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Masood Y, Alvarez Nishio A, Starling B, Dawson S, Salsberg J, Blackburn S, van Vliet E, Pittens CA. Series: Public engagement with research. Part 2: GPs and primary care researchers working inclusively with minoritised communities in health research to help address inequalities. Eur J Gen Pract 2024; 30:2322996. [PMID: 38477291 PMCID: PMC10939099 DOI: 10.1080/13814788.2024.2322996] [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] [Received: 07/04/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Public engagement in health research is vital for addressing health disparities and promoting inclusivity among minoritised communities who often face barriers to accessing healthcare. Minoritised communities are groups, which have been made minorities by a dominant culture, race, ethnic group and/or social class and may experience health inequalities as a result. By incorporating diverse perspectives and lived experiences of minoritised communities, this approach aims to achieve contextually relevant research outcomes that reduce health inequalities and improve overall well-being. However, underrepresentation and lack of inclusivity challenges persist, necessitating the establishment of inclusive partnerships and grassroots participatory methodologies. To foster inclusive public engagement, it is important to overcome structural and cultural barriers, address socioeconomic challenges, and build trust with minoritised communities. This can be achieved by promoting a cultural shift that values inclusivity, providing comprehensive training to researchers, and collecting rigorous data on engagement demographics for transparency and accountability. Involving minoritised communities in decision-making through participatory research approaches enhances trust and yields successful outcomes. Additionally, allocating sufficient resources, collaborating in co-production, and prioritising the diverse needs and perspectives of stakeholders contribute to fostering inclusive public engagement in research. Overall, inclusive engagement practices particularly in primary care research have the potential to reduce health inequalities and cater to the unique requirements of minoritised communities, thereby creating more impactful outcomes and promoting equitable healthcare access.
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Affiliation(s)
- Yumna Masood
- Centre for Evidence Based Medicine | Nuffield Department of Primary Care Health Sciences |, University of Oxford Radcliffe Primary Care Building, University of Oxford, Oxford, UK
| | | | - Bella Starling
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Shoba Dawson
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Jon Salsberg
- University of Limerick, Family Medicine Limerick, Limerick, Ireland
| | - Steven Blackburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Esther van Vliet
- Academic Collaborative Centers, Knowledge Transfer Office, Tilburg University, Tilburg, The Netherlands
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Lamoureux G, Finlay S, Moïse-Richard A, Ménard L, Verduyckt I. Mitigating stuttering self-stigma: How do we start and where do we go? Using a Participative Concept Mapping Approach to develop a local framework of principles. JOURNAL OF FLUENCY DISORDERS 2024; 81:106075. [PMID: 39067312 DOI: 10.1016/j.jfludis.2024.106075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE This study aims to create a stigma reduction framework for stuttering in the local context of Québec, Canada using the Participative Concept Mapping Approach (PCMA), focusing on both self and societal stigma. METHOD Employing a mixed-methods approach, this study engaged 17 experts-people who stutter, clinicians and health innovation specialists-in PCMA workshops. Via diverse steps, including generation, sorting and rating of ideas in response to the focus prompt, "To effectively address stuttering (self-)stigma, an intervention should…" these sessions led to a framework depicted in visual maps, then refined into actionable principles through qualitative analysis. Mixed-methods data analysis used the open-source R-CMap software to generate visual maps illustrating the relationships among ideas as well as importance and feasibility ratings. RESULTS The collaborative workshops identified 95 ideas in response to the focus prompt, reunited in 7 clusters, evolving into 16 principles to mitigate stuttering stigma and self-stigma. At the therapy level, these principles emphasize personalized therapy, thorough assessments, stigma-free therapeutic environment, empowerment, and the importance of group inclusivity and educating the relational circles. Societally, they advocate for initiatives such as improved educational outreach, empathy enhancement, and better representation. This dual approach targets individual experiences and societal views on stuttering, stressing the need for an all-encompassing intervention framework. CONCLUSION The findings demonstrate PCMA's usefulness in crafting local, culturally sensitive, tailored interventions for stigma reduction. The study emphasizes the necessity of holistic approaches that address individual experiences and societal perceptions, offering a model to conduct similar exercises in diverse local settings.
