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Norr KF, Banda CK, Chang C, Krishna S, Kumbani LC, Liu L, McCreary LL, Patil CL. Condom use increased after a peer group intervention implemented by community volunteers in Malawi. Res Sq 2023:rs.3.rs-3120974. [PMID: 37461672 PMCID: PMC10350185 DOI: 10.21203/rs.3.rs-3120974/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. Methods Three communities sequentially rolled out the program. Effectiveness was evaluated using repeated surveys. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 776) and condom use at last sex (N = 880). For each indicator, the sample included all sexually active persons answering that question at one or more time points. Regression analyses were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. Results This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final regression models. Other predictors of greater condom use for at least one condom use indicator included younger age group (13-19), male gender, not married/cohabiting, high involvement in religiously affiliated activities, higher safer sex self-efficacy, and greater partner communication. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. Conclusions This community engaged implementation study found that an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Leveraging community strengths and human capital resources facilitated implementation of this effective HIV prevention program in rural Malawi. Community ownership and program delivery by trained local volunteers offers an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening heathcare systems in sub. Trial registration Clinical Trials.gov NCT02765659 Registered May 6, 2016.
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Affiliation(s)
| | | | - Cecilia Chang
- School of Public Health, University of Illinois Chicago
| | | | | | - Li Liu
- School of Public Health, University of Illinois Chicago
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Uwizeye G, DeVon HA, McCreary LL, Patil CL, Thayer ZM, Rutherford JN. Children born of genocidal rape: What do we know about their experiences and needs? Public Health Nurs 2021; 39:350-359. [PMID: 34881464 DOI: 10.1111/phn.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An often under addressed and tragic legacy of genocide is the conception of children from rape. While the experience has been documented from their mothers' perspective, the perspectives and needs of individuals born of genocidal rape has been under-studied. METHODS We conducted an integrative review of all peer-reviewed articles that reported on studies conducted among individuals born of genocidal rape published through 2020. We used an inductive process to identify and describe the themes from those studies. RESULTS Twelve studies met the inclusion criteria. Ten articles reported on youth born of genocidal rape in Rwanda aged between 16 and 21 years, and two articles represented the perspective of adolescents in the former Yugoslavia aged 1416 years. Four themes were indentified: (1) birth origin stories associated with the crime of the father, (2) fractured sense of belonging to the victim-mother, perpetrator-father, their families, and the community at large, (3) intergenerational legacy of trauma and family identity, and (4) strategies to move forward including knowing the truth about one's origin, mental health, and peer support. CONCLUSION These findings suggest that understanding increased risk of adverse health outcomes of youth born of genocidal rape could inform the design of evidence-based interventions for these and similar populations.
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Affiliation(s)
- Glorieuse Uwizeye
- Society of Fellows, Dartmouth College, Hanover, New Hampshire, USA.,Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | - Linda L McCreary
- Global Health I PAHO/WHO Collaborating Centre for International Nursing Development in Primary Health Care, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA.,Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Zaneta M Thayer
- Society of Fellows, Dartmouth College, Hanover, New Hampshire, USA.,Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Julienne N Rutherford
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Jeremiah RD, Patel DR, Chirwa E, Kapito E, Mei X, McCreary LL, Norr KF, Liu L, Patil CL. A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania. BMC Pregnancy Childbirth 2021; 21:790. [PMID: 34819018 PMCID: PMC8611988 DOI: 10.1186/s12884-021-04267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.
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Affiliation(s)
- Rohan D Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, USA.
