing HIV prevention among people living with HIV (PLH) and their social networks. The overall goal of this intervention is to improve psychological wellbeing and reduce HIV risk behaviours. These analyses aim to describe the barriers and facilitators of implementing the NAMWEZA intervention from the perspective of participants and trained peer group facilitators. Twenty-four in-depth interviews were conducted with NAMWEZA participants, and 50 pooled peer facilitator self-assessment reports were obtained from 16 trained peers. Participants identified personal and structural barriers, including fear of inadvertent HIV status disclosure, time constraints, level of participant reimbursements, and limited space available for group sessions. Factors facilitating effective implementation included perceived benefits of the program, such as reduction in HIV-related risk behaviours, increased self-esteem, and improvement in confidence in HIV prevention communications. Scaling up the NAMWEZA intervention to other areas of Tanzania or regionally should take into account these facilitators and barriers to implementation.
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Affiliation(s)
- Magreat Somba
- School of Medicine, Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Sylvia Kaaya
- School of Medicine, Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Kicki Oljemark
- Academy of Health, Care and Social Welfare, University of Malardalen, Västerås, Sweden
| | - Donald Ainebyona
- School of Medicine, Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - James Todd
- London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
| | - Irene Andrew
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | | | - Neema Mleli
- School of Medicine, Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samwel Makongwa
- School of Medicine, Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sabina Haberlen
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Trejos-Castillo E. Technology Platforms and Family Engagement for HIV/AIDS Prevention: Addressing the Needs of Minority Rural Youth. J Adolesc Health 2019; 65:171-172. [PMID: 31331537 DOI: 10.1016/j.jadohealth.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
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Murry VM, Berkel C, Inniss-Thompson MN, Debreaux ML. Pathways for African American Success: Results of Three-Arm Randomized Trial to Test the Effects of Technology-Based Delivery for Rural African American Families. J Pediatr Psychol 2019; 44:375-387. [PMID: 30865782 PMCID: PMC6657445 DOI: 10.1093/jpepsy/jsz001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to test the effectiveness of a technology-based program to avert risky behaviors among rural African American youth. We hypothesized that the technology-based and group-based formats of the Pathways for African Americans Success (PAAS) program would lead to improvements in primary outcomes, and that the technology condition would perform at least as well as the group condition. METHODS A three-arm Randomized Control Trial (RCT) ([N = 141] technology-based delivery, [N = 141] small group delivery, and [N = 136] literature control) was conducted with 421 sixth graders and their caregivers, Summer 2009-Fall 2012. Families were recruited from five rural counties in Tennessee and completed baseline, posttest [M = 14.5 (4.4) months after pretest] and long-term follow-up [M = 22.6 (3.7) months after posttest]. Structural Equation Modeling (SEM) was used to test intervention-induced changes in both parents and youths' primary outcomes (pretest to posttest) and on secondary targeted outcome, youth sexual risk, and substance use patterns (pretest to follow-up). RESULTS Parents in the technology condition reported significant increases in strategies to reduce risk. Youth in the technology condition experienced a significant decline in intent to engage in risk behaviors and reduction in substance use and sexual risk behavior. Youth in the group condition experienced a significant increase in affiliation with deviant peers. CONCLUSIONS This study provides evidence of the ability of eHealth to improve parenting and reduce adolescent engagement in substance use and sexual risk behavior. Suggestions for dissemination in schools and health-care systems are offered.
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Affiliation(s)
- Velma McBride Murry
- Human and Organizational Development, Vanderbilt University Peabody College of Education and Human Development
| | - Cady Berkel
- REACH Institute, Arizona State University College of Liberal Arts and Sciences
| | - Misha N Inniss-Thompson
- Human and Organizational Development, Vanderbilt University Peabody College of Education and Human Development
| | - Marlena L Debreaux
- Human and Organizational Development, Vanderbilt University Peabody College of Education and Human Development
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Ritchwood TD, Dave G, Carthron DL, Isler MR, Blumenthal C, Wynn M, Odulana A, Lin FC, Akers AY, Corbie-Smith G. Adolescents and parental caregivers as lay health advisers in a community-based risk reduction intervention for youth: baseline data from Teach One, Reach One. AIDS Care 2015; 28:537-42. [PMID: 26573538 DOI: 10.1080/09540121.2015.1112348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of the current study is to describe the demographic, behavioral, and psychosocial characteristics of adolescent and caregiver lay health advisers (LHAs) participating in an intervention designed to reduce risk behaviors among rural African-American adolescents. Teach One, Reach One integrates constructs from the Theory of Planned Behavior and Social Cognitive Theory. It acknowledges that changing the sexual behaviors of African-American adolescents requires changing one's knowledge, attitudes, normative beliefs about the behavior of peers, and self-efficacy regarding adolescent sexual behavior, parent-teen communication about sex, and healthy dating relations among adolescents. Study participants completed baseline questionnaires assessing demographics and psychosocial determinants (knowledge, attitudes, perceived social norms, and self-efficacy) of sexual behaviors. Sixty-two adolescent and caregiver dyads participated. Caregivers included biological parents, legal guardians, or other parental figures. Strengths and areas in need of improvement were determined using median splits. Few adolescents had initiated sex. Their strengths included high levels of open parent-teen communication; positive attitudes and normative beliefs regarding both sex communication and healthy dating relationships; and high knowledge and self-efficacy for healthy dating behaviors. Areas needing improvement included low knowledge, unfavorable attitudes, poor normative beliefs, and low self-efficacy regarding condom use. Caregiver strengths included positive attitudes, normative beliefs, and self-efficacy for sex communication; positive attitudes and self-efficacy for condom use; and low acceptance of couple violence. Areas needing improvement included low levels of actual communication about sex and low knowledge about effective communication strategies and condom use. The current study highlights the value of assessing baseline characteristics of LHAs prior to intervention implementation, as it enables a better understanding of the key characteristics necessary for planning and implementing interventions, as well as engaging in targeted training activities.
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Affiliation(s)
- Tiarney D Ritchwood
- a Department of Public Health Sciences , Medical University of South Carolina , Charleston , SC , USA.,g Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA
| | - Gaurav Dave
- b NC TraCS Institute , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Dana L Carthron
- c School of Nursing , University of North Carolina at Greensboro , Greensboro , NC , USA
| | - Malika Roman Isler
- d Office of Wellness , Wake Forest University , Winston-Salem , NC , USA
| | - Connie Blumenthal
- e Department of Social Medicine, Center for Health Equity Research (CHER) , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mysha Wynn
- f Project Momentum , Inc, Rocky Mount , NC , USA
| | - Adebowale Odulana
- g Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA
| | - Feng-Chang Lin
- h Department of Biostatistics, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Aletha Y Akers
- i The Craig Dalsimer Division of Adolescent Medicine , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Giselle Corbie-Smith
- b NC TraCS Institute , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,e Department of Social Medicine, Center for Health Equity Research (CHER) , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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