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Affiliation(s)
- Geneviève Lamoureux
- School of Speech-Language Therapy and Audiology, Université de Montréal, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada.
| | - Sébastien Finlay
- School of Speech-Language Therapy and Audiology, Université de Montréal, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Anne Moïse-Richard
- School of Speech-Language Therapy and Audiology, Université de Montréal, Montreal, Canada; Marie Enfant Rehabilitation Centre of Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Lucie Ménard
- Marie Enfant Rehabilitation Centre of Sainte-Justine University Hospital Centre, Montreal, Canada; Laboratoire de Phonétique, Université du Québec à Montréal, Canada
| | - Ingrid Verduyckt
- School of Speech-Language Therapy and Audiology, Université de Montréal, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
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Rodriguez-Hart C, Bradley C, German D, Baral S, Ononaku U, Dimlong OT, Crowell TA, Charurat M, Nowak RG. "Building that strong energy": An exploration of stigma coping strategies among sexual and gender minorities in Nigeria. STIGMA AND HEALTH 2023; 8:223-231. [PMID: 37377985 PMCID: PMC10292765 DOI: 10.1037/sah0000319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Sexual and gender minority stigma (SGM stigma) affecting Nigerian sexual and gender minorities (SGM) is associated with suboptimal HIV outcomes, and one mechanism found to explain the relationship is suicidal ideation. A better understanding of coping strategies may help mitigate the harmful impacts of SGM stigma. Interviews of 25 SGM from Abuja, Nigeria participating in the [Blinded for Review] study were thematically analyzed in regards to how they coped with SGM stigma. Four coping themes emerged: avoidant behaviors, self-monitoring so as to not attract stigma, seeking support and safe spaces to be themselves, and empowerment and self-acceptance through a process of cognitive change. They utilized multiple coping strategies, often believing that stigma could be avoided through the right actions and a masculine appearance. Multi-level and person-centered interventions that increase safety and support, facilitate resiliency, and improve mental health and engagement in HIV programming could mitigate the effects of SGM stigma and coping responses of isolation, blame, and mental health stressors among Nigerian SGM.
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Affiliation(s)
- Cristina Rodriguez-Hart
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, MD
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cory Bradley
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Uchenna Ononaku
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, MD
| | - Olivia Tapkat Dimlong
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, MD
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Man Charurat
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, MD
| | - Rebecca G. Nowak
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, MD
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Mol MM, Visser MJ, Rai SS, Peters RMH. Measuring health-related stigma: Exploring challenges and research priorities to improve assessment. Glob Public Health 2023; 18:2264960. [PMID: 37801723 DOI: 10.1080/17441692.2023.2264960] [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] [Received: 03/10/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
Despite the advances in stigma research, measuring health-related stigma continues to be challenging and knowledge gaps remain. This study gained insight into challenges and research priorities related to the assessment of health-related stigma. Interviews were conducted with 14 stigma researchers, followed by a survey that was completed by 36 respondents. The findings showed a diverse range of research priorities. Among the top ranked priorities were the need for robust measurement properties of existing scales (content validity, responsiveness, validation across settings), exploration and assessment of subtle changes in stigma, and investigation on ways to assess actual behaviour and discrimination. Various challenges with the cross-cultural use of measures were identified, along with a research opportunity to shorten the cross-cultural validation process. Other identified research priorities related to: studying multi-level intersectional stigma; focusing on positive features that counter stigma; rephrasing negative and offending scale items; developing generic measures; and, the further development of practical tools to support researchers with scale implementation. The defined research priorities can guide future studies to advance stigma measurements and, as our ability to measure is critical for our understanding, enhance our knowledge about the complex stigma processes.