| | - Dhruvi R Patel
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Xiaohan Mei
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Kathleen F Norr
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Li Liu
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, Chicago, USA
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Kittiteerasack P, Matthews AK, Steffen A, Corte C, McCreary LL, Bostwick W, Park C, Johnson TP. The influence of minority stress on indicators of suicidality among lesbian, gay, bisexual and transgender adults in Thailand. J Psychiatr Ment Health Nurs 2021; 28:656-669. [PMID: 33190351 DOI: 10.1111/jpm.12713] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Established research from the United States and other Western countries has found that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. Suicidality among LGBT individuals is understudied in Thailand and other Asian countries, warranting additional research to better understand risk factors and to create effective treatment and suicide prevention interventions. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The study examined rates and predictors of suicidality in Thai LGBT adults. Study findings suggest that general (e.g. stress and loneliness) and minority stressors (e.g. discrimination and victimization) played important roles in predicting lifetime and past-year suicidal ideation, while socio-demographic and health-related factors (e.g. living in high poverty area and having chronic diseases) were associated with suicide attempts among LGBT individuals. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Changes in the nursing curriculum and continuing education resources are needed to improve knowledge and core competencies in the mental health and treatment needs of LGBT individuals in Thailand. Among LGBT serving practitioners, routine assessment of suicidality is needed to increase the early identification and treatment of individual at risk for suicidal behaviours. Standardized measures of sexual orientation and gender identity should be included in all patient intake forms. In conducting research on strategies to improve mental health outcomes among LGBT populations, standardized measures of sexual orientation/gender identity and minority-specific stressors should be used. Suicide prevention interventions aimed at reducing general and minority stress among LGBT populations should be a priority in mental health nursing. ABSTRACT INTRODUCTION: A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. AIM To examine rates and predictors of suicidality among Thai LGBT adults (N = 411). METHOD Data collection was conducted via online and in-person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health-related factors, general and minority-specific stressors and suicidality were completed. RESULTS Thirty-nine per cent of participants reported lifetime suicidal ideation, 19.0% past 12-month suicidal ideation and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness and chronic disease (OR = 1.12, 1.16, 2.75, and 1.46, p ≤ .05, R2 = 0.327). Past-year suicidal ideation was associated with victimization, stress, loneliness and being a former smoker (OR = 1.52, 1.20, 2.34, and 4.89, p < .05, R2 = 0.345). Suicide attempts were associated with internalized homophobia, poverty, chronic disease, alcohol use and physical health (OR = 1.44, 1.06, 1.59, 1.45 and 0.95, p ≤ 0.05, R2 = 0.187). DISCUSSION General and minority-specific stressors negatively impacted suicidality among LGBT participants. IMPLICATION FOR PRACTICE Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals.
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Affiliation(s)
| | - Alicia K Matthews
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Alana Steffen
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Colleen Corte
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Linda L McCreary
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Wendy Bostwick
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Timothy P Johnson
- College of Urban Planning and Public Affairs, The University of Illinois at Chicago, Chicago, IL, USA
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Uwizeye G, Thayer ZM, DeVon HA, McCreary LL, McDade TW, Mukamana D, Park C, Patil CL, Rutherford JN. Double Jeopardy: Young adult mental and physical health outcomes following conception via genocidal rape during the 1994 genocide against the Tutsi in Rwanda. Soc Sci Med 2021; 278:113938. [PMID: 33905987 DOI: 10.1016/j.socscimed.2021.113938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/15/2022]
Abstract
Rwandans conceived by rape during the 1994 genocide against the Tutsi have endured a violent beginning and a troubled childhood. Given compelling evidence of the influence of prenatal environments and adverse childhood experiences (ACEs) on future health, these individuals are at high risk of poor mental and physical health outcomes. The purpose of the study was to characterize mental and physical health outcomes in young adults who were exposed prenatally to maternal stress due to the genocide in general and those conceived by genocidal rape, and to determine whether ACEs compound these effects. Ninety-one 24-year-old Rwandans - 30 conceived by genocidal rape, 31 born of genocide survivors not raped, and a control group of 30 born of women with neither exposure - completed the Adverse Childhood Experiences International Questionnaire and measures of multiple physical and mental health characteristics. Data were collected from March 7 to April 6, 2019. Findings demonstrated that 1) individuals conceived during the genocide had poorer mental function (p = 0.002) and higher scores in post-traumatic stress disorder (PTSD), anxiety, depression, physical function, pain intensity, and sleep disturbance compared to young adults who were not exposed to genocide (all p < 0.033); 2) individuals conceived by genocidal rape reported more depression, PTSD, and pain interference compared to those prenatally exposed to maternal genocide stress only (all p < 0.008); and 3) among the group conceived via genocidal rape, the effects of prenatal exposures on depression, physical function, pain intensity and pain interference were exacerbated by ACEs (all p < 0.041). Being conceived during genocide, especially through genocidal rape, is associated with poor adult physical and mental health. The role of ACEs in exacerbating prenatal genocide exposure highlights opportunities for interventions to reduce these effects.
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Affiliation(s)
- Glorieuse Uwizeye
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA; Society of Fellows, Dartmouth College, Hanover, NH, 03755, USA; Department of Anthropology, Dartmouth College, 3 Tuck Drive, Silsby Hall, Hanover, NH, 03755, USA.
| | - Zaneta M Thayer
- Society of Fellows, Dartmouth College, Hanover, NH, 03755, USA; Department of Anthropology, Dartmouth College, 3 Tuck Drive, Silsby Hall, Hanover, NH, 03755, USA.
