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Coulibaly K, Bousmah MAQ, Ravalihasy A, Taéron C, Mbiribindi R, Senne JN, Gubert F, Gosselin A, Desgrées du Loû A. Bridging the knowledge gap of biomedical HIV prevention tools among sub-saharan african immigrants in France. Results from an empowerment-based intervention. SSM Popul Health 2023; 23:101468. [PMID: 37560089 PMCID: PMC10407280 DOI: 10.1016/j.ssmph.2023.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Biomedical HIV prevention tools are available in France to prevent new infections. However, evidence suggests a lack of knowledge of these tools among sub-Saharan African immigrants, who are particularly affected by HIV due to social hardship, an indirect factor of HIV acquisition. We analysed the impact of an empowerment-based intervention on the knowledge of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in a population of precarious sub-Saharan African immigrants. METHODS Data were collected throughout the MAKASI project. Following an outreach approach, participants were recruited in public places based on their precarious situations and followed for six months (0, 3, 6 months) between 2018 and 2021. Participants were randomized into two groups and received an empowerment intervention sequentially (stepped wedge design). We used random-effects logistic regression models to evaluate the intervention effect on the knowledge of biomedical HIV prevention tools. ClinicalTrials.gov Identifier: NCT04468724. RESULTS The majority of the participants were men (77.5%), and almost half of them had arrived in France within 2 years prior to inclusion (49.3%). At baseline, 56% of participants knew about TasP, 6% knew about PEP and 4% knew about PrEP. Receiving the intervention increased the odds of knowing about PEP (aOR = 2.02 [1.09-3.75]; p < 0.026). Intervention effects were observed for TasP and PrEP only after 6 months. We found significant time effects for PEP (at 3 months, aOR = 4.26 [2.33-7.80]; p < 0.001; at 6 months, aOR = 18.28 [7.39-45.24]; p < 0.001) and PrEP (at 3 months, aOR = 4.02 [2.10-7.72]; p < 0.001; at 6 months, aOR = 28.33 [11.16-71.91]; p < 0.001). CONCLUSIONS We showed that the intervention increased the knowledge of biomedical HIV prevention tools. The effect of the intervention was coupled with an important time effect. This suggested that exposure to the intervention together with other sources of information contributed to increased knowledge of biomedical HIV prevention tools among precarious sub-Saharan African immigrants.
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Affiliation(s)
- Karna Coulibaly
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Marwân-al-Qays Bousmah
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | | | | | | | - Flore Gubert
- IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Anne Gosselin
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
- Institut National D’Études Démographiques, Aubervilliers, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
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McCuistian C, Peteet B, Burlew K, Jacquez F. Sexual Health Interventions for Racial/Ethnic Minorities Using Community-Based Participatory Research: A Systematic Review. HEALTH EDUCATION & BEHAVIOR 2023; 50:107-120. [PMID: 33870765 PMCID: PMC9004606 DOI: 10.1177/10901981211008378] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Racial/ethnic minorities (REMs) continue to carry the burden of sexual health disparities in the United States, including increased health risks and lower proportions of preventative care. Community-based participatory research (CBPR) has been useful in developing interventions aimed at reducing these disparities. Specifically, partnership with the target group members has resulted in more culturally relevant intervention strategies. AIM The purpose of this systematic review was to analyze the existing research on sexual health interventions targeting U.S. REMs that were developed using CBPR, to highlight the role target group members played in the development of these interventions, and to explore the benefits and outcomes of these partnerships. METHOD Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guided the search of 46 thesauri terms for CBPR, sexual health, and REMs across six databases. RESULTS The initial search yielded 805 identified studies. After applying limiters, reviewing abstracts, and doing a full-text review, 24 appropriate studies were retained. The key findings indicated significant intervention outcomes such as increased health knowledge, attitude change, and behavioral intention that could reduce sexual risk-taking behaviors. Twelve studies detailed the methods for partnering with target group members to formulate interventions, highlighting the benefits related to recruitment, retention, and cultural relevance. DISCUSSION CBPR is well-positioned to address sexual health disparities among REMs. While community partnership strategies vary, the findings yield evidence that CBPR addressing sexual health disparities is achievable, can influence the effectiveness of interventions, and should be considered as an orientation in future sexual health research.
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Coulibaly K, Gosselin A, Carillon S, Ravalihasy A, Melchior M, Ridde V, Desgrées du Loû A. Is empowerment in sexual health measurable? A scoping review of definitions and measurement indicators. Health Promot Int 2022; 37:6730779. [PMID: 36173607 DOI: 10.1093/heapro/daac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The concept of empowerment in sexual health is widely used in health promotion. This scoping review aims to identify how it is defined and measured. PubMed, Sage Journals, PsycInfo and the Web of Science are data sources. The inclusion criteria for studies were as follows: (1) an analysis of empowerment in sexual health, (2) quantitative evaluation and (3) publication in a peer-reviewed journal in French or English since January 1996. Data were extracted using a summary table of the definitions and indicators of empowerment in sexual health. Of the 2181 articles found, 29 met the inclusion criteria. Only 4 studies on 29 clearly defined empowerment in sexual health. Five dimensions emerged from the indicators used in the 29 studies in relation to sexual empowerment (social participation, participation in decision making, power to act, sexual health knowledge and gender norms), with two types of indicators: indicators unspecific to sexual health, which can be viewed as empowerment basic skills, and indicators specific to sexual health. Most studies concerned women and focused on individual empowerment, with a lack of measure of collective and structural levels of empowerment. Despite great heterogeneity in the definitions and indicators used, a set of core indicators emerged: participation in decision making, sexual negotiation power and sexual communication skills, knowledge and use of contraceptive methods, and HIV and sexually transmitted infections risk perception. This set could be systematically used in each study based on sexual empowerment concept, completed by supplementary indicators considering the specific context.
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Affiliation(s)
- Karna Coulibaly
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Anne Gosselin
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,French Institute for Demographic Studies (INED), Aubervilliers, France
| | | | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
| | - Maria Melchior
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
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Ravalihasy A, Rude N, Yazdanpanah Y, Kardas-Sloma L, Desgrées du Loû A, Gosselin A, Ridde V. Development and Validation of an HIV/AIDS Empowerment Scale for Impact Intervention Evaluation. An Example from the MAKASI Intervention. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1955230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrainolo Ravalihasy
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- UMR 1137, Inserm, University of Paris, IAME
- French Collaborative Institute on Migrations, CNRS
| | - Nathalie Rude
- UFR Santé, EA 481 Neurosciences, Université de Franche Comté
| | | | | | - Annabel Desgrées du Loû
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
| | - Anne Gosselin
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- French Collaborative Institute on Migrations, CNRS
- ERES, Social Epidemiology Unit, IPLESP, INSERM S1136
| | - Valéry Ridde
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
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Patrão AL, McIntyre TM, Costa ECV, Matediane E, Azevedo V. Testing the Effectiveness of Two Psychosocial Interventions on Socio-Cognitive Risk Factors for HIV/AIDS in Mozambican Women: A Randomized Controlled Trial. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:169-186. [PMID: 34014113 DOI: 10.1521/aeap.2021.33.3.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.
