Community health nurses' HIV care behavior

Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories

BACKGROUND

There is an important gap between the implications of clinical research evidence and the routine clinical practice of healthcare professionals. Because individual decisions are often central to adoption of a clinical-related behaviour, more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals. The aim of this study was to systematically review the published scientific literature about factors influencing health professionals' behaviours based on social cognitive theories. These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations.

METHODS

We searched psycINFO, MEDLINE, EMBASE, CIHNAL, Index to theses, PROQUEST dissertations and theses and Current Contents for articles published in English only. We included studies that aimed to predict healthcare professionals' intentions and behaviours with a clear specification of relying on a social cognitive theory. Information on percent of explained variance (R(2)) was used to compute the overall frequency-weighted mean R(2) to evaluate the efficacy of prediction in several contexts and according to different methodological aspects. The cognitive factors most consistently associated with prediction of healthcare professionals' intention and behaviours were documented.

RESULTS

Seventy eight studies met the inclusion criteria. Among these studies, 72 provided information on the determinants of intention and 16 prospective studies provided information on the determinants of behaviour. The theory most often used as reference was the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB). An overall frequency-weighted mean R(2) of 0.31 was observed for the prediction of behaviour; 0.59 for the prediction of intention. A number of moderators influenced the efficacy of prediction; frequency-weighted mean R(2) varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention.

CONCLUSION

Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention. In addition, given the variations in efficacy of prediction, special care should be given to methodological issues, especially to better define the context of behaviour performance.

HIV/AIDS and health care workers: contact with patients and attitudes towards them

Data on a range of variables associated with contact with patients with HIV/AIDS and attitudes towards them were collected from 174 Scottish health care workers. Measures of attitudes and contact (overall, social and physical) were derived from the scales devised by Pleck et al. (1988). The measure of overall contact was not significantly related to attitudes, but those with predominantly social contact with patients with HIV/AIDS had more positive attitudes towards them. This relationship was moderated by occupational characteristics, concern about working with people of unknown HIV status and neuroticism. With all these variables controlled, including social contact, those who had not received in-service training relating to HIV/AIDS had more negative attitudes. The results are discussed with regard to the measurement of social contact with patients, salient beliefs, the occupational characteristics associated with attitudes, and in-service education.

Predictors of quality of life in AIDS patients

BACKGROUND

While much work has been completed in relation to measuring and defining the varying dimensions of quality of life in HIV/AIDS, very little research attention has been directed toward identifying factors that influence or enhance quality of life.

OBJECTIVE

This study examined whether variables relating to demographic characteristics, severity of illness, psychological status, or level of engagement in nursing care would predict quality of life in persons with advanced or late stage HIV/AIDS.

METHODS

A convenience sample of 162 hospitalized male and female patients with AIDS participated in this study. The participants completed the HIV Symptom Checklist, the Beck Depression Inventory, the HIV-QAM (a measure of changes in the status of hospitalized AIDS patients due to nursing care), and two measures of engagement in nursing care. The Living With HIV Scale was used as the measure of quality of life. The two components of this scale were analyzed independently.

RESULTS

The strongest predictor of decreased quality of life scores was depression (accounting for 23% of the variance), with symptoms accounting for 9.75% and female gender accounting for an additional 8%. Two measures of patient engagement with nursing care providers contributed a total of 13.44% of the variance in quality of life scores.

CONCLUSIONS

The findings emphasize the importance of recognizing and treating depression in persons with HIV/AIDS. The number of symptoms and their frequency also has a profound effect on quality of life. Although modest, study findings suggest that quality of life for an acutely ill, hospitalized patient with AIDS is enhanced through more active involvement or engagement in the process of nursing care.

Predictors of rural critical care nurses' willingness to care for people with AIDS

The purpose of this study was to examine the relationship between rural critical care nurses' attitudes about acquired immunedeficiency syndrome (AIDS) and people with AIDS (PWAs), and their willingness to provide care to AIDS patients. Sixty-one critical care nurses in nine rural counties in the northeastern USA completed a mailed questionnaire as part of a larger study of 957 rural nurses. A bivariate logistic regression analysis revealed a relationship between willingness to provide care and positive attitudes about homosexuality, nursing care concerns, and professional-societal concerns. However, a multivariate logistic regression indicated that the most significant factors influencing rural critical care nurses' willingness to care were their feelings of not being prepared to care for people with AIDS, and their anxiety and fears about contracting the disease from their patients. These findings add insight into the care of critically ill AIDS patients and support the need for continuing educational efforts in rural areas of the USA to address critical care nurses' concerns.

Personal and social determinants of rural nurses' willingness to care for persons with AIDS

The purpose of this study was to investigate the individual and social determinants of rural nurses' willingness to care for people with AIDS (PWAs). Willingness to care was viewed as a function of nurses' personal attitudes about AIDS care and PWAs; the influence of normative (significant others), comparative (the nursing profession), and generalized (the rural community) reference group norms on these attitudes; and how much importance respondents placed on membership in these reference groups. Responses to a mailed questionnaire from 615 rural nurses were analyzed. Individual determinants were nurses' feelings of preparedness and favorable attitudes about their personal safety when administering care. Social determinants were the degree of upset of respondents' significant others about their caring for AIDS patients and favorable attitudes of the respondents about professional and social concerns related to AIDS.

People with HIV/AIDS: who cares?

Studies have shown that some nurses, doctors and other carers have negative attitudes towards people with human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Some cope by avoiding working with such patients, while others just do the best they can. But does it matter? This paper describes a review of the literature on the impact of attitudes to care and the barriers affecting the quality of care for people with HIV/AIDS by professional health care workers and other carers. Most of the reports identified were based on attitude scales, mostly unique and often unvalidated. Attitudes of health care workers based in the community, and 'house keeping' staff such as porters, receptionists, etc., have been neglected areas of research. There is also little information about the culture of organizations and the attitudes of individuals with HIV/AIDS to care. Only three references were found in which both patients' and carers' attitudes to each other were considered and none of these looked at negative feelings and their impact. There is scope therefore to investigate the attitudes of patients and carers towards each other and how this can effect the quality of care. It is anticipated that the benefits of such investigations could lead to the development of educational strategies designed to improve the quality of patient care.