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, 700 Tiverton Ave., Los Angeles, CA, 90095, USA.
| | - Linda L McCreary
- Department Health Systems Science, College of Nursing University of Illinois at Chicago, 845 S. Damen Ave., MC 802, Chicago, Ilinois, 60612, USA.
| | - Thomas W McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, 1810 Hinman Avenue, Evanston, IL, 60208, USA.
| | - Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda.
| | - Chang Park
- Department Health Systems Science, College of Nursing University of Illinois at Chicago, 845 S. Damen Ave., MC 802, Chicago, Ilinois, 60612, USA.
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA.
| | - Julienne N Rutherford
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA.
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Pearson T, Chandler R, McCreary LL, Patil CL, McFarlin BL. Perceptions of African American Women and Health Care Professionals Related to Pre-Exposure Prophylaxis to Prevent HIV. J Obstet Gynecol Neonatal Nurs 2020; 49:571-580. [PMID: 32822648 DOI: 10.1016/j.jogn.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To describe the perceptions of African American women and health care professionals (HCPs) about factors that likely influence the use of pre-exposure prophylaxis (PrEP) to prevent HIV among African American women. DESIGN Prospective mixed methods. SETTING Chicago, IL. PARTICIPANTS Fifty-eight participants included HCPs (n = 10) and African American women (n = 48). METHODS Following the six steps of concept mapping, participants identified and rated factors they perceived to influence decisions to use PrEP among African American women. RESULTS African American women generated a list of statements, and we grouped the statements into eight clusters: access, financial, best benefits, protection, medication, setbacks, network, and fear. HCPs ranked having an HIV-positive partner as the most influential factor that affected African American women's decisions to use PrEP (network cluster). African American women ranked ability to prevent HIV when condom use cannot be negotiated as their top reason (best benefits cluster) for using PrEP. CONCLUSION African American women wanted to know how they could protect themselves and were open to using PrEP. For African American women considering the use of PrEP, the most influential factors were related to the benefits and accessibility of PrEP. HCPs should know that African American women are not afraid to discuss HIV risk and testing.
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Chirwa E, Kapito E, Jere DL, Kafulafula U, Chodzaza E, Chorwe-Sungani G, Gresh A, Liu L, Abrams ET, Klima CS, McCreary LL, Norr KF, Patil CL. An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi. BMC Public Health 2020; 20:205. [PMID: 32039721 PMCID: PMC7008527 DOI: 10.1186/s12889-020-8276-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes. METHODS Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. DISCUSSION This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.
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Affiliation(s)
- Ellen Chirwa
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Esnath Kapito
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Diana L Jere
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Ursula Kafulafula
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Elizabeth Chodzaza
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | | | - Ashley Gresh
- Johns Hopkins University, School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Li Liu
- University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street (M/C 932), Chicago, IL, 60612, USA
| | - Elizabeth T Abrams
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Carrie S Klima
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Linda L McCreary
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Kathleen F Norr
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Crystal L Patil
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA.
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McCreary LL, Jere D, Patil C, Norr K. An implementation model to guide rural Malawian communities in the scaling-up of an effective HIV prevention programme: an implementation science study. The Lancet Global Health 2019. [DOI: 10.1016/s2214-109x(19)30107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jaigarun P, Corte C, McCreary LL, Finnegan L, Hughes TL, Thorkildsen T. Attributes of the drinker prototype among Thai adolescents. Cogent Psychology 2018. [DOI: 10.1080/23311908.2018.1502501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Patcharee Jaigarun
- Boromarajonani College of Nursing, Sanpasithiprasong, Ubon Ratchathani, Thailand
| | - Colleen Corte
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Linda L. McCreary
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Lorna Finnegan
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Cancedda C, Cotton P, Shema J, Rulisa S, Riviello R, Adams LV, Farmer PE, Kagwiza JN, Kyamanywa P, Mukamana D, Mumena C, Tumusiime DK, Mukashyaka L, Ndenga E, Twagirumugabe T, Mukara KB, Dusabejambo V, Walker TD, Nkusi E, Bazzett-Matabele L, Butera A, Rugwizangoga B, Kabayiza JC, Kanyandekwe S, Kalisa L, Ntirenganya F, Dixson J, Rogo T, McCall N, Corden M, Wong R, Mukeshimana M, Gatarayiha A, Ntagungira EK, Yaman A, Musabeyezu J, Sliney A, Nuthulaganti T, Kernan M, Okwi P, Rhatigan J, Barrow J, Wilson K, Levine AC, Reece R, Koster M, Moresky RT, O’Flaherty JE, Palumbo PE, Ginwalla R, Binanay CA, Thielman N, Relf M, Wright R, Hill M, Chyun D, Klar RT, McCreary LL, Hughes TL, Moen M, Meeks V, Barrows B, Durieux ME, McClain CD, Bunts A, Calland FJ, Hedt-Gauthier B, Milner D, Raviola G, Smith SE, Tuteja M, Magriples U, Rastegar A, Arnold L, Magaziner I, Binagwaho A. Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda. Int J Health Policy Manag 2018; 7:1024-1039. [PMID: 30624876 PMCID: PMC6326644 DOI: 10.15171/ijhpm.2018.61] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/19/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
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Affiliation(s)
- Corrado Cancedda
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phil Cotton
- Office of the Vice-Chancellor, University of Rwanda, Kigali, Rwanda
| | - Joseph Shema
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Stephen Rulisa
- Office of the Dean, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa V. Adams
- Center for Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Paul E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeanne N. Kagwiza
- Office of the Principal, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University - Western Campus, Ishaka, Uganda
| | - Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Chrispinus Mumena
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David K. Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lydie Mukashyaka
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Esperance Ndenga
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Theogene Twagirumugabe
- Department of Anesthesiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kaitesi B. Mukara
- Department of Ear, Nose, and Throat, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Vincent Dusabejambo
