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Thompson VL, Li Y, Liu Y, Hong J, Sharma S, Metoyer G, Clark-Cutaia MN, Purnell TS, Crews DC, Segev DL, McAdams-DeMarco M. Medical Distrust Among Kidney Transplant Candidates. Clin Transplant 2024; 38:e15395. [PMID: 39023087 PMCID: PMC11259129 DOI: 10.1111/ctr.15395] [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: 09/19/2023] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Medical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting. METHODS Among 812 candidates (2018-2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood-level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting. RESULTS At KT evaluation, candidates who were aged 35-49 years (difference = 1.97, 95% CI: 0.78-3.16), female (difference = 1.10, 95% CI: 0.23-1.97), and Black (difference = 1.47, 95% CI: 0.47-2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35-49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59-1.68) and values distrust score (difference = 0.83, 95% CI: 0.05-1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76-2.07; Hispanic, difference = 1.52, 95% CI: 0.35-2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63-0.98), whereas this association was not observed among males. Similarly, among non-White candidates, each 1-point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77-0.99) and values (aHR = 0.82, 95% CI: 0.68-0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates. CONCLUSION Female, younger, and non-White candidates reported higher distrust scores. Values distrust may contribute to the long-standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.
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Affiliation(s)
- Valerie L. Thompson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Yi Liu
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Jingyao Hong
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Swati Sharma
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Garyn Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | | | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Zimmer D, Staab EM, Ridgway JP, Schmitt J, Franco M, Hunter SJ, Motley D, Laiteerapong N. Population-Level Portal-Based Anxiety and Depression Screening Perspectives in HIV Care Clinicians: Qualitative Study Using the Consolidated Framework for Implementation Research. JMIR Form Res 2024; 8:e48935. [PMID: 38206651 PMCID: PMC10811578 DOI: 10.2196/48935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Depression and anxiety are common among people with HIV and are associated with inadequate viral suppression, disease progression, and increased mortality. However, depression and anxiety are underdiagnosed and undertreated in people with HIV owing to inadequate visit time and personnel availability. Conducting population-level depression and anxiety screening via the patient portal is a promising intervention that has not been studied in HIV care settings. OBJECTIVE We aimed to explore facilitators of and barriers to implementing population-level portal-based depression and anxiety screening for people with HIV. METHODS We conducted semistructured hour-long qualitative interviews based on the Consolidated Framework for Implementation Research with clinicians at an HIV clinic. RESULTS A total of 10 clinicians participated in interviews. In total, 10 facilitators and 7 barriers were identified across 5 Consolidated Framework for Implementation Research domains. Facilitators included advantages of systematic screening outside clinic visits; the expectation that assessment frequency could be tailored to patient needs; evidence from the literature and previous experience in other settings; respect for patient privacy; empowering patients and facilitating communication about mental health; compatibility with clinic culture, workflows, and systems; staff beliefs about the importance of mental health screening and benefits for HIV care; engaging all clinic staff and leveraging their strengths; and clear planning and communication with staff. Barriers included difficulty in ensuring prompt response to suicidal ideation; patient access, experience, and comfort using the portal; limited availability of mental health services; variations in how providers use the electronic health record and communicate with patients; limited capacity to address mental health concerns during HIV visits; staff knowledge and self-efficacy regarding the management of mental health conditions; and the impersonal approach to a sensitive topic. CONCLUSIONS We proposed 13 strategies for implementing population-level portal-based screening for people with HIV. Before implementation, clinics can conduct local assessments of clinicians and clinic staff; engage clinicians and clinic staff with various roles and expertise to support the implementation; highlight advantages, relevance, and evidence for population-level portal-based mental health screening; make screening frequency adaptable based on patient history and symptoms; use user-centered design methods to refine results that are displayed and communicated in the electronic health record; make screening tools available for patients to use on demand in the portal; and create protocols for positive depression and anxiety screeners, including those indicating imminent risk. During implementation, clinics should communicate with clinicians and clinic staff and provide training on protocols; provide technical support and demonstrations for patients on how to use the portal; use multiple screening methods for broad reach; use patient-centered communication in portal messages; provide clinical decision support tools, training, and mentorship to help clinicians manage mental health concerns; and implement integrated behavioral health and increase mental health referral partnerships.
