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Chen S, Walt G, Aldrich A, McAlearney AS, Linas B, Amuchi B, Freedman DA, Goddard-Eckrich D, Gibson E, Hartman Ms J, Bosak J, Lunze K, Jones L, Christopher M, Salsberry P, Jackson R, Back S, Drainoni ML, Walker DM. A Qualitative Study of Health Equity's Role in Community Coalition Development. HEALTH EDUCATION & BEHAVIOR 2024; 51:613-624. [PMID: 37376998 DOI: 10.1177/10901981231179755] [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] [Indexed: 06/29/2023]
Abstract
Opioid overdose deaths are dramatically increasing in the United States and disproportionately affecting minority communities, with the increasing presence of fentanyl exacerbating this crisis. Developing community coalitions is a long-standing strategy used to address public health issues. However, there is a limited understanding of how coalitions operate amid a serious public health crisis. To address this gap, we leveraged data from the HEALing Communities Study (HCS)-a multisite implementation study aiming to reduce opioid overdose deaths in 67 communities. Researchers analyzed transcripts of 321 qualitative interviews conducted with members of 56 coalitions in the four states participating in the HCS. There were no a priori interests in themes, and emergent themes were identified through inductive thematic analysis and then mapped to the constructs of the Community Coalition Action Theory (CCAT). Themes emerged related to coalition development and highlighted the role of health equity in the inner workings of coalitions addressing the opioid epidemic. Coalition members reported seeing the lack of racial and ethnic diversity within their coalitions as a barrier to their work. However, when coalitions focused on health equity, they noted that their effectiveness and ability to tailor their initiatives to their communities' needs were strengthened. Based on our findings, we suggest two additions to enhance the CCAT: (a) incorporating health equity as an overarching construct that affects all stages of development, and (b) ensuring that data about individuals served are included within the pooled resource construct to enable monitoring of health equity.
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Affiliation(s)
- Sadie Chen
- The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandi Back
- University of Kentucky, Lexington, KY, USA
| | - Mari-Lynn Drainoni
- Boston Medical Center, Boston, MA, USA
- Boston University, Boston, MA, USA
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Bauermeister JA, Horvath KJ, Lin WY, Golinkoff JM, Claude KF, Dowshen N, Castillo M, Sullivan PS, Paul M, Hightow-Weidman L, Stephenson R. Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139). BMC Public Health 2024; 24:1072. [PMID: 38632603 PMCID: PMC11025185 DOI: 10.1186/s12889-024-18522-w] [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] [Received: 02/04/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational resources, in motivating young men who have sex with men (YMSM) to undergo regular HIV and STI testing. METHODS Participants were randomly placed in one of two conditions. The first condition included the full version of GC (GC-PLUS), which included content tailored to users' psychosocial characteristics (e.g., age, race/ethnicity, relationship status, HIV/STI testing history). The second condition served as our attention-control and only included the testing locator (GC-TLO) for HIV/STI testing services. Participants were recruited from three cities (Houston, Philadelphia, and Atlanta) characterized by high HIV incidence. Assessments were collected at 1, 3-, 6-, 9- and 12-month follow-ups. RESULTS Both versions of GC were acceptable and efficacious in increasing routine HIV and STI testing over a 12-month period. 40% of the sample reported testing at least twice, with no main effects observed across the two intervention arms (OR = 1.11; 95% CI: 0.69, 1.80), p =.66). Greater intervention effects were observed among YMSM who engaged more frequently with the intervention, with regional differences observed. CONCLUSIONS Our findings underscore the need to cater to the diverse needs of YMSM through multilevel approaches. Broadly, mHealth HIV/STI testing interventions, such as Get Connected, would benefit from matching technologies to the local context to have the greatest impact. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov (NCT03132415).
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Affiliation(s)
- J A Bauermeister
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA.