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Timothy D. Walker
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Department of General Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Emmy Nkusi
- Department of Neurosurgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lisa Bazzett-Matabele
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alex Butera
- Department of Orthopedic Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Belson Rugwizangoga
- Department of Pathology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Kabayiza
- Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Simon Kanyandekwe
- Department of Mental Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Louise Kalisa
- Department of Radiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Faustin Ntirenganya
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Tanya Rogo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Pediatrics, BronxCare Health System, Bronx, NY, USA
| | - Natalie McCall
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Mark Corden
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rex Wong
- Global Health Leadership Institute, Yale School of Public Health, New Haven, CT, USA
| | - Madeleine Mukeshimana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Agnes Gatarayiha
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Preventive and Community Dentistry, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Egide Kayonga Ntagungira
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Attila Yaman
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
| | | | | | - Peter Okwi
- Clinton Health Access Initiative, Kigali, Rwanda
| | - Joseph Rhatigan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jane Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Kim Wilson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebecca Reece
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Koster
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel T. Moresky
- sidHARTe Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Jennifer E. O’Flaherty
- Department of Anesthesiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Paul E. Palumbo
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Rashna Ginwalla
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Nathan Thielman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Michael Relf
- Duke Global Health Institute, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Rodney Wright
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, New York City, NY, USA
- Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, New York City, NY, USA
| | - Mary Hill
- Division of Nursing, Howard University College of Nursing and Allied Health Sciences, Washington, DC, USA
| | - Deborah Chyun
- University of Connecticut School of Nursing, Storrs, CT, USA
| | - Robin T. Klar
- New York University Rory Meyers College of Nursing, New York City, NY, USA
| | - Linda L. McCreary
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, New York City, NY, USA
| | - Marik Moen
- Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Global Education and Mentorship, Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Valli Meeks
- Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Beth Barrows
- Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Partnerships, Professional Education, and Practice, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marcel E. Durieux
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Craig D. McClain
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Amy Bunts
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Forrest J. Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Danny Milner
- Center for Global Health, American Society for Clinical Pathology, Chicago, IL, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Stacy E. Smith
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Meenu Tuteja
- Global Health and Research Programs, Biomedical Research Institute, Brigham and Women’s Hospital, Boston MA, USA
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Asghar Rastegar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Linda Arnold
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
- Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda
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11
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Jere DLN, Banda CK, Kumbani LC, Liu L, McCreary LL, Park CG, Patil CL, Norr KF. A hybrid design testing a 3-step implementation model for community scale-up of an HIV prevention intervention in rural Malawi: study protocol. BMC Public Health 2018; 18:950. [PMID: 30071866 PMCID: PMC6090759 DOI: 10.1186/s12889-018-5800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Scaling-up evidence-based behavior change interventions can make a major contribution to meeting the UNAIDS goal of no new HIV infections by 2030. We developed an evidence-based peer group intervention for HIV prevention and testing in Malawi that is ready for wider dissemination. Our innovative approach turns over ownership of implementation to rural communities. We adapted a 3-Step Implementation Model (prepare, roll-out and sustain) for communities to use. Using a hybrid design, we simultaneously evaluate community implementation processes and program effectiveness. METHODS Three communities in southern Malawi begin implementation in randomly-assigned order using a stepped wedge design. Our evaluation sample size of 144 adults and 144 youth per community provides sufficient power to examine primary outcomes of condom use and HIV testing. Prior to any implementation, the first participants in all three communities are recruited and complete the Wave 1 baseline survey. Waves 2-4 surveys occur after each community completes roll-out. Each community follows the model's three steps. During Prepare, the community develops a plan and trains peer group leaders. During Roll-Out, peer leaders offer the program. During Sustain, the community makes and carries out plans to continue and expand the program and ultimately obtain local funding. We evaluate degree of implementation success (Aim 1) using the community's benchmark scores (e.g, # of peer groups held). We assess implementation process and factors related to success (Aim 2) using repeated interviews and observations, benchmarks from Aim 1 and fidelity assessments. We assess effectiveness of the peer group intervention when delivered by communities (Aim 3) using multi-level regression models to analyze data from repeated surveys. Finally, we use mixed methods analyses of all data to assess feasibility, acceptability and sustainability (Aim 4). DISCUSSION The project is underway, and thus far the first communities have enthusiastically begun implementation. We have had to make several modifications along the way, such as moving from rapid-tests of STIs to symptoms screening by a nurse due to problems with test reliability and availability. If successful, results will provide a replicable evidence-based model for future community implementation of this and other health interventions. TRIAL REGISTRATION Clinical Trials.gov NCT02765659 Registered May 6, 2016.