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Affiliation(s)
- Marente M Mol
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marlies J Visser
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sarju S Rai
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ruth M H Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Breland AB, Carroll D, Denlinger-Apte R, Ross JC, Soto C, White C, Donny EC, Fagan P, Gardiner P, Eissenberg T, Guy MC. Centering racial justice for Black/African American and Indigenous American people in commercial tobacco product regulation. Prev Med 2022; 165:107117. [PMID: 35716811 PMCID: PMC9722549 DOI: 10.1016/j.ypmed.2022.107117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/29/2022] [Accepted: 06/12/2022] [Indexed: 01/13/2023]
Abstract
Although overall health in the United States (US) has improved dramatically during the past century, long-standing health inequities, particularly the unequal and unjust burden of tobacco-related disease and death among racialized populations, persist. A considerable gap exists in our understanding of how commercial tobacco product regulations and policies cause and/or exacerbate race-based health inequities among Black/African American (B/AA) and Indigenous American people. The purpose of this paper is to 1) describe how existing US commercial tobacco regulatory policies may contribute to structural racism and undermine the full benefits of tobacco prevention and control efforts among B/AA and Indigenous American groups; and 2) initiate a call to action for researchers and regulators of tobacco products to examine policies using an equity lens. These actions are imperative if empirically-informed regulation of commercial tobacco products is to address health equity.
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Affiliation(s)
- Alison B Breland
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA.
| | - Dana Carroll
- University of Minnesota, School of Public Health, Division of Environmental Health Sciences, 717 Delaware St SE, Minneapolis, MN 55414, USA.
| | - Rachel Denlinger-Apte
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Claradina Soto
- University of Southern California, Keck School of Medicine, Institute for Health Promotion and Disease Prevention Research, SSB 300 2001 N. Soto Street, Health Sciences Campus, Los Angeles, CA 90033, USA.
| | - Cassidy White
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Eric C Donny
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Pebbles Fagan
- University of Arkansas for Health Sciences, Fay W. Boozman College of Public Health, 4301 West Markham, # 820, Little Rock, AK 72205, USA.
| | - Phillip Gardiner
- African American Tobacco Control Leadership Council, 390 Fourth Street, San Francisco, CA 94107, USA
| | - Thomas Eissenberg
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA.
| | - Mignonne C Guy
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA; Virginia Commonwealth University, Department of African American Studies, 816 W. Franklin St., Box 842509, Richmond, VA 23284, USA.
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Sukhera J, Knaak S. A realist review of interventions to dismantle mental health and substance use related structural stigma in healthcare settings. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Goodenow MM, Rausch DM. Recent Key Efforts to Improve HIV-Related Intersectional Stigma and Discrimination Research. Am J Public Health 2022; 112:S393-S394. [PMID: 35763741 DOI: 10.2105/ajph.2022.306712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Maureen M Goodenow
- Maureen M. Goodenow is with the Office of AIDS Research, National Institutes of Health (NIH), Rockville, MD. Dianne M. Rausch is with the Division of AIDS Research, National Institute of Mental Health, NIH
| | - Dianne M Rausch
- Maureen M. Goodenow is with the Office of AIDS Research, National Institutes of Health (NIH), Rockville, MD. Dianne M. Rausch is with the Division of AIDS Research, National Institute of Mental Health, NIH
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Rodriguez-Hart C, Boone CA, Del Río-González AM, Kutner BA, Baral S, Burns PA, German D, Eaton L, Lucas L, Remien RH, Ellis M, Dale SK. Monitoring Intersectional Stigma: A Key Strategy to Ending the HIV Epidemic in the United States. Am J Public Health 2022; 112:S350-S355. [PMID: 35763745 PMCID: PMC9241480 DOI: 10.2105/ajph.2022.306733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Cristina Rodriguez-Hart
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Cheriko A Boone
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Ana María Del Río-González
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Bryan A Kutner
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Stefan Baral
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Paul A Burns
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Danielle German
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Lisa Eaton
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Lisa Lucas
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Robert H Remien
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Marcia Ellis
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
| | - Sannisha K Dale
- Cristina Rodriguez-Hart is with the New York City Department of Health and Mental Hygiene, New York, NY. Cheriko A. Boone and Ana María del Río-González are with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC. Bryan A. Kutner and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, New York, NY. Stefan Baral and Lisa Lucas are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Paul A. Burns is with the John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson. Danielle German is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Lisa Eaton is with the University of Connecticut, Department of Human Development and Family Sciences, Storrs. Marcia Ellis is with the DC Center for AIDS Research, Washington, DC. Sannisha K. Dale is with the Department of Psychology, University of Miami, Miami, FL