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Affiliation(s)
- Ana Luísa Patrão
- University of Porto, Portugal and Federal University of Bahia, Brazil
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Abstract
We examined the association of women empowerment and HIV testing in Nepalese women. Data from the 2012 Nepal Demographic and Health Survey provided a sample of 6,579 females ages 15-49 years. Women empowerment subcategories included participation in decision making, attitudes about safer sex negotiation, and sexual autonomy. Only 454 participants (6.9%) had been tested for HIV. Of note, 41.3% had high participation in decision making, 84.5% showed positive attitudes about safer sex negotiation, and 71.8% scored high in sexual autonomy. After adjusting potential confounders, the odds of being tested were higher for women with positive attitudes about safer sex negotiation (adjusted odds ratio = 1.444, 95% confidence interval: 1.006-2.072, p = .046) and high sexual autonomy (adjusted odds ratio = 3.138, 95% confidence interval: 1.375-7.164, p = .007). Age, education, and wealth were independent factors determining the women's HIV testing approach. Our study can be a guide for interventions and policies to empower women and encourage HIV testing in Nepal.
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Kteily-Hawa R, Hari S, Soor JK, Wong JPH, Chikermane V, Chambers LA, Vahabi M. Paradigm shifts in sexual health: Quantitative analysis of story and fact-based health education interventions. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2020. [DOI: 10.3138/cjhs.2018-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a pressing need for sex education interventions that combat stigma and increase HIV knowledge and comfort in talking about sex among Canadian South Asians. A community-based research study in the Greater Toronto Area in Ontario, Canada assessed (1) the impact of fact-based versus story-based interventions on two outcomes: knowledge of HIV/STIs and HIV-related stigma; and (2) the potential of parasocial contact to reduce HIV-related stigma. This is a peer-facilitated, mixed method intervention involving a partnership between the Alliance for South Asian AIDS Prevention (ASAAP), an organization serving South Asian and Middle Eastern people living with and affected by HIV, knowledge users, and a team of academic researchers. Eight South Asian women peer leaders were trained to help carry out the interventions. A convenience sample of 78, ages 18–60 were recruited. Participants were randomly allocated to traditional fact sheets (n = 40), and stories (n = 38). Analysis of Covariance (ANCOVA) was conducted to investigate the differences in the two outcome variables (HIV/STI knowledge and stigma) between the two study groups after the intervention controlling for differences in measures before the intervention. Adjusted mean for the HIV/STI knowledge after the intervention was significantly higher in the story-sharing group (M = 8.02, SE = .28) vs fact-based group (M = 7.13, SE = .27), F(1, 75) = 5.10, p = .027, with the small effect size, partial Π2 = .06. Similarly, a significant difference was found in the mean post-intervention stigma scores between the story-sharing group and the fact-based group, F(1, 41) = 5.03, p = .030, with moderate effect size, partial Π2 = .11. Specifically, the mean stigma scores in the story-sharing group (M = 45.75, SE = 2.72) were significantly lower than the fact-based group (M = 54.80, SE = 2.85). Story-based interventions facilitated through parasocial contact with peer leaders offer powerful potential across populations and showed promise by increasing HIV/STI knowledge, reducing HIV-related stigma, and fostering capacity building, agency and empowerment.
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Affiliation(s)
- Roula Kteily-Hawa
- Faculty of Education and Social Work, Thompson Rivers University, Kamloops, BC
- Ontario HIV Treatment Network, Toronto, ON
| | - Shriya Hari
- Alliance for South Asian AIDS Prevention, Toronto, ON
| | | | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | | | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
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Yaya S, Shibre G, Idriss-Wheeler D, Uthman OA. Women's Empowerment and HIV Testing Uptake: A Meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African Countries. Int J MCH AIDS 2020; 9:274-286. [PMID: 32742742 PMCID: PMC7384337 DOI: 10.21106/ijma.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is a growing body of evidence suggesting that women's empowerment can help achieve better health behaviours and outcomes. However, few have looked at the impact of women's empowerment on HIV testing in Sub-Saharan Africa (SSA). This study investigated the association between women's empowerment and HIV testing among women in 33 countries across SSA. METHODS Cross-sectional data from the most recent Demographic and Health Surveys (2005-2018) of 33 countries in SSA were used. Confounder adjusted logistic regression analysis was completed separately for each of the 33 DHS datasets to produce the adjusted Odds Ratio (OR) for the association between women empowerment and HIV testing. The regression analysis strictly accounted for the three design elements (weight, cluster and strata) to produce an estimate representative of the respective countries. Finally, an Individual Participant Data (IPD) meta-analysis approach was used to statistically pool the effect of women empowerment on HIV testing. RESULTS There was a wide variation in the percentage of women who were empowered among the countries studied, with only a few countries such as South Africa, Angola and Ghana having a high prevalence of negative attitudes toward wife beating. HIV testing was higher in Angola, Lesotho, Uganda and South Africa. While participation in one or two of the three decisions had been marginally associated with lower odds of HIV testing across the SSA regions (0.89; 95%CI: 0.83, 0.97); the corresponding prediction interval crossed the null. Being involved in the three decisions (0.92; 95%CI: 0.84, 1.00) and disagreement to wife-beating (0.99; 95%CI: 0.94, 1.05) had no statistical relationship with HIV testing uptake. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS The two indirect indicators of women empowerment could not predict HIV testing uptake. Further studies are recommended to establish the nature of the relationship between HIV testing and women's empowerment that is measured through standard tools.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| | - Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Gosselin A, Carillon S, Coulibaly K, Ridde V, Taéron C, Kohou V, Zouménou I, Mbiribindi R, Derche N, Desgrées du Loû A. Participatory development and pilot testing of the Makasi intervention: a community-based outreach intervention to improve sub-Saharan and Caribbean immigrants' empowerment in sexual health. BMC Public Health 2019; 19:1646. [PMID: 31805909 PMCID: PMC6896752 DOI: 10.1186/s12889-019-7943-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sub-Saharan and Caribbean immigrants are particularly affected by HIV in Europe, and recent evidence shows that a large portion of them acquired HIV after arrival. There is a need for efficient interventions that can reduce immigrants’ exposure to HIV. We describe the pilot phase of a community-based empowerment outreach intervention among sub-Saharan and Caribbean immigrants in the greater Paris area aimed at 1) constructing the intervention, 2) assessing its feasibility, and 3) assessing the feasibility of its evaluation based on a stepped-wedge approach. Methods 1) To develop the intervention, a literature review was conducted on existing interventions and participatory approaches developed, including the constitution of peer groups. 2) To assess the intervention’s feasibility, a pilot was conducted between April 2018 and December 2018. A daily register was used to collect data on sociodemographic characteristics of all persons who visited the mobile team to assess eligibility and acceptability. 3) To assess the feasibility of performing a stepped-wedge trial to evaluate the intervention, we compared eligibility, enrolment and retention at 3 months in two arms (immediate vs deferred). Chi-squared tests were used to compare reach and retention between the two arms. Results Intervention development. The Makasi intervention was designed as an outreach intervention that starts with the persons’ capacities and helps them appropriate existing resources and information and obtain knowledge about sexual health, based upon motivational interviewing techniques. Intervention Feasibility. Between April 2018 and December 2018, a total of 485 persons were identified as eligible. Participation in the intervention was proposed to 79% of eligible persons. When proposed, the persons enrolled in the intervention with a response rate of 69%. Some were lost to follow-up, and 188 persons were finally included. Evaluation Feasibility. The proportions of eligible (45 and 42%) individuals and of enrolled individuals (65 and 74%) were similar and not significantly different in the immediate and deferred arms, respectively. Conclusions A community-based outreach intervention aimed at improving sub-Saharan and Caribbean immigrants’ empowerment in sexual health is feasible. The pilot phase was key to identifying challenges, designing a relevant intervention and validating the stepped-wedge protocol for evaluation.