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Affiliation(s)
- Diana L. N. Jere
- Community and Mental Health Nursing, Kamuzu College of Nursing, University of Malawi, P.O Box, 415, Blantyre, Malawi
| | - Chimwemwe K. Banda
- Medical-Surgical Nursing, Kamuzu College of Nursing, University of Malawi, P.O Box, 415, Blantyre, Malawi
| | - Lily C. Kumbani
- Faculty of Midwifery, Neonatal and Reproductive Health, Kamuzu College of Nursing, University of Malawi, P.O Box, 415, Blantyre, Malawi
| | - Li Liu
- Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Linda L. McCreary
- Health Systems Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
| | - Chang Gi Park
- Health Systems Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
| | - Crystal L. Patil
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
| | - Kathleen F. Norr
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
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Zerwic JJ, Scott LD, McCreary LL, Corte C. Programmatic Evaluation of Holistic Admissions: The Influence on Students. J Nurs Educ 2018; 57:416-421. [DOI: 10.3928/01484834-20180618-06] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/27/2018] [Indexed: 11/20/2022]
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13
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Min H, Vincent C, Park CG, Matthews AK, McCreary LL, Latimer M. Factors affecting Korean neonatal nurses' pain care: Psychometric evaluation of three instruments. Jpn J Nurs Sci 2018; 16:125-135. [PMID: 29888526 DOI: 10.1111/jjns.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to evaluate the psychometric properties of the Korean-language versions of Pain Knowledge and Use (PKU-K), Collaboration and Satisfaction About Care Decisions (CSACD-K), and Environmental Complexity Scale (ECS-K). METHODS A cross-sectional design was used with a convenience sample of 159 Korean nurses in seven neonatal intensive care units (NICUs). The data were collected by surveying the nurses with the PKU-K, CSACD-K, and ECS-K. Internal consistency reliability was assessed and Horn's parallel analysis, a confirmatory factor analysis, and a convergent construct validity test were conducted in order to evaluate the psychometric properties of the instruments. RESULTS The PKU-K, CSACD-K, and ECS-K exhibited strong internal consistency reliability. Horn's parallel analysis showed four factor structures for the PKU-K, one for the CSACD-K, and three for the ECS-K. The confirmatory factor analysis showed a good model fit for the PKU-K and CSACD-K, but the ECS-K model showed a poor fit. Most factor loadings were statistically significant. The CSACD-K's convergent validity was supported by significant correlations for collegial nurse-physician relations with a validated instrument. CONCLUSION The findings support the reliability and validity of the PKU-K, CSACD-K, and ECS-K for measuring nurses' knowledge about neonatal pain care, nurse-physician collaboration, and the work environment in NICUs. However, the ECS-K needs further refinement before it is applied to Korean NICU nurses.
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Affiliation(s)
- Haeyoung Min
- College of Nursing, Gyeongsang National University, Jinju, South Korea
| | - Catherine Vincent
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chang G Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Margot Latimer
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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14
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Kim GS, Kim S, Choi JY, Lee JI, Park CG, McCreary LL. Mediators and Moderators of Health-Related Quality of Life in People Living with HIV. J Assoc Nurses AIDS Care 2018; 29:580-591. [PMID: 29506952 DOI: 10.1016/j.jana.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Abstract
We examined whether social support moderated communication and self-management, and tested whether self-management mediated communication, instrumental and emotional social support (ISS, ESS), and health-related quality of life (HRQOL) in Korean people living with HIV (PLWH). A cross-sectional research design using a self-reported survey questionnaire was conducted. Data for 205 PLWH were collected at the outpatient divisions of seven hospitals. HRQOL was positively associated with communication, ISS, ESS, and self-management. ESS moderated the relationship between communication and self-management through a significant interaction with communication. Johnson-Neyman analysis indicated that the interaction effect of ESS was significant at the range from 4 to 14.4. However, the ISS did not moderate the relationship between communication and self-management. Self-management mediated the relationship between communication, ESS, and HRQOL. The findings suggest that nursing interventions should be focused on providing interactive communication and ESS to improve self-management and HRQOL of PLWH.