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Kerr J, Lelutiu-Weinberger C, Nelson LE, Turan JM, Frye V, Matthews DW, Leddy AM, Jackson SD, Boyd D, Hightow-Weidman L. Addressing Intersectional Stigma in Programs Focused on Ending the HIV Epidemic. Am J Public Health 2022; 112:S362-S366. [PMID: 35763743 PMCID: PMC9241451 DOI: 10.2105/ajph.2021.306657] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Jelani Kerr
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Corina Lelutiu-Weinberger
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - LaRon E Nelson
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Janet M Turan
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Victoria Frye
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - David W Matthews
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Anna M Leddy
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Skyler D Jackson
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Donte Boyd
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Lisa Hightow-Weidman
- Jelani Kerr is with the School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Corina Lelutiu-Weinberger is with Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey, Newark. LaRon E. Nelson is with the School of Nursing, Yale University, New Haven, CT. Janet M. Turan is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. Victoria Frye and David W. Matthews are with the City University of New York School of Medicine, New York, NY. Anna M. Leddy is with the Department of Medicine, University of California, San Francisco. Skyler D. Jackson is with the Yale School of Public Health, Yale University. Donte Boyd is with the Graduate College of Social Work, University of Houston, Houston, TX. Lisa Hightow-Weidman is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
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Afifi RA, Parker EA, Dino G, Hall DM, Ulin B. Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States. Annu Rev Public Health 2022; 43:135-154. [PMID: 34910581 PMCID: PMC11295601 DOI: 10.1146/annurev-publhealth-052020-123413] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this article, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity.
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Affiliation(s)
- R A Afifi
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - E A Parker
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - G Dino
- Department of Social and Behavioral Sciences, and West Virginia Prevention Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia, United States;
| | - D M Hall
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
| | - B Ulin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
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11
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Austin JK, Birbeck G, Parko K, Kwon CS, Fernandes PT, Braga P, Fiest KM, Ali A, Cross JH, de Boer H, Dua T, Haut SR, Jacoby A, Lorenzetti DL, Mifsud J, Moshé SL, Tripathi M, Wiebe S, Jette N. Epilepsy-related stigma and attitudes: Systematic review of screening instruments and interventions - Report by the International League Against Epilepsy Task Force on Stigma in Epilepsy. Epilepsia 2022; 63:598-628. [PMID: 34985766 DOI: 10.1111/epi.17133] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This is a systematic review aimed at summarizing the evidence related to instruments that have been developed to measure stigma or attitudes toward epilepsy and on stigma-reducing interventions. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A broad literature search (1985-2019) was performed in 13 databases. Articles were included if they described the development and testing of psychometric properties of an epilepsy-related stigma or attitude scale or stigma-reducing interventions. Two reviewers independently screened abstracts, reviewed full-text articles, and extracted data. Basic descriptive statistics are reported. RESULTS We identified 4234 abstracts, of which 893 were reviewed as full-text articles. Of these, 38 met inclusion criteria for an instrument development study and 30 as a stigma-reduction intervention study. Most instruments were initially developed using well-established methods and were tested in relatively large samples. Most intervention studies involved educational programs for adults with pre- and post-evaluations of attitudes toward people with epilepsy. Intervention studies often failed to use standardized instruments to quantify stigmatizing attitudes, were generally underpowered, and often found no evidence of benefit or the benefit was not sustained. Six intervention studies with stigma as the primary outcome had fewer design flaws and showed benefit. Very few or no instruments were validated for regional languages or culture, and there were very few interventions tested in some regions. SIGNIFICANCE Investigators in regions without instruments should consider translating and further developing existing instruments rather than initiating the development of new instruments. Very few stigma-reduction intervention studies for epilepsy have been conducted, study methodology in general was poor, and standardized instruments were rarely used to measure outcomes. To accelerate the development of effective epilepsy stigma-reduction interventions, a paradigm shift from disease-specific, siloed trials to collaborative, cross-disciplinary platforms based upon unified theories of stigma transcending individual conditions will be needed.