| | - K J Horvath
- San Diego State University, San Diego, CA, USA
| | - W Y Lin
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
| | - J M Golinkoff
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
| | - K F Claude
- Florida State University, Tallahassee, FL, USA
| | - N Dowshen
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Castillo
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - M Paul
- Baylor College of Medicine, Houston, TX, USA
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Bonett S, Mahajan A, Williams J, Watson DL, Wood SM, Meanley S, Brady KA, Bauermeister JA. Perspectives From Community-Based HIV Service Organization Leaders on Priorities in Serving Sexual and Gender Minority Populations. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:277-289. [PMID: 37535325 PMCID: PMC10461513 DOI: 10.1521/aeap.2023.35.4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Sexual and gender minority (SGM) populations experience discrimination and care-related barriers when seeking appropriate sexual health services. Using rapid assessment procedures we conducted site visits with 11 community-based HIV service agencies to identify priorities, assets, and needs related to serving SGM clients and assessed the alignment of these services with the city's local Ending the HIV Epidemic plan. We identified and mapped themes across agencies into the Consolidated Framework for Implementation Research domains of inner and outer settings: client-facing materials; priorities in serving SGM communities; SGM policies and protocols; collecting sexual orientation and gender identity data; training and education; and funding and scope of programs. Rapid assessment procedures can accelerate the collection and interpretation of data to help public health institutions and community partners make timely adaptations when implementing comprehensive and culturally humble sexual health services for SGM communities.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Javontae Williams
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Dovie L Watson
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah M Wood
- Perelman School of Medicine, University of Pennsylvania, and Adolescent HIV Services, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen A Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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Unreasonable Expectations: A Call for Training and Educational Transparency in Gender-affirming Surgery. Plast Reconstr Surg Glob Open 2023; 11:e4734. [PMID: 36699231 PMCID: PMC9833440 DOI: 10.1097/gox.0000000000004734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023]
Abstract
Although in most areas of practice, there is a reasonable expectation that doctors are sufficiently trained to offer care, this is not true in the case of gender-affirming procedures, which are not required learning in any surgical residency. At the current time, the field of gender surgery is too rapidly evolving, with available resources too scarce for fellowship or residency training to be a realistic requirement for offering these procedures, as the demand already outstrips the available workforce. However, patients are currently given too little information about surgeons' history with these procedures to provide truly informed consent. There is, as such, an ethical mandate to mold the culture of gender-affirming surgery such that surgeons are expected to routinely disclose relevant information about their training, experience, and outcomes to facilitate patient decision-making about care.
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Drab R, Wolfe JR, Chavanduka TMD, Bonar EE, Guest JL, Hightow-Weidman L, Castel AD, Horvath KJ, Sullivan PS, Stephenson R, Bauermeister J. Constructing a web-based health directory for adolescent men who have sex with men: Strategies for development and resource verification. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1597-1615. [PMID: 34716596 PMCID: PMC8916971 DOI: 10.1002/jcop.22738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Online health directories are increasingly used to locate health services and community resources, providing contact and service information that assists users in identifying resources that may meet their health and wellness needs. However, service locations require additional vetting when directories plan to refer vulnerable populations. As a tool included as part of a trial of a mobile life skills intervention for cisgender adolescent men who have sex with men (AMSM; ages 13-18), we constructed and verified resources for an online resource directory focused on linking young people to LGBTQ+ friendly and affirming local health and community social services resources. We collected information for 2301 individual directory listings through database and internet searches. To ensure the listings aligned with the project's focus of supporting young sexual minority men, we developed multiple data verification assessments to ensure community appropriateness resulting in verification of 1833 resources suitable for inclusion in our locator tool at project launch (March 2018). We offer lessons learned and future directions for researchers and practitioners who may benefit from adapting our processes and strategies for building culturally-tailored resource directories for vulnerable populations.
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Affiliation(s)
- Ryan Drab
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - James R. Wolfe
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Tanaka MD Chavanduka
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
| | - Erin E. Bonar
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
- Department of Psychiatry, School of Medicine, Addiction Center, Ann Arbor, Michigan, US
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, US
| | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, Georgia, US
- Emory University School of Medicine, Emory University, Atlanta, Georgia, US
| | | | - Amanda D. Castel
- Milken Institute School of Public Health, George Washington University, Washington, D.C., US
| | | | | | - Rob Stephenson
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
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Lanford D, Petiwala A, Landers G, Minyard K. Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:432-447. [PMID: 34018268 PMCID: PMC9291477 DOI: 10.1111/hsc.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 06/01/2023]
Abstract
Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.