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Jeong YM, McCreary LL, Hughes TL. Qualitative Study of Depression Literacy Among Korean American Parents of Adolescents. J Psychosoc Nurs Ment Health Serv 2017; 56:48-56. [PMID: 28990637 DOI: 10.3928/02793695-20170929-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/07/2017] [Indexed: 11/20/2022]
Abstract
Lack of depression literacy is associated with low help-seeking behaviors for mental health care in adolescents. As parents generally determine adolescents' health care, ensuring parents can recognize depressive symptoms is crucial. The current study explored depression literacy among Korean American parents of adolescents ages 12 to 19 using a qualitative descriptive design. Semantic content analysis was performed using data from three focus group interviews conducted in 2015 with Korean American parents (10 mothers, four fathers) of adolescents. Participants lacked knowledge about the biological causes and medicinal treatment of depression. Most believed that depression cannot be fully treated, relapses occur easily, and medication is taken indefinitely. Gender influenced perceptions of symptoms. Parents often overlooked children's depressive symptoms until schools alerted them. Nursing interventions should educate parents about the biological causes of depression, strategies for addressing adolescents' symptoms, community-based professional resources, and success stories about depression treatment. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 48-56.].
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Cassiani SHDB, Wilson LL, Mikael SDSE, Peña LM, Grajales RAZ, McCreary LL, Theus L, Agudelo MDCG, Felix ADS, de Uriza JM, Gutierrez NR. The situation of nursing education in Latin America and the Caribbean towards universal health. Rev Lat Am Enfermagem 2017; 25:e2913. [PMID: 28513769 PMCID: PMC5466053 DOI: 10.1590/1518-8345.2232.2913] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. METHOD: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. RESULTS: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. CONCLUSION: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care. OBJETIVO: avaliar a situação da educação em enfermagem e analisar o quanto os programas de educação em enfermagem, no nível de Bacharelado na América Latina e no Caribe, estão preparando graduados a contribuir para o alcance da Saúde Universal. MÉTODO: estudo quantitativo, descritivo/exploratório, transversal, realizado em 25 países. RESULTADOS: um total de 246 escolas de enfermagem participaram do estudo. O corpo docente com nível de Doutorado totalizou 31,3%; sem o Brasil o número fica reduzido a 8,3%. A razão entre experiências clínicas nos serviços de atenção primária à saúde e nos serviços hospitalares foi de 0,63, indicando que os estudantes têm mais experiências clínicas nos cenários hospitalares. Os resultados sugeriram necessidade de aprimoramento relacionada ao acesso à Internet; tecnologia da informação; acesso para portadores de deficiências; avaliação do programa, do corpo docente e dos estudantes; e aos métodos de ensino/aprendizagem. CONCLUSÃO: há heterogeneidade na educação em enfermagem na América Latina e no Caribe. Os currículos de enfermagem incluem, geralmente, os princípios e valores da Saúde Universal e da atenção primária à saúde, bem como aqueles princípios subjacentes às modalidades de educação transformativa, como o desenvolvimento de pensamento crítico e complexo, a solução de problemas, a tomada de decisão clínica baseada em evidências, e aprendizagem contínua. No entanto, é preciso promover uma mudança de paradigma na educação em enfermagem que inclua mais treinamento na atenção primária à saúde. OBJETIVO: evaluar la situación de la educación en enfermería y analizar en qué grado los programas de educación de enfermería a nivel de grado en América Latina y el Caribe están preparando a los graduados para contribuir al logro de la Salud Universal. MÉTODO: se llevó a cabo un estudio transversal, cuantitativo, descriptivo y exploratorio en 25 países. RESULTADOS: participaron en el estudio 246 escuelas de enfermería. El porcentaje de profesores con títulos de doctorado fue de 31,3%; pero, si se excluye a Brasil esta cifra se reduce a 8,3%. La proporción de la experiencia clínica adquirida en los servicios de atención primaria de salud en relación con la adquirida en servicios hospitalarios fue de 0,63, lo que indica que los estudiantes adquieren la mayor parte de su experiencia clínica en entornos hospitalarios. Los resultados mostraron una necesidad de mejorar el acceso a internet; la tecnología de la información; la accesibilidad para las personas discapacitadas; la evaluación de los programas, de los profesores y de los estudiantes; y los métodos de enseñanza y aprendizaje. CONCLUSIONES: hay heterogeneidad en la educación en enfermería en América Latina y el Caribe. En general, los programas de estudios de enfermería han adoptado los principios y los valores de la Salud Universal y la atención primaria de salud, así como los principios que sustentan las modalidades de educación transformadora, como son el desarrollo del pensamiento crítico y complejo, la solución de problemas, la toma de decisiones clínicas basadas en la evidencia y el aprendizaje a lo largo de toda la vida. Sin embargo, hay necesidad de promover un cambio en el paradigma de la educación en enfermería, a fin de que abarque más capacitación en la atención primaria de salud.