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Affiliation(s)
- Joan K Austin
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Gretchen Birbeck
- Epilepsy Division, University of Rochester, Rochester, New York, USA.,Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
| | - Karen Parko
- Department of Neurology, University of California at San Francisco, San Francisco, California, USA.,Epilepsy Center, San Francisco VA Medical Center, San Francisco, California, USA
| | - Churl-Su Kwon
- Departments of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paula T Fernandes
- Department of Sport Science, Faculty of Physical Education, UNICAMP, Campinas, Brazil
| | - Patricia Braga
- Institute of Neurology, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Kirsten M Fiest
- Department of Critical Care Medicine and Department of Community Health Sciences, Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Amza Ali
- Kingston Public Hospital and University of the West Indies, Kingston, Jamaica
| | - J Helen Cross
- Developmental Neurosciences Programme, UCL-Great Ormond Street Institute of Child Health, London, UK
| | | | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Sheryl R Haut
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary and Heath Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Solomon L Moshé
- Department of Pediatrics and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Samuel Wiebe
- Department of Clinical Neurosciences and Department of Community Health Sciences, Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Ayala G, Sprague L, van der Merwe LLA, Thomas RM, Chang J, Arreola S, Davis SLM, Taslim A, Mienies K, Nilo A, Mworeko L, Hikuam F, de Leon Moreno CG, Izazola-Licea JA. Peer- and community-led responses to HIV: A scoping review. PLoS One 2021; 16:e0260555. [PMID: 34852001 PMCID: PMC8635382 DOI: 10.1371/journal.pone.0260555] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track. METHODS We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS' definition of 'community-led' and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research. FINDINGS Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices. CONCLUSIONS AND RECOMMENDATIONS Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.
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Affiliation(s)
- George Ayala
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Alameda County Department of Public Health, Oakland, CA, United States of America
- * E-mail:
| | - Laurel Sprague
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - L. Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women in Africa, East London, South Africa
- Innovative Response Globally to Transgender Women and HIV (IRGT), Oakland, CA, United States of America
| | | | - Judy Chang
- International Network of People Who Use Drugs, London, United Kingdom
| | - Sonya Arreola
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Arreola Research, San Francisco, CA, United States of America
| | | | | | - Keith Mienies
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern Africa, Kampala, Uganda
| | - Felicita Hikuam
- AIDS and Rights Alliance for Southern Africa, Windhoek, Namibia
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Caswell G, Dubula V, Baptiste S, Etya’ale H, Syarif O, Barr D. The continuing role of communities affected by HIV in sustained engagement in health and rights. J Int AIDS Soc 2021; 24 Suppl 3:e25724. [PMID: 34189840 PMCID: PMC8242979 DOI: 10.1002/jia2.25724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The meaningful involvement of persons affected by a disease is a unique aspect of the HIV response that places people living with (PLHIV) and those directly affected by HIV (peers) at the centre of the design, development and implementation of service delivery and research and policy making. The principle of greater involvement of PLHIV (GIPA) has and will increasingly ensure equitable access to services and engagement of marginalized groups in the HIV response, and to health services more broadly. This paper describes the history, current place in the HIV response and potential future role of PLHIV and communities in health responses. DISCUSSION Historically, the role of communities of PLHIV and peers in service delivery, research and drug development, advocacy, social and political accountability, resource mobilization and social and human rights protection is well documented. Their leadership and engagement have contributed directly to improved outcomes in access to HIV treatment, prevention, support and care services around the world. Their continued and expanded role is especially important for the future success of HIV responses in sub-Saharan Africa, where the HIV burden remains the greatest. The lessons learned from the leadership and involvement of communities of PLHIV and peers in the HIV response hold value beyond HIV responses. The models and approaches they have efficiently and effectively utilized have relevant applications in addressing shortfalls in health systems in the COVID-19 era, as well as broader, more integrated health challenges as countries move to develop and operationalize universal health coverage (UHC). However, neither HIV nor other health and development targets can be met if their contributions are not adequately recognized, valued and funded. CONCLUSIONS The past three decades have demonstrated that communities of PLHIV and their peers are instrumental in sustaining engagement and advocacy for health equity and financing for health and ensuring that the human rights of all people are recognized and upheld. Quality and effective integration of health systems and UHC can be more effectively designed, implemented and sustained with communities of PLHIV and peers at the centre.