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Affiliation(s)
- Daniel Lanford
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Aliza Petiwala
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Glenn Landers
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Karen Minyard
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
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Petiwala A, Lanford D, Landers G, Minyard K. Community voice in cross-sector alignment: concepts and strategies from a scoping review of the health collaboration literature. BMC Public Health 2021; 21:712. [PMID: 33849498 PMCID: PMC8042631 DOI: 10.1186/s12889-021-10741-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background Health care access is an important driver of population health, and factors beyond health care also drive health outcomes. Recognizing the importance of the social determinants of health (SDOH), different actors in the health care, public health, and social service sectors are increasingly collaborating to improve health outcomes in communities. To support such collaboration, the Robert Wood Johnson Foundation developed a cross-sector alignment theory of change. According to the cross-sector alignment theory of change, community voice is critical for helping collaboratives address community health needs. Yet research on health collaboratives offers mixed guidance on how community voice should be understood and which community voice strategies are most effective. Methods This study addresses a gap in the literature with a systematic scoping review of research on health-oriented cross-sector collaboration and community voice. By scanning key academic journals, searching three academic databases, and obtaining documents from across our professional networks, we identified 36 documents that address community voice in health collaboratives. Results The review reveals several conceptions of community voice and a range of community voice strategies. We find that community voice strategies fall on a spectrum between two broad types of approaches: active and passive. These vary not only in the level of power shared between communities and collaborators, but also in the level of involvement required from the community, and this in turn has important implications for community collaboration strategies. We also find that while most strategies are discussed in the context of short-term collaboration, many also lend themselves to adoption in the context of sustainable collaboration and, ultimately, cross-sector alignment. Conclusion This review provides a characterization and conceptualization of community voice in health-oriented collaborations that provides a new theoretical basis for future research. Passive and active community voice strategies can be studied in more detail for their expected impact on health outcomes and disparities. Increased attention to active community voice and the resources it requires can help practitioners achieve improved health outcomes and researchers understand the pathways to health improvement through collaboration.
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Affiliation(s)
- Aliza Petiwala
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA.
| | - Daniel Lanford
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
| | - Glenn Landers
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
| | - Karen Minyard
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
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Jadwin-Cakmak L, Bauermeister JA, Cutler JM, Loveluck J, Sirdenis TK, Fessler KB, Popoff EE, Benton A, Pomerantz NF, Atkins SLG, Springer T, Harper GW. The Health Access Initiative: A Training and Technical Assistance Program to Improve Health Care for Sexual and Gender Minority Youth. J Adolesc Health 2020; 67:115-122. [PMID: 32268999 PMCID: PMC7739871 DOI: 10.1016/j.jadohealth.2020.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/17/2019] [Accepted: 01/03/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE This article describes the Health Access Initiative (HAI), an intervention to improve the general and sexual health care experiences of sexual and gender minority youth (SGMY) by providing training and technical assistance to providers and staff. The training consisted of an online and in-person training, followed by site-specific technical assistance. We present the findings of a pilot evaluation of the program with 10 diverse clinics in Michigan. METHODS This program was developed using community-based participatory research principles. Based on a framework of cultural humility, program activities are guided by the Situated Information-Motivation-Behavioral Skills Model. The mixed method program evaluation used training feedback surveys assessing program feasibility, acceptability, and effectiveness; pre/post surveys assessing knowledge, attitudes, and practices toward SGMY; and in-depth interviews with site liaisons assessing technical assistance and structural change. RESULTS The HAI is a highly feasible and acceptable intervention for providers and staff at a variety of health care sites serving adolescents and emerging adults. The results from 10 clinics that participated in the HAI indicate strong intervention efficacy, with significant and meaningful improvements seen in the knowledge of, attitudes toward, and practices with SGMY reported by providers and staff at 6-month follow-up compared with baseline, as well as in qualitative interviews with site liaisons. CONCLUSIONS The HAI is a promising intervention to improve the quality of primary and sexual health care provided to SGMY. Expanded implementation with continued evaluation is recommended. The HAI may also be adapted to address specific health needs of SGMY beyond sexual health.
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Affiliation(s)
- Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | | | - Jacob M. Cutler
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Triana Kazaleh Sirdenis
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kathryn B. Fessler
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Elliot E. Popoff
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Naomi F. Pomerantz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | | | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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Testing the Testers: Are Young Men Who Have Sex With Men Receiving Adequate HIV Testing and Counseling Services? J Acquir Immune Defic Syndr 2020; 82 Suppl 2:S133-S141. [PMID: 31658201 PMCID: PMC6820705 DOI: 10.1097/qai.0000000000002173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The United States Centers for Disease Control and Prevention promote HIV testing every 6 months among young men who have sex with men (YMSM) to facilitate entry into the HIV prevention and care continuum. Willingness to be tested may be influenced by testing services' quality. Using a novel mystery shopper methodology, we assessed YMSM's testing experiences in 3 cities and recommend service delivery improvements.
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