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Affiliation(s)
- Anne Gosselin
- French Collaborative Institute on Migrations, Paris, France. .,Department of Social Epidemiology (ERES), Pierre Louis Institute for Epidemiology and Public Health (IPLESP/ INSERM UMR_S 1136), Paris, France. .,CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.
| | - Séverine Carillon
- CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.,Solthis, Paris, France
| | - Karna Coulibaly
- CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France
| | - Valéry Ridde
- French Collaborative Institute on Migrations, Paris, France.,CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.,IRD, French Institute for Sustainable Development, Paris, France
| | | | | | | | | | | | - Annabel Desgrées du Loû
- French Collaborative Institute on Migrations, Paris, France.,CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.,IRD, French Institute for Sustainable Development, Paris, France
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Gullo S, Kuhlmann AS, Galavotti C, Msiska T, Nathan Marti C, Hastings P. Creating spaces for dialogue: a cluster-randomized evaluation of CARE's Community Score Card on health governance outcomes. BMC Health Serv Res 2018; 18:858. [PMID: 30428881 PMCID: PMC6237012 DOI: 10.1186/s12913-018-3651-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/26/2018] [Indexed: 12/02/2022] Open
Abstract
Background Social accountability interventions such as CARE’s Community Score Card© show promise for improving sexual, reproductive, and maternal health outcomes. A key component of the intervention is creation of spaces where community members, healthcare workers, and district officials can safely interact and collaborate to improve health-related outcomes. Here, we evaluate the intervention’s effect on governance constructs such as power sharing and equity that are central to our theory of change. Methods We randomly assigned ten matched pairs of communities to intervention and control arms, administering endline surveys to women in each arm who had given birth in the last 12 months. Forty-six governance items were reduced by factor analysis into eight underlying scales. We evaluated the intervention’s impact on these constructs using local average treatment effect estimates. Results Among intervention-area women who reported a community meeting, we further evaluated the influence of the governance constructs on health-related outcomes: home visit from a community health worker, modern family planning, and satisfaction with health services. A significantly greater proportion of intervention-area women compared to control reported the existence of community groups that provide and facilitate negotiated space between community members and healthcare workers (p = .003). Several governance constructs were positively associated with the health-related outcomes. Further, active participation in the intervention was also positively associated with several governance constructs. Conclusions CARE’s Community Score Card© facilitated the creation and claiming of effective and inclusive negotiated spaces in which community members and healthcare workers could vocalize service delivery issues and prioritize actions for improvement. We argue that reliable measurement of governance concepts such as power sharing, equity and quality of negotiated space, collective efficacy, and mutual responsibility will enhance our ability to evaluate social accountability interventions and understand the processes by which they affect change.
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Affiliation(s)
- Sara Gullo
- CARE USA, 151 Ellis St NE, Atlanta, GA, 30303, USA.
| | - Anne Sebert Kuhlmann
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Salus Center 309, St. Louis, MO, 63104, USA
| | | | - Thumbiko Msiska
- CARE Malawi, Pamodzi House, Private Bag A89, Lilongwe, 3, Malawi
| | - C Nathan Marti
- Far Harbor, LLC, 816 Congress Ave #1400, Austin, TX, 78701, USA
| | - Philip Hastings
- Far Harbor, LLC, 816 Congress Ave #1400, Austin, TX, 78701, USA
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An approach to building Field Epidemiology Training Programme (FETP) trainees' capacities as educators. Western Pac Surveill Response J 2018; 9:1-3. [PMID: 30377543 PMCID: PMC6194225 DOI: 10.5365/wpsar.2018.9.1.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wong JPH, Vahabi M, Miholjcic J, Tan V, Owino M, Li ATW, Poon MKL. Knowledge of HPV/cervical cancer and acceptability of HPV self-sampling among women living with HIV: A scoping review. ACTA ACUST UNITED AC 2018; 25:e73-e82. [PMID: 29507498 DOI: 10.3747/co.25.3855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer rates are disproportionately high among women living with the human immunodeficiency virus (wlhiv). Cervical cancer is preventable through hpv screening, regular Pap tests, and early cancer detection. Evidence indicates that hpv and cervical cancer screening are suboptimal among wlhiv, who face a myriad of access barriers. Considering that screening is an effective first-line defense to cervical cancer, we conducted a scoping review with the aim of gaining a better understanding about: (1) the knowledge and perceptions of hpv and cervical cancer screening among wlhiv; and (2) the acceptability of self-sampling for hpv among wlhiv. We searched five electronic databases for peer-reviewed articles that were published in English within the last ten years, reported on studies with hiv-positive women who were aged 16 or older, and satisfied the topics of the review. A total of 621 articles were found. After accounting for duplicates and unmet criteria, 17 articles and 1 abstract, reporting on studies in the United States and Africa, were included in this review. The review highlighted that most wlhiv had inadequate knowledge of hpv transmission and cervical cancer prevention, which influenced their perceptions of risk and susceptibility. Screening barriers included misconceptions about Pap tests, fear of diagnosis of serious illness, perceived pain, embarrassment, bodily modesty, and limited access to female health care providers. This review also affirms that self-sampling is an acceptable and promising screening option for wlhiv. Implications for policy, research, and practice are discussed.
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Affiliation(s)
- J P H Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - J Miholjcic
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - V Tan
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - M Owino
- Committee for Accessible aids Treatment, Toronto, ON
| | - A T W Li
- Committee for Accessible aids Treatment, Toronto, ON.,Regent Park Community Health Centre, Toronto, ON
| | - M K L Poon
- School of Social Work, York University, Toronto, ON
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Bernier A, Yattassaye A, Beaulieu-Prévost D, Otis J, Henry E, Flores-Aranda J, Massie L, Préau M, Keita BD. Empowering Malian women living with HIV regarding serostatus disclosure management: Short-term effects of a community-based intervention. PATIENT EDUCATION AND COUNSELING 2018; 101:248-255. [PMID: 28789863 DOI: 10.1016/j.pec.2017.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to assess the short-term effects of Gundo-So-a program aimed at empowering Malian women living with HIV (WLHIV) regarding serostatus disclosure management. METHODS A pre-experimental study with two measures (one week before and four weeks after Gundo-So) was carried out. A 35-item questionnaire was administered to a convenience sample of 210 WLHIV. Six outcomes were considered: ability to decide whether or not to disclose HIV status, self-efficacy to keep HIV status a secret, self-efficacy to disclose HIV status, feeling crushed by the weight of secrecy, perceived physical health, and perceived psychological health. For each outcome, temporal changes associated with the intervention were assessed using linear regressions with random intercepts. RESULTS Statistically significant change was observed for all six outcomes between the pre- and post-intervention measures. Furthermore, several variables were associated with the baseline levels of the outcomes and the intervention effect. CONCLUSION The results suggest that Gundo-So empowers Malian WLHIV with regard to serostatus disclosure management, thus improving their perceived physical and psychological health. PRACTICAL IMPLICATIONS These results highlight the need for programs to empower WLHIV regarding serostatus disclosure, so that WLHIV can make free and informed decisions regarding serostatus disclosure.