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Affiliation(s)
- Silvia Helena De Bortoli Cassiani
- PhD, Regional Advisor on Nursing and Allied Health Personnel, Pan
American Health Organization/World Health Organization (PAHO/WHO), Washington, DC,
United States of America
| | - Lynda Law Wilson
- PhD, Professor Emeritus, School of Nursing, University of Alabama at
Birmingham, Birmingham, AL, United States of America
| | - Sabrina de Souza Elias Mikael
- MSc, International Consultant, Pan American Health Organization/World
Health Organization (PAHO/WHO), Washington, DC, United States of America
| | - Laura Morán Peña
- PhD, President, Asociación Latinoamericana de Escuelas y Facultades de
Enfermería (ALADEFE), Ciudad de México, DF, Mexico
| | - Rosa Amarilis Zarate Grajales
- MEd, Adjunct Professor, Escuela Nacional de Enfermería y Obstetricia,
Universidad Nacional Autónoma de México, Ciudad de México, DF, Mexico. Director,
PAHO/WHO Collaborating Centre for the Development of Professional Nursing, Ciudad de
México, México
| | - Linda L. McCreary
- PhD, Associate Professor, College of Nursing, University of Illinois at
Chicago, Chicago, IL, United States of America. Co-Director, PAHO/WHO Collaborating
Centre for International Nursing Development in Primary Health Care, Chicago, IL, United
States of America
| | - Lisa Theus
- MPH, Program Coordinator, PAHO/WHO Collaborating Centre for
International Nursing, School of Nursing, University of Alabama at Birmingham,
Birmingham, AL, United States of America
| | - Maria del Carmen Gutierrez Agudelo
- MEd, Associate Professor, Facultad de Enfermería y Rehabilitación,
Universidad de la Sabana, Chía, Colombia. Executive Director, Asociación Colombiana de
Facultades de Enfermería (ACOFAEN), PAHO/WHO Collaborating Centre for the Development of
Innovative Methodologies in the Teaching-Learning in Primary Health Care, Bogotá,
Colombia
| | - Adriana da Silva Felix
- PhD, Volunteer (2014), Pan American Health Organization/World Health
Organization (PAHO/WHO), Washington, DC, United States of America
| | - Jacqueline Molina de Uriza
- MHA, Project Administrator, Asociación Colombiana de Facultades de
Enfermería (ACOFAEN), PAHO/WHO Collaborating Centre for the Development of Innovative
Methodologies in the Teaching-Learning in Primary Health Care, Bogotá, Colombia
| | - Nathaly Rozo Gutierrez
- MPH, Project Coordinator, Asociación Colombiana de Facultades de
Enfermería (ACOFAEN), PAHO/WHO Collaborating Centre for the Development of Innovative
Methodologies in the Teaching-Learning in Primary Health Care, Bogotá, Colombia
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Min H, Vincent C, Matthews AK, McCreary LL, Park CG, Latimer M. Factors Affecting Korean Neonatal Infant Pain Care: Translation and Validation of Three Instruments. West J Nurs Res 2017; 40:222-241. [PMID: 28322663 DOI: 10.1177/0193945917690124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to translate three English-language instruments-Pain Knowledge and Use (PKU), Collaboration and Satisfaction About Care Decisions (CSACD), and Environmental Complexity Scale (ECS)-into Korean and evaluate the equivalence of the instrument versions. Three Korean translators and two senior reviewers translated the instruments' 56 items using a committee approach. Eight Korean experts evaluated the cultural relevance of the translated instruments using a content validity index (CVI), and 12 Korean neonatal nurses were interviewed to assess their understanding of items. In an expert panel review, the item-CVI was less than 0.78 for 14 items. Based on cognitive interviews, four items were found to be unsuitable in Korea. Based on expert panel review and cognitive interviews, unsuitable items were modified or deleted. In another expert panel review, the scale-CVI was 1.00 for the final instruments. The findings support the validity of the Korean-language PKU, CSACD, and ECS for research application.