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Affiliation(s)
- Daniela Zimmer
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
| | - Erin M Staab
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
| | - Jessica P Ridgway
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
| | - Jessica Schmitt
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
| | - Melissa Franco
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
| | - Scott J Hunter
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
- Western Institutional Review Board- Copernicus Group, Princeton, NJ, United States
| | - Darnell Motley
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
| | - Neda Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States
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3
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Adekunle TA, Knowles JM, Hantzmon SV, DasGupta MN, Pollak KI, Gaither SE. A qualitative analysis of trust and distrust within patient-clinician interactions. PEC INNOVATION 2023; 3:100187. [PMID: 37457672 PMCID: PMC10339236 DOI: 10.1016/j.pecinn.2023.100187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/12/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Objectives Trust represents a key quality of strong clinician-patient relationships.1 Many have attempted to assess patient-reported trust. However, most trust measures suffer from ceiling effects, with no variability, making it not possible to examine predictors of trust and distrust. Rather than rely on patient reports, we created a codebook for instances of trust and distrust from actual patient-clinician encounters. Methods Three coders conducted a qualitative analysis of audio recordings among patient-cardiologist outpatient encounters. Results We identified trust and distrust based on vocal and verbal cues in the interactions. We found consistent patterns that indicated patient trust and distrust. Conclusion Overall, this work empirically validates a new more accurate measurement of trust for patient-doctor interactions. Innovation We are the first to use audio recordings to identify verbal markers of trust and distrust in patient-clinician interactions. From this work, others can code trust and distrust in recorded encounters rather than rely on self-report measures.
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Affiliation(s)
- Temi A. Adekunle
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Joy M. Knowles
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Sarah V. Hantzmon
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
| | - Maya N. DasGupta
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
| | - Kathryn I. Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E. Gaither
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
- Samuel DuBois Cook Center on Social Equity, Duke University, Durham, NC, USA
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Mathai R, Hinestrosa F, DeJesus E, Rolle CP. Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic. J Investig Med 2023; 71:946-952. [PMID: 37365802 DOI: 10.1177/10815589231182313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Prior studies demonstrate that non-White patients are less likely to achieve human immunodeficiency virus (HIV) suppression compared to White patients due to lack of health insurance. This study aims to determine whether racial disparities in the HIV care cascade persist among a cohort of privately and publicly insured patients. This retrospective analysis evaluated HIV care outcomes during the first year of care. Eligible patients were aged 18-65 years, treatment-naïve, and seen between 2016 and 2019. Demographic and clinical variables were extracted from the medical record. Differences in the proportion of patients achieving each HIV care cascade stage by race were evaluated using unadjusted chi-square testing. Risk factors for viral non-suppression at 52 weeks were analyzed using multivariate logistic regression. We included 285 patients; ninety-nine were White, 101 were Black, and 85 identified as Hispanic/LatinX ethnicity. Significant differences in retention in care for Hispanic/LatinX patients (odds ratio (OR): 0.214, 95% confidence interval (CI): 0.067-0.676) and viral suppression for both Black (OR: 0.348, 95% CI: 0.178, 0.682) and Hispanic/LatinX patients (OR: 0.392, 95% CI: 0.195, 0.791) compared to White patients were observed. In multivariate analyses, Black patients were less likely to achieve viral suppression compared to White patients (OR: 0.464, 95% CI: 0.236, 0.902). This study showed that non-White patients were less likely to achieve viral suppression after 1 year despite insurance and suggests that other unmeasured factors may disproportionately affect viral suppression in these patients. Interventions to identify and address these factors are needed to improve HIV care outcomes for non-White populations.