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Affiliation(s)
| | - Vuyiseka Dubula
- Centre for Civil SocietyUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Solange Baptiste
- International Treatment Preparedness CoalitionJohannesburgSouth Africa
| | - Helen Etya’ale
- International Treatment Preparedness CoalitionJohannesburgSouth Africa
| | - Omar Syarif
- Global Network of People Living with HIVAmsterdamThe Netherlands
| | - David Barr
- The Fremont CenterNew YorkUnited States of America
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Using community engagement to implement evidence-based practices for opioid use disorder: A data-driven paradigm & systems science approach. Drug Alcohol Depend 2021; 222:108675. [PMID: 33757707 PMCID: PMC8058324 DOI: 10.1016/j.drugalcdep.2021.108675] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 12/18/2022]
Abstract
Community-driven responses are essential to ensure the adoption, reach and sustainability of evidence-based practices (EBPs) to prevent new cases of opioid use disorder (OUD) and reduce fatal and non-fatal overdoses. Most organizational approaches for selecting and implementing EBPs remain top-down and individually oriented without community engagement (CE). Moreover, few CE approaches have leveraged systems science to integrate community resources, values and priorities. This paper provides a novel CE paradigm that utilizes a data-driven and systems science approach; describes the composition, functions, and roles of researchers in CE; discusses unique ethical considerations that are particularly salient to CE research; and provides a description of how systems science and data-driven approaches to CE may be employed to select a range of EBPs that collectively address community needs. Finally, we conclude with scientific recommendations for the use of CE in research. Greater investment in CE research is needed to ensure contextual, equitable, and sustainable access to EBPs, such as medications for OUD (MOUD) in communities heavily impacted by the opioid epidemic. A data-driven approach to CE research guided by systems science has the potential to ensure adequate saturation and sustainability of EBPs that could significantly reduce opioid overdose and health inequities across the US.
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15
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Afifi RA, Abdulrahim S, Betancourt T, Btedinni D, Berent J, Dellos L, Farrar J, Nakkash R, Osman R, Saravanan M, Story WT, Zombo M, Parker E. Implementing Community-Based Participatory Research with Communities Affected by Humanitarian Crises: The Potential to Recalibrate Equity and Power in Vulnerable Contexts. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:381-391. [PMID: 32797639 DOI: 10.1002/ajcp.12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Worldwide, over 70.8 million people are forcibly displaced from their homes as a result of persecution, conflict, violence, or human rights violation. In humanitarian crises, protection and the provision of basic needs are often prioritized. Research may be seen as opportunistic. However, without documenting and researching humanitarian responses, knowledge is not shared and does not accumulate, limiting the application of evidence-based interventions where they are most needed. Research in humanitarian crises is complex, both ethically and methodologically. Community-engaged research, and specifically community-based participatory research (CBPR), can address some of the challenges of research in these settings. Using case studies of research we have conducted with communities affected by humanitarian crises, we highlight challenges and opportunities of the application of the ten core principles of CBPR in humanitarian settings. Despite some challenges and barriers, CBPR is a highly effective approach to use when engaging these populations in research. We argue that the application of CBPR in these settings has the potential to recalibrate the scales of equity and power among vulnerable populations.