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Affiliation(s)
| | | | | | - Joanne Otis
- Sexology department, Université du Québec à Montréal, Montréal, Canada
| | | | | | - Lyne Massie
- Sexology department, Université du Québec à Montréal, Montréal, Canada
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Kellett NC, Gnauck K. The intersection of antiretroviral therapy, peer support programmes, and economic empowerment with HIV stigma among HIV-positive women in West Nile Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:341-348. [PMID: 27974024 DOI: 10.2989/16085906.2016.1241288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
HIV stigma remains a major problem of the AIDS epidemic in sub-Saharan Africa. Women fear impending social stigma including blame, isolation and abuse. HIV infection and HIV stigma interact cyclically, creating and reinforcing economic and social exclusion for individuals living with HIV. Evidence suggests that interventions for people living with HIV infection that include, in combination, antiretroviral therapy (ART), peer support and economic empowerment are likely to be more effective than if used alone. We report a qualitative study in West Nile Uganda that explored perceptions of HIV stigma among fifty-four HIV-positive women who had similar access to ART and HIV peer support programmes, but varying levels of participation (full-time, intermittent, none) in economic empowerment programmes. Our study found that access to ART, peer support groups, and economic empowerment programmes helped to curb perceptions of deep-seated HIV stigma for participants. More expressions of usefulness, hope and psychological well-being prevailed with participants who had increased participation in economic empowerment programmes. Our findings underscore the value of HIV outreach programmes which combine ART, peer support and economic empowerment to alleviate HIV stigma. Further research to quantify the interaction of these factors is warranted.
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Affiliation(s)
| | - Katherine Gnauck
- b University of New Mexico Health Sciences Center, University of New Mexico , Albuquerque , USA
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15
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Garces-Ozanne A, Kalu EI, Audas R. The Effect of Empowerment and Self-Determination on Health Outcomes. HEALTH EDUCATION & BEHAVIOR 2016; 43:623-631. [DOI: 10.1177/1090198116667665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There remains a persistent gap in health outcomes between wealthy and poor countries. Basic measures such as life expectancy and infant and under-five mortality remain divergent, with preventable deaths being unacceptably high, despite significant efforts to reduce these disparities. We examine the impact of empowerment, measured by Freedom House’s ratings of country’s political rights and civil liberties, while controlling for per capita gross domestic product, secondary school enrollment, and income inequality, on national health outcomes. Using data from 1970 to 2013 across 149 countries, our results suggest, quite strongly, that higher levels of empowerment have a significant positive association with life expectancy, particularly for females, and lower rates of infant and under-five mortality. Our results point to the need for efforts to stimulate economic growth be accompanied with reforms to increase the levels empowerment through increasing political rights and civil liberties.
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16
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Brothers J, Hotton AL, Hosek SG, Harper GW, Fernandez MI. Young Women Living with HIV: Outcomes from a Targeted Secondary Prevention Empowerment Pilot Trial. AIDS Patient Care STDS 2016; 30:229-35. [PMID: 27158851 DOI: 10.1089/apc.2015.0294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Women account for 1 in 5 new HIV infections in the US, make up 24% of people living with HIV, and represent a quarter of AIDS diagnoses. Despite the need for continued prevention among young women living with HIV, there is very little in the literature on how best to reduce sexual risk and increase the health and well-being of young women living with HIV. This article explores the primary and secondary outcomes of a randomized controlled pilot trial of an intervention entitled EVOLUTION Young Women Taking Charge and Growing Stronger. This behavioral intervention aimed to decrease sexual risk and empower young women living with HIV by enhancing young women's knowledge and skills pertaining to HIV risk reduction as well as to the factors that increase women's vulnerability, such as sexual inequality, gender, and power imbalances. Findings from this trial demonstrate that group-based behavioral interventions for young women living with HIV have promise to reduce the total number of sexual partners and reduce unprotected vaginal and anal intercourse. However, more work is needed to understand how best to address the challenges young women face in their day to day lives that impact their sexual risk as well as their overall health and access to care and treatment.
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Affiliation(s)
- Jennifer Brothers
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Anna L. Hotton
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Sybil G. Hosek
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Gary W. Harper
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - M. Isabel Fernandez
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
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"It's In My Veins": Exploring the Role of an Afrocentric, Popular Education-Based Training Program in the Empowerment of African American and African Community Health Workers in Oregon. J Ambul Care Manage 2015; 38:297-308. [PMID: 26353023 DOI: 10.1097/jac.0000000000000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The role racism and other social determinants of health play in the creation of health inequities in African American communities in the United States is increasingly understood. In this article, we explore the effectiveness of an Afrocentric, popular education-based community health worker (CHW) training program in creating positive change among CHW participants and their communities in Portland, Oregon. Findings suggest that CHW participants experienced 4 types of awakening, in addition to changes in their interaction with their family members and increased community involvement. The CHWs identified group bond, Afrocentrism, public health knowledge, popular education, facilitators, and time management as important elements of an effective training program for this community. Psychological empowerment, self-reported health status, and health behavior among participants generally increased over time, but changes were not statistically significant.
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Cyril S, Smith BJ, Renzaho AMN. Systematic review of empowerment measures in health promotion. Health Promot Int 2015; 31:809-826. [PMID: 26137970 DOI: 10.1093/heapro/dav059] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Empowerment, a multi-level construct comprising individual, community and organizational domains, is a fundamental value and goal in health promotion. While a range of scales have been developed for the measurement of empowerment, the qualities of these have not been rigorously assessed. The aim of this study was to evaluate the measurement properties of quantitative empowerment scales and their applicability in health promotion programs. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was done to evaluate empowerment scales across three dimensions: item development, reliability and validity. This was followed by assessment of measurement properties using a ratings scale with criteria addressing an a priori explicit theoretical framework, assessment of content validity, internal consistency and factor analysis to test structural validity. Of the 20 studies included in this review, only 8 (40%) used literature reviews, expert panels and empirical studies to develop scale items and 9 (45%) of studies fulfilled ≥5 criteria on the ratings scale. Two studies (10%) measured community empowerment and one study measured organizational empowerment, the rest (85%) measured individual empowerment. This review highlights important gaps in the measurement of community and organizational domains of empowerment using quantitative scales. A priority for future empowerment research is to investigate and explore approaches such as mixed methods to enable adequate measurement of empowerment across all three domains. This would help health promotion practitioners to effectively measure empowerment as a driver of change and an outcome in health promotion programs.
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Affiliation(s)
- Sheila Cyril
- School of Public Health and Preventive Medicine, Monash University, Lev 6, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Lev 6, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith 2751 NSW Australia
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19
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Mugweni E, Omar M, Pearson S. Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions. HEALTH EDUCATION RESEARCH 2015; 30:388-399. [PMID: 25503579 DOI: 10.1093/her/cyu073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage women's safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.
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Affiliation(s)
- Esther Mugweni
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Mayeh Omar
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Stephen Pearson
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
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Altman L, Kuhlmann AKS, Galavotti C. Understanding the black box: a systematic review of the measurement of the community mobilization process in evaluations of interventions targeting sexual, reproductive, and maternal health. EVALUATION AND PROGRAM PLANNING 2015; 49:86-97. [PMID: 25615599 DOI: 10.1016/j.evalprogplan.2014.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 11/08/2014] [Accepted: 11/19/2014] [Indexed: 06/04/2023]
Abstract
Community mobilization (CM) interventions are often used to improve sexual, reproductive, and maternal health (SRMH). This systematic review provides an overview of CM indicators used in evaluation and then focuses on the use of linking constructs-those measures of the process of CM between programmatic outputs and outcomes. We identified 108 English-language articles evaluating 86 CM interventions that target SRMH. Content analysis was used to code CM indicators into five categories: qualitative descriptions of CM; participation, diffusion and community action indicators that measure tangible, programmatic outputs; and linking constructs that capture the process of moving from participation to empowerment. Fifty-five (64.0%) interventions include a CM indicator. Diffusion indicators are most common (56.4%); linking constructs are least common (20.0%). We found 23 linking constructs used in evaluations of 11 interventions, with limited information on psychometric properties available. Three evaluations report positive relationships between linking constructs and condom use, one of which was significant in multivariate analysis. To better understand how CM leads to improved outcomes, we recommend increasing the measurement of linking constructs in evaluations of CM interventions. Research should focus on developing and validating new linking construct indicators and better disseminating existing measurement tools.