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Affiliation(s)
- Reanne Mathai
- University of Central Florida, College of Medicine, Orlando, USA
| | | | - Edwin DeJesus
- University of Central Florida, College of Medicine, Orlando, USA
- Orlando Immunology Center, Orlando, FL, USA
| | - Charlotte-Paige Rolle
- Orlando Immunology Center, Orlando, FL, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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Cleland CM, Gwadz M, Collins LM, Wilton L, Leonard NR, Ritchie AS, Martinez BY, Silverman E, Sherpa D, Dorsen C. Effects of Behavioral Intervention Components for African American/Black and Latino Persons Living with HIV with Non-suppressed Viral Load Levels: Results of an Optimization Trial. AIDS Behav 2023; 27:3695-3712. [PMID: 37227621 PMCID: PMC10211286 DOI: 10.1007/s10461-023-04086-0] [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: 05/15/2023] [Indexed: 05/26/2023]
Abstract
There is an urgent need for efficient behavioral interventions to increase rates of HIV viral suppression for populations with serious barriers to engagement along the HIV care continuum. We carried out an optimization trial to test the effects of five behavioral intervention components designed to address barriers to HIV care continuum engagement for African American/Black and Latino persons living with HIV (PLWH) with non-suppressed HIV viral load levels: motivational interviewing sessions (MI), focused support groups (SG), peer mentorship (PM), pre-adherence skill building (SB), and navigation with two levels, short (NS) and long (NL). The primary outcome was HIV viral suppression (VS) and absolute viral load (VL) and health-related quality of life were secondary outcomes. Participants were 512 African American/Black and Latino PLWH poorly engaged in HIV care and with detectable HIV viral load levels in New York City, recruited mainly through peer referral. Overall, VS increased to 37%, or 45% in a sensitivity analysis. MI and SG seemed to have antagonistic effects on VS (z = - 1.90; p = 0.057); the probability of VS was highest when either MI or SG was assigned, but not both. MI (Mean Difference = 0.030; 95% CI 0.007-0.053; t(440) = 2.60; p = 0.010) and SB (Mean Difference = 0.030; 95% CI 0.007-0.053; t(439) = 2.54; p = 0.012) improved health-related quality of life. This is the first optimization trial in the field of HIV treatment. The study yields a number of insights into approaches to improve HIV viral suppression in PLWH with serious barriers to engagement along the HIV care continuum, including chronic poverty, and underscores challenges inherent in doing so.
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Affiliation(s)
- Charles M Cleland
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA
| | - Marya Gwadz
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA.
- NYU Silver School of Social Work, 1 Washington Square North, Room 303, New York, NY, 10003, USA.
| | - Linda M Collins
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
- NYU Silver School of Social Work, 1 Washington Square North, Room 303, New York, NY, 10003, USA
| | | | - Elizabeth Silverman
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Dawa Sherpa
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
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Ajayi KV, Flores S, Fan Q, Ezenwanne F, Garney W, Wachira E. Prevalence, correlates, and sources of women's health information-seeking behaviors in the United States. PATIENT EDUCATION AND COUNSELING 2023; 111:107703. [PMID: 36905765 DOI: 10.1016/j.pec.2023.107703] [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: 10/25/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate the prevalence, correlates, and sources of women's health information-seeking behaviors in the United States using the Andersen Behavioral Model. METHODS The 2012-2019 Health Information National Trends Survey data were used to analyze how and where women seek health theoretically. Weighted prevalence, descriptive analysis, and separate multivariable logistic regression models were computed to test the argument. RESULTS The overall prevalence of seeking health information from any source was (83%, 95% CI: 0.82-0.84). Between 2012 and 2019, the analysis revealed a downward trend in health information seeking from any source (85.2-82.4%), health care provider (19.0-14.8%), family/friends (10.4-6.6%), and traditional channels (5.4-4.8%). Interestingly, there was an increase in Internet usage from 65.4% to 73.8%. CONCLUSIONS We found statistically significant relationships between the predisposing, enabling, and need factors of the Andersen Behavioral Model. Specifically, age, race/ethnicity, income levels, educational status, perceived health status, having a regular provider, and smoking status predicted women's health information-seeking behaviors. PRACTICE IMPLICATIONS Our study concludes that several factors influence health information-seeking behaviors, and disparities exist in the channels through which women seek care. The implications for health communication strategies, practitioners, and policymakers are also discussed.
