Theoretical Domains: A Heuristic for Teaching Behavioral Theory in HIV/STD Prevention Courses

Evaluation of factors influencing the guide to read biomedical English literature course for Chinese new medical postgraduates-a multiple regression analysis

BACKGROUND

There is a dearth of published literature that demonstrates the impact of a Guide to Reading Biomedical English Literature course on new Chinese medical postgraduates. Keeping this gap in mind, the objectives of this study were to assess the factors associated with course effectiveness using the teacher, postgraduate and organizational factors.

METHODS

This study was conducted at Nanjing Medical University from December 2014 to December 2015. The participants were 440 new graduate students from different medical specialties. At baseline, each student was assessed for teacher factors, individual factors and organizational factors using a self-administered structured scored anonymous questionnaire. After that, Pearson chi-square analysis was conducted to evaluate the factors that impact teacher factors (knowledge level, teaching style, individualized teaching, logical teaching, heuristic teaching, literature difficulty, bilingual teaching), individual factors (gender, attitude toward studying, previewing literature, English literacy level) and course management (such as teaching objectives and assessment system) on this course. Furthermore, multiple logistic regression analyses were performed to determine the impact of the above factors on our outcome variables (knowledge level, teaching style, individualized teaching, heuristic teaching, study attitude, previewing literature, management).

RESULTS

Nearly all of the participants (420 of 440, 95.5%) thought this course was helpful for learning to read scientific literature and understanding scientific research design. Multivariate logistic regression analyses showed that the participants perception of the course as effective was associated with teachers' high knowledge level (Adjusted Odds Ratio, AOR = 49.673; 95% confidence interval, 95% CI = 4.28, 575.90). In addition, heuristic teaching was found to be significantly associated with a positive teaching effect of teaching (AOR = 12.76; 95% CI = 1.78, 91.64). Furthermore, the participants perception of the course as effective was associated with positive attitude toward studying (AOR = 25.004; 95% CI = 2.51, 249.09). Previewing literature was also associated with course effectiveness (AOR = 0.02; 95% CI = 0.04, 0.11).

CONCLUSIONS

This study indicated that the course effectiveness of the Guide for Reading Biomedical English Literature was associated with i) teachers' knowledge, ii) heuristic teaching, iii) students' positive attitude, and iv) students' previewing literature.

Formação, práticas e trajetórias de aconselhadores de centros de testagem anti-HIV do Rio de Janeiro, Brasil

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.

A "Common Factors" Approach to Developing Culturally Tailored HIV Prevention Interventions

The current dominant model of HIV prevention intervention dissemination involves packaging interventions developed in one context, training providers to implement that specific intervention, and evaluating the extent to which providers implement it with fidelity. Research shows that providers rarely implement these programs with fidelity due to perceived incompatibility, resource constraints, and preference for locally generated solutions. In this study, we used the concept of "common factors," or broad constructs shared by most evidence-based HIV prevention interventions, to train service providers to develop their own programs. We recruited eight Ukrainian HIV prevention organizations from regions with HIV epidemics concentrated among people who inject drugs. We trained staff to identify HIV risk behaviors and determinants, construct behavior change logic models, and develop and manualize an intervention. We systematically reviewed each manual to assess intervention format and content and determine whether the program met intervention criteria as taught during training. All agencies developed programs that reflected common factors of effective behavior change HIV prevention interventions. Each agency's program targeted a unique population that reflected local HIV epidemiology. All programs incorporated diverse pedagogical strategies that focused on skill-building, goal-setting, communication, and empowerment. Agencies struggled to limit information dissemination and the overall scope and length of their programs. We conclude that training service providers to develop their own programs based on common elements of effective behavior change interventions can potentially transform existing processes of program development, implementation, and capacity building. Expanding this model will require committed training and support resources.

Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention

Background

Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men.

Methods

CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis.

Results

Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and Adaptation Issues.

Conclusions

The entire ecological system in which an EBI occurs affects implementation. It is imperative to focus capacity-building efforts on getting individuals at different levels of the HIV Prevention System into alignment regarding understanding and believing in the program’s goals and methods. For a Prevention Support System to be maximally useful, it must address facilitators or barriers to implementation, address the right people, and use modalities to convey information that are acceptable for users of the system.

Telephone counseling to improve osteoporosis treatment adherence: an effectiveness study in community practice settings

Treatment nonadherence is a recognized problem, but most practice settings use education alone to address it. Psychological counseling methods generate greater behavior change but are not widely used. Telehealth nursing can be used to integrate these methods into routine clinical practice. This study was a nonrandomized trial of a telehealth program that used motivational interviewing and cognitive- behavioral techniques to improve osteoporosis medication adherence. Registered nurses delivered the intervention to 402 participants recruited from provider offices across the United States. Initial participation rates were high in this community-based sample, although attrition also was high. Six-month adherence based on pharmacy and clinical interview data was significantly higher than the general population rate. A comparison with nonparticipants approached significance, and there was a significant dose-response effect. Most reasons given for nonadherence were psychological. The results support the use of psychological techniques to improve adherence and the use of telehealth to disseminate evidence-based patient counseling.

Assessing community needs and agency capacity--an integral part of implementing effective evidence-based interventions

Community-based organizations and public health departments have historically applied for and received funding to implement a variety of HIV prevention interventions, but it is unclear how they make decisions regarding which interventions to implement or whether their agency has sufficient capacity and/or resources to effectively carry them out. Assessment activities can play a valuable role in helping agencies make these decisions by providing information to better target services. Recent funding efforts supporting the Diffusion of Effective Behavioral Interventions Project and other evidence-based approaches for HIV prevention require that agencies possess basic skills to effectively conduct individual-, group-, or community-level interventions, as well as the specific activities associated with an evidence-based intervention (EBI). We examine the link among community assessment, agency capacity, and intervention effectiveness, and provide resources to better guide programs in assessing their communities and organizations in order to implement the most effective EBI.

Adapting efficacious interventions: advancing translational research in HIV prevention

The Human Immunodeficiency Virus (HIV) has infected approximately 1.5 million people in the United States. Type 1 translation research (basic research, methods development, and efficacy trials) has yielded multiple efficacious behavioral HIV prevention programs. Type 2 translation research (dissemination and effectiveness studies) has been less prevalent or successful. Adaptation of efficacious interventions for culturally diverse populations has received increasing researcher attention, and empirical validation of adaptation procedures promises to help bridge the gap between Type 1 and Type 2 studies. In this article, the authors briefly discuss the development, testing, and dissemination of efficacious HIV prevention programs and then focus on research-based principles and processes that can guide researchers'adaptation efforts and steps that researchers can take to help empower practitioners to conduct science-based adaptation. Greater collaboration between researchers and service providers to test adaptation frameworks promises to benefit both research and practice.