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Affiliation(s)
- Lara Altman
- MANILA Consulting Group, Inc., 1420 Beverly Road Suite 220, McLean, VA 22101, USA; CARE USA, 51 Ellis Street, Atlanta, GA 30303, USA.
| | - Anne K Sebert Kuhlmann
- MANILA Consulting Group, Inc., 1420 Beverly Road Suite 220, McLean, VA 22101, USA; George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA.
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21
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Successful strategies to engage research partners for translating evidence into action in community health: a critical review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2015; 2015:191856. [PMID: 25815016 PMCID: PMC4359847 DOI: 10.1155/2015/191856] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/01/2015] [Indexed: 11/18/2022]
Abstract
Objectives. To undertake a critical review describing key strategies supporting development of participatory research (PR) teams to engage partners for creation and translation of action-oriented knowledge. Methods. Sources are four leading PR practitioners identified via bibliometric analysis. Authors' publications were identified in January 1995–October 2009 in PubMed, Embase, ISI Web of Science and CAB databases, and books. Works were limited to those with a process description describing a research project and practitioners were first, second, third, or last author. Results. Adapting and applying the “Reliability Tested Guidelines for Assessing Participatory Research Projects” to retained records identified five key strategies: developing advisory committees of researchers and intended research users; developing research agreements; using formal and informal group facilitation techniques; hiring co-researchers/partners from community; and ensuring frequent communication. Other less frequently mentioned strategies were also identified. Conclusion. This review is the first time these guidelines were used to identify key strategies supporting PR projects. They proved effective at identifying and evaluating engagement strategies as reported by completed research projects. Adapting these guidelines identified gaps where the tool was unable to assess fundamental PR elements of power dynamics, equity of resources, and member turnover. Our resulting template serves as a new tool to measure partnerships.
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22
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Ramsden V, Martin R, McMillan J, Granger-Brown A, Tole B. Participatory health research within a prison setting: a qualitative analysis of ‘Paragraphs of passion’. Glob Health Promot 2014; 22:48-55. [PMID: 25312768 DOI: 10.1177/1757975914547922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 07/11/2014] [Indexed: 11/16/2022]
Abstract
The purpose of this research was to engage, empower and enhance the health and well-being of incarcerated women. The integration of primary health care, community-based participatory research, a settings approach to health promotion, and transformative action research guided the design of this study. A partnership between incarcerated women who became peer-researchers, correctional staff, and academic researchers facilitated the equitable contribution of expertise and decision-making by all partners. The study was conducted in a short sentence (two years or less), minimum/medium security Canadian women’s correctional centre. Of the approximately 200 women that joined the research team, 115 participated in writing a ‘paragraph of passion’ while incarcerated between November, 2005 and August, 2007. Participatory, inductive qualitative, narrative and content analysis were used to illuminate four themes: expertise, transformation, building self-esteem, as well as access and support. The women organized monthly health forums in the prison to share their new knowledge and life experience with other incarcerated women, correctional staff, academics, and community members, and in doing so have built bridges and relationships, some of which have lasted to the present day.
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Affiliation(s)
- Vivian Ramsden
- University of Saskatchewan – Academic Family Medicine, West Winds Primary Health Centre, Saskatoon, Saskatchewan, Canada
| | - Ruth Martin
- University of British Columbia – Family Practice, Vancouver, British Columbia, Canada
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Alarid LF, Hahl JM. Seroconversion Risk Perception Among Jail Populations. JOURNAL OF CORRECTIONAL HEALTH CARE 2014; 20:116-26. [DOI: 10.1177/1078345813518631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Leanne Fiftal Alarid
- Department of Criminal Justice, University of Texas at El Paso, El Paso, TX, USA
| | - Jeannie M. Hahl
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
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Nitsch M, Waldherr K, Denk E, Griebler U, Marent B, Forster R. Participation by different stakeholders in participatory evaluation of health promotion: a literature review. EVALUATION AND PROGRAM PLANNING 2013; 40:42-54. [PMID: 23732440 DOI: 10.1016/j.evalprogplan.2013.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 06/02/2023]
Abstract
Participatory evaluation has been increasingly used in health promotion (HP) and various forms of participatory evaluation have been put into practice. Simultaneously, the concept of participation has become more important for evaluation research in general, which is equally diverse and the subject of various discourses. This study addresses the issue of how the concept of participation has been established in HP evaluation practice. An analytical framework was developed, which served as a basis for a literature review, but can also be used as a general framework for analyzing and planning the scope of participation by various stakeholders within different phases of participatory evaluation. Three dimensions of participation, which refer to decision making (decision power, deliberation) and action processes are distinguished. The results show that only a few articles discussed participatory evaluation processes and participatory (evaluation) research was largely put forth by participatory (action) research in communities. The articles analyzed referred mostly to three stakeholder groups - evaluators, program staff and beneficiaries - and to participation processes in the initial evaluation phases. The application of the framework revealed that decision power seems to be held predominantly by program staff, evaluators seem to be more involved in action processes and beneficiaries in deliberation processes.
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Affiliation(s)
- Martina Nitsch
- Ludwig Boltzmann Institute Health Promotion Research, Untere Donaustraße 47, 1020 Vienna, Austria.
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25
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Gnauck K, Ruiz J, Kellett N, Sussman A, Sullivan MA, Montoya M, Levin N, Tomedi A, Mwanthi MA. Economic empowerment and AIDS-related stigma in rural Kenya: a double-edged sword? CULTURE, HEALTH & SEXUALITY 2013; 15:851-865. [PMID: 23668536 DOI: 10.1080/13691058.2013.789127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Economic empowerment, HIV risk and AIDS-related stigma appear intricately intertwined for women in Kenya. Their interaction must be understood in order to implement effective economic interventions that also decrease HIV risk and stigma. We conducted a qualitative study amongst women in a rural Kamba-speaking community of southeastern Kenya to pursue whether engagement in an economic empowerment initiative (a basket weaving cooperative) influences women's perspectives and experiences with HIV risk and AIDS-related stigma. We conducted seven women's focus groups: participants in the local basket-weaving cooperative comprised four focus groups and non-participants comprised the remaining three groups. The HIV status of the women was not known. Three dominant themes emerged from the focus groups: empowerment, pervasive vulnerability and unanticipated social paradoxes. Contradictions found in these themes suggest that economic empowerment can become a double-edged sword. Economic empowerment enhanced perceived individual, domestic and social community status. However, this enhancement was not protective of domestic violence and perceived HIV risk. Social perceptions may have paradoxically contributed barriers to HIV testing and treatment putting women at greater HIV risk. In conclusion, economic empowerment initiatives for women in developing countries in the context of the HIV epidemic should be coupled with peer mediated support and HIV-risk education.
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Affiliation(s)
- Katherine Gnauck
- University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, USA.
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26
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Jesmin SS, Chaudhuri S, Abdullah S. Educating women for HIV prevention: does exposure to mass media make them more knowledgeable? Health Care Women Int 2013; 34:303-31. [PMID: 23394327 DOI: 10.1080/07399332.2012.736571] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mass media is an important vehicle for health promotion in developing countries. In Bangladesh multiple media campaigns are being carried out to educate people about HIV/AIDS. We examined the extent of HIV/AIDS knowledge and the association of exposure to mass media among women in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) provides data for this article. We found that media exposure (combined index of television, radio, and newspaper) was a highly significant predictor of women's knowledge about HIV and AIDS. Other significant predictors of HIV knowledge include women's education, age, employment, and urban residence.