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Affiliation(s)
- Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA.
| | - Sara Flores
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Qiping Fan
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Folakemi Ezenwanne
- Department of Epidemiology, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Whitney Garney
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Elizabeth Wachira
- Department of Health and Human Performance, Texas A&M University Commerce, TX 75428, USA
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Gwadz M, Serrano S, Linnemayr S, Cleland CM, Cluesman SR, Freeman RM, Kellam K, De Stefano C, Israel K, Pan E. Behavioral intervention grounded in motivational interviewing and behavioral economics shows promise with Black and English-speaking Latino persons living with HIV with unsuppressed HIV viral load in New York City: A mixed methods pilot study. Front Public Health 2022; 10:916224. [PMID: 36187648 PMCID: PMC9522600 DOI: 10.3389/fpubh.2022.916224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/15/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Sustained HIV viral suppression is the ultimate goal of HIV treatment. African American/Black and Latino persons with HIV (PWH) in the United States are less likely than their White peers to achieve and sustain viral suppression. To address these disparities, we developed a "low-touch" behavioral intervention drawing on motivational interviewing and behavioral economics. The intervention had three main components: (1) a motivational interviewing counseling session, (2) 16 weeks of automated text messages and quiz questions about HIV management, where participants earned points by answering quiz questions, and 3) a lottery prize, based on viral suppression status, number of points earned, and chance (max. $275). Materials and methods The intervention was tested in a pre-test/post-test design. The present pilot study used mixed methods to explore the intervention's feasibility, acceptability, impact, and ways it could be improved. Participants engaged in a baseline assessment, qualitative interview, and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. We carried out descriptive quantitative analyses. Qualitative data were analyzed using a directed content analysis approach. Data integration was carried out using the joint display method. Findings Participants (N = 40) were 50 years old, on average (SD = 11), and approximately half (58%) were male. Close to two-thirds (68%) were African American/Black and 32% were Latino. Participants were diagnosed with HIV 22 years ago on average (SD = 8). The intervention was feasible (e.g., mean number of quiz questions answered = 13/16) and highly acceptable. While not powered to assess efficacy, the proportion with suppressed HIV viral load increased from baseline to follow-up (46% participants at the first, 52% participants at the second follow-up evidenced HIV viral suppression). In qualitative analyses, perspectives included that overall, the intervention was acceptable and useful, it was distinct from other programs, lottery prizes were interesting and appreciated but not sufficient to motivate behavior change, and the structure of lottery prizes was not sufficiently clear. Regarding data integration, qualitative data shed light on and extended quantitative results, and added richness and context. Conclusion This low-touch intervention approach is sufficiently promising to warrant refinement and study in future research.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, United States,Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States,*Correspondence: Marya Gwadz
| | - Samantha Serrano
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, United States
| | | | - Charles M. Cleland
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, United States,Department of Biostatistics, New York University School of Medicine, New York, NY, United States,Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Sabrina R. Cluesman
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, United States
| | | | - Kinsey Kellam
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, United States
| | - Corey De Stefano
- North Jersey Community Research Initiative, Newark, NJ, United States
| | - Khadija Israel
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, United States
| | - Emily Pan
- Rory Meyers School of Nursing, New York University, New York, NY, United States
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Gwadz M, Cluesman SR, Freeman R, Collins LM, Dorsen C, Hawkins RL, Cleland CM, Wilton L, Ritchie AS, Torbjornsen K, Leonard NR, Martinez BY, Silverman E, Israel K, Kutnick A. Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study. Int J Equity Health 2022; 21:97. [PMID: 35840962 PMCID: PMC9286957 DOI: 10.1186/s12939-022-01699-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants' perspectives on the study's acceptability, feasibility, and impact, and the conceptual model's contribution to these experiences. METHODS Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. RESULTS On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants' experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. CONCLUSIONS The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA. .,Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.
| | - Sabrina R Cluesman
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | | | - Linda M Collins
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.,Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | | | - Robert L Hawkins
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Karen Torbjornsen
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA.,School of Global Public Health, New York University, New York, NY, USA
| | | | - Elizabeth Silverman
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Khadija Israel
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
| | - Alexandra Kutnick
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
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