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Affiliation(s)
- Rima A Afifi
- Community and Behavioral Health Department, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sawsan Abdulrahim
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Theresa Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Dima Btedinni
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jenna Berent
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Laura Dellos
- Obstetrics and Gynecology Department, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Rima Nakkash
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rilwan Osman
- Maine Immigrant and Refugee Services, Lewiston, ME, USA
| | - Monisa Saravanan
- Community and Behavioral Health Department, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - William T Story
- Community and Behavioral Health Department, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | - Edith Parker
- Community and Behavioral Health Department, College of Public Health, University of Iowa, Iowa City, IA, USA
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16
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A multilevel intervention to reduce stigma among alcohol consuming men living with HIV receiving antiretroviral therapy: findings from a randomized control trial in India. AIDS 2020; 34 Suppl 1:S83-S92. [PMID: 32881797 DOI: 10.1097/qad.0000000000002604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India. DESIGN A crossover randomized controlled trial in four sites. SETTING Government ART centres (ARTCs) offering core services in the greater Mumbai area. PARTICIPANTS Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited. INTERVENTION Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each. MAIN OUTCOME MEASURE HIV stigma, measured using the 16-item Berger Stigma scale. METHODS The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression. RESULTS At baseline, 57% of participants had moderate-high levels of stigma (scores >40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: βcoeff = -9.71; p < 0.001; group intervention: βcoeff = -5.22; p < 0.001; individual counselling: βcoeff = -4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (βcoeff = -10.29; p < 0.001), followed by GI+CA+IC (βcoeff = -8.23, p < 0.001). CONCLUSION Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program.
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Abrams JA, Tabaac A, Jung S, Else-Quest NM. Considerations for employing intersectionality in qualitative health research. Soc Sci Med 2020; 258:113138. [PMID: 32574889 PMCID: PMC7363589 DOI: 10.1016/j.socscimed.2020.113138] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022]
Abstract
Intersectionality theory has recently emerged in the health sciences as a critical theoretical and methodical approach. Though some scholars have outlined explicit guidelines for applying intersectionality in research using quantitative methods, others have cited epistemological concerns and additive thinking to advocate for the analysis of intersectionality with qualitative methods. Thus, there remains a need for additional guidance and support for utilizing and applying intersectionality theory throughout the qualitative research process. With the goal of demystifying the process of utilizing intersectionality as a methodological approach in qualitative research in the health sciences, this paper provides researchers with recommendations, specific examples, and important considerations for incorporating intersectional approaches into study conceptualization, participant recruitment, data collection, and data analysis. Additionally, this paper reviews challenges that researchers may experience in conducting research using intersectional approaches and offers suggestions for overcoming challenges. This paper offers timely and relevant information that can be used to strengthen the theoretical and methodological rigor of qualitative health research, especially studies that seek to advance health equity.
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Affiliation(s)
- Jasmine A Abrams
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Ariella Tabaac
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Jung
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Nicole M Else-Quest
- Department of Women and Gender Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rice WS, Fletcher FE, Akingbade B, Kan M, Whitfield S, Ross S, Gakumo CA, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Pence BW, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Turan B, Turan JM. Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study. Int J Equity Health 2020; 19:115. [PMID: 32631424 PMCID: PMC7336413 DOI: 10.1186/s12939-020-01230-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ending the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women's perspectives on the quality of care they receive are understudied. METHODS We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis. RESULTS Themes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness). CONCLUSIONS Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.