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Affiliation(s)
- Syeda S Jesmin
- Department of Sociology and Psychology, Division of Liberal Arts and Life Sciences, University of North Texas at Dallas, Dallas, TX 75241, USA.
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27
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Bandali S. HIV risk assessment and risk reduction strategies in the context of prevailing gender norms in rural areas of Cabo Delgado, Mozambique. J Int Assoc Provid AIDS Care 2012; 12:50-4. [PMID: 22875582 DOI: 10.1177/1545109712453937] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since minimal information exists on how individuals work within existing social norms to reduce HIV risk, this study explored the specific factors influencing men and women to reduce their HIV risk in the face of prevailing gender norms in rural villages of Cabo Delgado, Mozambique. Qualitative data were gathered from 160 participants through 29 in-depth interviews to explore gender norms, HIV risk determinants, and risk reduction responses. Results were analyzed using adaptations of grounded theory and constant comparative analysis. Men and women who actively take measures to decrease their risk of HIV infection associate a partner's acceptance of condom use and an HIV test as confirmation of emotional intimacy in the relationship. Other factors influencing risk reduction efforts include various levels of influence from family or peers, prior experience, relationship dynamics, and a reflection of broader personal outcomes.
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Affiliation(s)
- Sarah Bandali
- London School of Hygiene and Tropical Medicine, London, UK.
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28
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Hosek S, Brothers J, Lemos, and the Adolescent Medicine D. What HIV-positive young women want from behavioral interventions: a qualitative approach. AIDS Patient Care STDS 2012; 26:291-7. [PMID: 22675725 DOI: 10.1089/apc.2011.0035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Young women living with HIV in the United States face many social and psychological challenges, including involvement in health care and secondary prevention efforts. The factors that put these young women at risk for HIV acquisition initially, such as poverty, gender roles, cultural norms, and limited perceived control over sexual relationships, continue to place them at risk for both adverse mental and physical health outcomes that impact their daily lives and secondary prevention efforts. This study utilized focus groups with young HIV-positive women in order to better understand their perceived problems and pressures and to inform a developmentally appropriate secondary prevention intervention for young HIV-positive women that could be implemented in clinical care settings. Focus groups with young HIV-positive women were convened in three U.S. cities: Baltimore, Chicago, and Tampa. A total of 17 young, HIV-positive women, age range 17–24 (mean age=21), participated in the focus groups. This article describes the psychological and social challenges these young women face as well as their suggestions regarding secondary HIV prevention intervention components.
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Affiliation(s)
- Sybil Hosek
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Jennifer Brothers
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
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29
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Baffour TD, Chonody JM. Do empowerment strategies facilitate knowledge and behavioral change? The impact of family health advocacy on health outcomes. SOCIAL WORK IN PUBLIC HEALTH 2012; 27:507-519. [PMID: 22873938 DOI: 10.1080/19371918.2010.494991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study evaluates the impact of a Family Health Advocacy (FHA) intervention on 46 African American women ages 13 to 35 living in a rural southern community. FHA utilizes empowerment strategies to provide education and social support to reduce risk factors for poor pregnancy outcomes. Use of a paired t test demonstrated a statistically significant difference between pretest and posttest scores in the acquisition of knowledge of safer sex practices, alcohol consumption, early prenatal care, maternal infection, and nutrition. Behavioral change was not realized in the areas of nutrition or behaviors that cause risk of maternal infection. Social workers can influence behavioral change for at-risk populations by addressing microlevel barriers such as education and resources and macrolevel barriers such as advocacy for expanded health and social services.
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Affiliation(s)
- Tiffany D Baffour
- aCenter for Teaching and Learning, Winston-Salem State University, Winston-Salem, North Carolina 27110, USA.
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30
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Duffy L. "Step-by-step we are stronger": women's empowerment through photovoice. J Community Health Nurs 2011; 28:105-16. [PMID: 21541872 DOI: 10.1080/07370016.2011.564070] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Photovoice, as one method of participatory action research, has been used to better understand local realities and promote health in many countries and with diverse populations. It has been especially effective as a process for women to explore health and contextual issues often related to oppression and marginalization. This article discusses the impact of a photovoice process on a small group of lone mothers carrying out a community health assessment in eastern Canada. According to the women, their level of empowerment increased considerably in the 2 years of the study and their stories of the project's impact provide the evidence.
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Affiliation(s)
- Lynne Duffy
- Faculty of Nursing, University of New Brunswick, Moncton, New Brunswick, Canada.
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Wiggins N. Popular education for health promotion and community empowerment: a review of the literature. Health Promot Int 2011; 27:356-71. [PMID: 21835843 DOI: 10.1093/heapro/dar046] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While there is now general agreement that the most effective way to promote health and decrease health inequities is by creating more just economic, social and political conditions, there is much less agreement about concrete ways in which public health practitioners can work with communities to address inequities such as poverty, racism and powerlessness. Practical strategies are desperately needed. Popular education, also known as Freirian and empowerment education, has been used successfully to create more equitable conditions around the world for >50 years. Its use to improve health has been documented in the public health literature since the early 1980s. Nonetheless, it remains largely unknown and its potential unrealized in mainstream public health circles in the industrialized world. In order to explore the potential of popular education as a tool to address inequities and improve health, a systematic review of the peer-reviewed international literature was conducted. Findings revealed that popular education is an effective method for enhancing empowerment and improving health. However, the existing literature does not provide empirical evidence that popular education is more effective than traditional education at increasing health knowledge and empowerment and changing health behavior. In order to fully understand the potential of popular education as a tool to eliminate health inequities and to advocate effectively for its use, further studies are needed that utilize mixed methods, participatory approaches and experimental or quasi-experimental designs.
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Affiliation(s)
- Noelle Wiggins
- Multnomah County Health Department, Community Capacitation Center, 10317 E Burnside St., Portland, OR 97217, USA.
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Hatcher A, de Wet J, Bonell CP, Strange V, Phetla G, Proynk PM, Kim JC, Morison L, Porter JDH, Busza J, Watts C, Hargreaves JR. Promoting critical consciousness and social mobilization in HIV/AIDS programmes: lessons and curricular tools from a South African intervention. HEALTH EDUCATION RESEARCH 2011; 26:542-555. [PMID: 20965911 DOI: 10.1093/her/cyq057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants.
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Affiliation(s)
- Abigail Hatcher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA 94105, USA.
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Corbie-Smith G, Adimora AA, Youmans S, Muhammad M, Blumenthal C, Ellison A, Akers A, Council B, Thigpen Y, Wynn M, Lloyd SW. Project GRACE: a staged approach to development of a community-academic partnership to address HIV in rural African American communities. Health Promot Pract 2011; 12:293-302. [PMID: 20685913 PMCID: PMC3063323 DOI: 10.1177/1524839909348766] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The HIV epidemic is a health crisis in rural African American communities in the Southeast United States; however, to date little attention has been paid to community-academic collaborations to address HIV in these communities. Interventions that use a community-based participatory research (CBPR) approach to address individual, social, and physical environmental factors have great potential for improving community health. Project GRACE (Growing, Reaching, Advocating for Change and Empowerment) uses a CBPR approach to develop culturally sensitive, feasible, and sustainable interventions to prevent the spread of HIV in rural African American communities. This article describes a staged approach to community-academic partnership: initial mobilization, establishment of organizational structure, capacity building for action, and planning for action. Strategies for engaging rural community members at each stage are discussed; challenges faced and lessons learned are also described. Careful attention to partnership development has resulted in a collaborative approach that has mutually benefited both the academic and community partners.
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Affiliation(s)
- Giselle Corbie-Smith
- Department of Social Medicine, University of North Carolina (UNC)-Chapel Hill, Chapel Hill, NC 27599, USA.
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Omare D, Kanekar A. Determinants of HIV/AIDS in armed conflict populations. J Public Health Afr 2011; 2:e9. [PMID: 28299050 PMCID: PMC5345483 DOI: 10.4081/jphia.2011.e9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/22/2010] [Indexed: 11/24/2022] Open
Abstract
More than 40 million people worldwide have been infected with human immunodeficiency virus (HIV) since it was first reported in 1981. Over 25 million of these have lost their lives to the disease. Most of the studies related to HIV/AIDS have been conducted in stable populations across the globe. Few of these studies have been devoted to displaced populations, particularly those in areas of conflict. Displaced populations that are forced to leave their homes in most cases find themselves in unfamiliar territories, often poor and hungry. Many of them become refugees and internally displaced people (IDPs). The objective of this review was to address a number of different social determinants of HIV/AIDS in displaced populations in areas of conflict. A comprehensive review of peer reviewed literature published in English between 1990 and 2010 obtained through an open search of PUBMED database using key words such as HIV and war, HIV/AIDS and conflict, AIDS and security was conducted. Twelve different studies that looked at the implications of HIV/AIDS in conflict or displaced populations were retrieved. The review revealed that there were various factors influencing conflict and HIV/AIDS such as forced population displacement, breakdown of traditional sexual norms, lack of health infrastructure, and poverty and powerlessness of women and children. Social determinants of increased HIV/AIDS prevalence in displaced populations are scarcity of food, poverty, insecurity of displaced populations and gender power differentials.
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Affiliation(s)
- Danvas Omare
- Department of Health Studies, East Stroudsburg University of Pennsylvania, USA
| | - Amar Kanekar
- Department of Health Studies, East Stroudsburg University of Pennsylvania, USA
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Effectiveness of an HIV prevention program for women visiting their incarcerated partners: the HOME Project. AIDS Behav 2011; 15:365-75. [PMID: 20703795 PMCID: PMC3032899 DOI: 10.1007/s10461-010-9770-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Having an incarcerated partner presents a unique HIV risk for women, particularly low-income women of color. We developed a population-specific risk reduction intervention for women visiting men in prison that was peer educator-based and included individual and community-level intervention components. Women who were assessed prior to the intervention period had a positive association between the number of unprotected penetrative intercourse (UPI) episodes prior to their partners' incarceration and the number of UPI episodes following partners' release from prison. However, this association was negated among women assessed during the intervention. Intervention participants also were more likely to be tested for HIV, to have partners who got tested, and to talk with their partners about significantly more HIV-related topics. Conducting intervention and evaluation activities with women visiting incarcerated men is feasible and is a useful model for reaching more at-risk women.
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Enriquez M, Cheng AL, Kelly PJ, Witt J, Coker AD, Kashubeck-West S. Development and feasibility of an HIV and IPV prevention intervention among low-income mothers receiving services in a Missouri Day Care Center. Violence Against Women 2010; 16:560-78. [PMID: 20388931 DOI: 10.1177/1077801210366869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article outlines the development and feasibility of an HIV and IPV prevention intervention. Researchers formed a partnership with a group of women representative of the population that the intervention was intended to reach using methods derived from participatory action research. The use of health protective behaviors changed from pre- to postintervention in the clinically desirable direction. Results indicated that intervention delivery was feasible in the novel setting of a large urban day care center. This intervention has promise as a strategy to reduce HIV among low-income women; however, a controlled study is indicated to further examine intervention efficacy.
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Affiliation(s)
- Maithe Enriquez
- University of Missouri-Kansas City, 2464 Charlotte Street,Health Sciences Building Rm. 2406, Kansas City, MO 64108, USA.
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Sowell RL, Phillips KD. Understanding and responding to HIV/AIDS stigma and disclosure: an international challenge for mental health nurses. Issues Ment Health Nurs 2010; 31:394-402. [PMID: 20450341 DOI: 10.3109/01612840903497602] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Stigma and discrimination are challenges in the care and treatment of persons with HIV infection worldwide. Fear of negative social consequences often causes persons with HIV/AIDS to keep their infection secret, resulting in negative psychological and physical outcomes and continued spread of the disease. Mental health nurses have a unique opportunity to influence the trajectory of HIV/AIDS though counseling and interventions that address HIV/AIDS stigma with clients, communities, and society. This article provides an in-depth examination of HIV/AIDS stigma and its relationship to nondisclosure as well as strategies to deal with these issues at individual and group levels.
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Affiliation(s)
- Richard L Sowell
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia 30144, USA.
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Corbie-Smith G, Akers A, Blumenthal C, Council B, Wynn M, Muhammad M, Stith D. Intervention mapping as a participatory approach to developing an HIV prevention intervention in rural African American communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:184-202. [PMID: 20528128 PMCID: PMC3037273 DOI: 10.1521/aeap.2010.22.3.184] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated intervention mapping (IM) methodology with community-based participatory research (CBPR) principles to develop a multilevel, multigenerational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR.
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Weeks MR, Liao S, Li F, Li J, Dunn J, He B, He Q, Feng W, Wang Y. Challenges, strategies, and lessons learned from a participatory community intervention study to promote female condoms among rural sex workers in Southern China. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:252-271. [PMID: 20528132 PMCID: PMC2896264 DOI: 10.1521/aeap.2010.22.3.252] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
China faces a rapidly emerging HIV epidemic and nationwide resurgence of sexually transmitted infections associated with a growing sex industry. Community empowerment and capacity building through community-based participatory research partnerships show promise for developing, testing, and refining multilevel interventions suited to the local context that are effective and appropriate to address these concerns. However, such efforts are fraught with challenges, both for community collaborators and for researchers. We have built an international team of scientists from Beijing and the United States and collaborating health policy makers, health educators, and care providers from Hainan and Guangxi Province Centers for Disease Prevention and Control and the local counties and towns where we are conducting our study. This team is in the process of testing a community-wide, multilevel intervention to promote female condoms and other HIV prevention within sex-work establishments. This article presents lessons learned from our experiences in the first two study sites of this intervention trial.
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Rosenthal L, Levy SR. Understanding Women's Risk for HIV Infection Using Social Dominance Theory and the Four Bases of Gendered Power. PSYCHOLOGY OF WOMEN QUARTERLY 2010. [DOI: 10.1111/j.1471-6402.2009.01538.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Theoretical models to date have fallen short of accounting for the alarming worldwide rates of HIV infection in women through heterosexual contact. In this article, social dominance theory and the four bases of gendered power—force, resource control, social obligations, and consensual ideologies—are used to organize and explain international research findings on women's risk of contracting HIV from male sexual partners. Research suggests that the four bases of gendered power contribute to women having less power than men in heterosexual relationships, resulting in challenges to preventing HIV transmission from male partners. Social dominance theory also recognizes the intersections among various group-based hierarchies, such as race and class, thereby helping explain why women of color and low-income women are disproportionately affected by HIV. The intergroup focus of social dominance theory points to gender inequality as increasing men's risk of HIV infection as well, and the construct of social dominance orientation helps to explain individual differences in HIV risk behavior. We discuss the ways the current theoretical framework can prove useful in helping to guide future research addressing the connections between power and HIV risk, including exploring mediators and links to other theoretical models. We also discuss the implications the framework has for intervention efforts aimed at reducing HIV rates worldwide, such as supporting efforts at increasing women's representation in hierarchy-enhancing positions, incorporating empowerment issues into current interventions, promoting use of female condoms, and targeting heterosexual men for interventions.