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Affiliation(s)
- Whitney S Rice
- Department of Behavioral, Social and Health Education Sciences, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Faith E Fletcher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Busola Akingbade
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Mary Kan
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Samantha Whitfield
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shericia Ross
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Ann Gakumo
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| | - Igho Ofotokun
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Deborah J Konkle-Parker
- Department of Medicine and School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Brian W Pence
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tonya N Taylor
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mirjam-Colette Kempf
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Abayneh S, Lempp H, Hanlon C. Participatory action research to pilot a model of mental health service user involvement in an Ethiopian rural primary healthcare setting: study protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:2. [PMID: 31934350 PMCID: PMC6951014 DOI: 10.1186/s40900-019-0175-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Involvement of service-users at all levels of the mental health system is a policy imperative in many countries internationally. However, putting policy into practice seems complex; little is known about how best to involve service users and efforts are often criticized for being tokenistic. In low-and-middle income countries, less attention has been given to the roles of service users within mental health systems. The proposed study is part of a larger project intended to develop service-user involvement in mental health system strengthening in Ethiopia. A Theory of Change (ToC) model has already been developed through a participatory approach. This study protocol aims to describe the theoretical background and methods to pilot this model using participatory action research (PAR) and explore participants' experience of involvement. METHODS The proposed study will apply a PAR approach situated in critical social theory and conduct a phenomenological case study to find out participants' experience of involvement. This will be conducted in three stages. The focus of Stage 1 will be to(i) establish a Research Advisory Group (RAG), and Research Participant Group (RPG) at district and primary healthcare facility levels, respectively, and (ii) identify and prioritize potential areas of concern for involvement in the domains of advocacy, service planning and development, monitoring and improving service quality. In Stage 2, we will work with the RPG to develop a plan of action for the selected area. Stage 3 will aim to assist the RPG to implement and evaluate the plan of action. Process indicators and observation will be combined with in-depth interviews with participants to elicit their experiences of involvement. Thematic content analysis will be used. DISCUSSION The participatory approach to mental health service user involvement in health system strengthening employed by this study will support the implementation of solutions through locally relevant and contextualized actions. Findings from this study will contribute to the body of knowledge towards understanding the complexity of implementation of service user involvement and refine the ToC model for transferability to similar settings.
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Affiliation(s)
- Sisay Abayneh
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- King’s College London, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, Weston Education Centre, 10, Cutcombe Rd, London, SE5 9RJ UK
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa University, Addis Ababa, Ethiopia
- King’s College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
HIV stigma is a harmful social phenomenon present in United States (US)-based health care settings. This study assessed the efficacy of a participatory PhotoVoice-informed stigma reduction training program focusing on people living with HIV (PLWH) and targeting health care workers. Seventy-three (N = 73) participants were assessed at baseline (T1), within approximately a week of the training (T2), and at a 3-month follow-up (T3) regarding their HIV/AIDS knowledge, attitudes towards PLWH, and observations of enacted HIV stigma. Findings indicated that the training increased knowledge and improved attitudes (β = 0.56, p < 0.01; β = 0.58, p < 0.01, respectively) at T2, but these effects diminished at T3 (β = - 0.03, p > 0.05; β = - 0.29, p > 0.05, respectively). The training did not, however, have an impact on observations of enacted stigma at T2 (β = 0.10, p > 0.05) or at T3 (β = 0.02, p > 0.05). Additional participatory stigma reduction programs that involve diverse groups of health care workers, offer salient study incentives, include time-saving training methods, and comprise a variety of stigma measures, may be particularly beneficial.
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Birbeck GL, Bond V, Earnshaw V, El-Nasoor ML. Advancing health equity through cross-cutting approaches to health-related stigma. BMC Med 2019; 17:40. [PMID: 30767765 PMCID: PMC6376639 DOI: 10.1186/s12916-019-1282-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/01/2022] Open
Abstract
Health-related stigma remains a major barrier to improving health and well-being for vulnerable populations around the world. This collection on stigma research and global health emerged largely as a result of a 2017 meeting on the "The Science of Stigma Reduction" sponsored by the US National Institutes of Health (NIH). An overwhelming consensus at the meeting was reached. It was determined that for stigma research to advance further, particularly to achieve effective and scalable stigma reduction interventions, the discipline of stigma research must evolve beyond disease-specific investigations and frameworks and move toward more unified theories of stigma that transcend individual conditions. This introduction reflects on the value of taking this cross-cutting approach from both a historical and current perspective, then briefly summarizes the span of articles. Collectively, the authors apply theory, frameworks, tools, interventions and evaluations to the breadth of stigma across conditions and vulnerabilities. They present a tactical argument for a more ethical, participatory, applied and transdisciplinary line of attack on health-related stigma, alongside promoting the dignity and voice of people living with stigmatized conditions. The collection homepage can be found at http://www.biomedcentral.com/collections/stigma .
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Affiliation(s)
- Gretchen L Birbeck
- Epilepsy Division, Department of Neurology, University of Rochester, Rochester, NY, USA
- Chikankata Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Musah Lumumba El-Nasoor
- Uganda Youth Coalition on Adolescent Sexual Reproductive Health Rights and HIV, Kampala, Uganda
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