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Martin CG, Andrade AA, Vila D, Acosta-Pérez E, Canino G. The development of a community-based family asthma management intervention for Puerto Rican children. Prog Community Health Partnersh 2010; 4:315-24. [PMID: 21169709 PMCID: PMC3113604 DOI: 10.1353/cpr.2010.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Puerto Rican children maintain disproportionately high asthma prevalence rates and effective asthma management interventions are needed. OBJECTIVES This article describes how community-based participatory research (CBPR) was implemented in the development of a culturally tailored family asthma management intervention for Puerto Rican children: CALMA (a Spanish acronym for Take Control, Empower Yourself, and Achieve Asthma Management). METHOD CALMA was developed according to CBPR principles and contemporary asthma guidelines through the collaboration of diverse members of the local, professional, and medical communities, academia, and local government. All group members contributed unique perspectives, making CALMA's development a collaborative effort. LESSONS LEARNED The CALMA community dealt with challenges in both incorporating and managing a diverse group of stakeholders and maintaining equity in decision making power. However, the community maintained strengths, such as incorporating culturally accepted remedies and addressing culturally specific myths in the intervention, as well as having the medical community directly involved in overseeing the accuracy of the intervention. CONCLUSION A CBPR approach enhanced the cultural sensitivity of the intervention as well as its potential for sustainability.
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Affiliation(s)
- Christina Gamache Martin
- Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus San Juan, Puerto Rico
| | | | - Doryliz Vila
- Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus San Juan, Puerto Rico
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus San Juan, Puerto Rico
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Martin RE, Murphy K, Chan R, Ramsden VR, Granger-Brown A, Macaulay AC, Kahlon R, Ogilvie G, Hislop TG. Primary health care: applying the principles within a community-based participatory health research project that began in a Canadian women’s prison. Glob Health Promot 2009; 16:43-53. [DOI: 10.1177/1757975909348114] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: the purpose of this research was to determine the feasibility of engaging incarcerated women in community-based participatory research and to identify, by and with the women, the health concerns to be addressed. Design: the integration of primary health care, community-based participatory research, a settings approach to health promotion and transformative action research guided the overall design of this study. Participants: Incarcerated women, correctional centre staff and academic researchers participated collaboratively. Setting. The study was conducted in the main short sentence (two years or less) minimum/medium security women’s correctional centre in a Canadian province. Results: In-depth interviews were conducted with 16 incarcerated women; in-depth group interviews were facilitated with 16 correctional centre staff. Twenty-one themes, which emerged from participatory, inductive and content analysis of the data, were presented at a face-to-face meeting attended by 120 incarcerated women, 10 correctional centre staff and 5 academic researchers. Underlying values and principles for the project were identified prior to a discussion of the results. During the course of this meeting, the themes were converged into five major categories: addictions and mental health; HIV, hepatitis and infections; health care in prison; life skills and re-entry into society (including homelessness and housing); and children, family and relationships. Numerous suggestions for health interventions and participatory projects were generated, each relating to one of the five major categories. Conclusions: this study was unique in that, to our knowledge, no other studies have utilized community-based participatory research methods in which incarcerated women played a role in designing the research questions and tools, collecting the data, analyzing the data, interpreting the data and authoring the publications and presentations. This study demonstrated that it is feasible for incarcerated women to engage in developing and utilizing community-based participatory research methods and that these methods can be grounded in a settings approach to whole prison health promotion. (Global Health Promotion, 2009; 16 (4): pp. 43—53)
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Affiliation(s)
| | - Kelly Murphy
- Women into Healing: Community-based peer researchers, BC Women's Hospital, Canada
| | - Rene Chan
- Women into Healing: Community-based peer researchers, BC Women's Hospital, Canada
| | - Vivian R. Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Canada
| | | | | | - Roopjeet Kahlon
- Department of Family Practice, University of British Columbia
| | - Gina Ogilvie
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Canada
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Gregg J, Centurion T, Aguillon R, Maldonado J, Celaya-Alston R. Beliefs About the Pap Smear Among Mexican Immigrants. J Immigr Minor Health 2009; 13:899-905. [DOI: 10.1007/s10903-009-9301-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wiggins N, Johnson D, Avila M, Farquhar SA, Michael YL, Rios T, Lopez A. Using popular education for community empowerment: perspectives of Community Health Workers in thePoder es Salud/Power for Health program. CRITICAL PUBLIC HEALTH 2009. [DOI: 10.1080/09581590802375855] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Elwood Martin R, Murphy K, Hanson D, Hemingway C, Ramsden V, Buxton J, Granger-Brown A, Condello LL, Buchanan M, Espinoza-Magana N, Edworthy G, Hislop TG. The development of participatory health research among incarcerated women in a Canadian prison. Int J Prison Health 2009; 5:95-107. [PMID: 25759141 PMCID: PMC2704626 DOI: 10.1080/17449200902884021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This paper describes the development of a unique prison participatory research project, in which incarcerated women formed a research team, the research activities and the lessons learned. The participatory action research project was conducted in the main short sentence minimum/medium security women's prison located in a Western Canadian province. An ethnographic multi-method approach was used for data collection and analysis. Quantitative data was collected by surveys and analysed using descriptive statistics. Qualitative data was collected from orientation package entries, audio recordings, and written archives of research team discussions, forums and debriefings, and presentations. These data and ethnographic observations were transcribed and analysed using iterative and interpretative qualitative methods and NVivo 7 software. Up to 15 women worked each day as prison research team members; a total of 190 women participated at some time in the project between November 2005 and August 2007. Incarcerated women peer researchers developed the research processes including opportunities for them to develop leadership and technical skills. Through these processes, including data collection and analysis, nine health goals emerged. Lessons learned from the research processes were confirmed by the common themes that emerged from thematic analysis of the research activity data. Incarceration provides a unique opportunity for engagement of women as expert partners alongside academic researchers and primary care workers in participatory research processes to improve their health.
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Affiliation(s)
- R Elwood Martin
- Department of Family Practice, University of British Columbia
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Collins PY, Elkington KS, von Unger H, Sweetland A, Wright ER, Zybert PA. Relationship of stigma to HIV risk among women with mental illness. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2008; 78:498-506. [PMID: 19123772 DOI: 10.1037/a0014581] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Urban women with severe mental illness (SMI) are vulnerable to stigma and discrimination related to mental illness and other stigmatized labels. Stigma experiences may increase their risk for negative health outcomes, such as HIV infection. This study tests the relationship between perceived stigma and HIV risk behaviors among women with SMI. The authors interviewed 92 women attending community mental health programs using the Stigma of Psychiatric Illness and Sexuality Among Women Questionnaire. There were significant relationships between personal experiences of mental illness and substance use accompanying sexual intercourse; perceived ethnic stigma and having a riskier partner type; and experiences of discrimination and having a casual or sex-exchange partner. Higher scores on relationship stigma were associated with a greater number of sexual risk behaviors. The findings underscore the importance of exploring how stigma attached to mental illness intersects with other stigmatized labels to produce unique configurations of HIV risk. HIV risk reduction interventions and prevention research should integrate attention to stigmatized identities in the lives of women with SMI.
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Affiliation(s)
- Pamela Y Collins
- Department of Epidemiology, Columbia University, New York, NY 10032, USA.
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