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McCreary LL, Tilekar SD, Nagothu LM, Kale R, Rajaput D, Biradar CM, Mathew J, Sebastian AK, Thomas P. Knowledge, Attitudes, and Perceptions of Tuberculosis Among Adults in Rural Maharashtra, India. West J Nurs Res 2016; 38:1393-4. [DOI: 10.1177/0193945916658204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kim GS, Chu SH, Park Y, Choi JY, Lee JI, Park CG, McCreary LL. Psychometric Properties of the Korean Version of the HIV Self-Management Scale in Patients with HIV. J Korean Acad Nurs 2016; 45:439-48. [PMID: 26159145 DOI: 10.4040/jkan.2015.45.3.439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to examine validity and reliability of Webel and colleagues' HIV Self-Management Scale when used with a Korean sample. METHODS The original 20-item HIV Self-Management Scale was translated into Korean using translation and back-translation. Nine HIV nurse experts tested content validity. Principal component analysis (PCA) and confirmatory factor analysis (CFA) of data from 203 patients was used to test construct validity. Concurrent validity was evaluated using correlation with patients' self-rating as a "smart patient" measured using a visual analogue scale. Internal consistency was tested by Cronbach's alpha coefficients. RESULTS All items were rated as having satisfactory content validity. Based on PCA and consideration of conceptual meaning, a three-factor solution was selected, explaining 48.76% of the variance. CFA demonstrated the adequacy of the three-domain structure of the construct HIV self-management: daily self-management health practices, social support and HIV self-management, and chronic nature of HIV self-management. Goodness-of-fit indices showed an acceptable fit overall with the full model (χ²/df(₁₆₄)=1.66, RMSEA=0.06, SRMR=0.05, TLI=0.91, and CFI=0.92). The Korean version of the HIV Self-Management Scale (KHSMS) was significantly correlated with patients' self-rated smart patient (r=.41). The subscale Cronbach's alpha coefficients ranged from .78 to .81; alpha for the total scale was .89. CONCLUSION The KHSMS provides a valid and reliable measure of self-management in Korean patients with HIV. Continued psychometric testing is recommended to provide further evidence of validity with this population.
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Affiliation(s)
- Gwang Suk Kim
- Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Sang Hui Chu
- Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Yunhee Park
- Department of Nursing, Youngdong University, Youngdong, Korea.
| | - Jun Yong Choi
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jeong In Lee
- Division of Nursing, Yonsei University Health System, Seoul, Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Linda L McCreary
- Health Systems Science · College of Nursing, University of Illinois at Chicago, Chicago, Illinois, U.S.A
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Crittenden KS, Kaponda CPN, Jere DL, McCreary LL, Norr KF. Participation and diffusion effects of a peer-intervention for HIV prevention among adults in rural Malawi. Soc Sci Med 2015; 133:136-44. [PMID: 25864150 DOI: 10.1016/j.socscimed.2015.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper examines whether a peer group intervention that reduced self-reported risky behaviors for rural adults in Malawi also had impacts on non-participants in the same communities. We randomly assigned two districts to the intervention and control conditions, and conducted surveys at baseline and 18 months post-intervention using unmatched independent random samples of intervention and control communities in 2003-2006. The six-session peer group intervention was offered to same-gender groups by trained volunteers. In this analysis, we divided the post-intervention sample into three exposure groups: 243 participants and 170 non-participants from the intervention district (total n = 415) and 413 control individuals. Controlling for demographics and participation, there were significant favorable diffusion effects on five partially overlapping behavioral outcomes: partner communication, ever used condoms, unprotected sex, recent HIV test, and a community HIV prevention index. Non-participants in the intervention district had more favorable outcomes on these behaviors than survey respondents in the control district. One behavioral outcome, community HIV prevention, showed both participation and diffusion effects. Participating in the intervention had a significant effect on six psychosocial outcomes: HIV knowledge (two measures), hope, condom attitudes, and self-efficacy for community HIV prevention and for safer sex; there were no diffusion effects. This pattern of results suggests that the behavioral changes promoted in the intervention spread to others in the same community, most likely through direct contact between participants and non-participants. These findings support the idea that diffusion of HIV-related behavior changes can occur for peer group interventions in communities, adding to the body of research supporting diffusion of innovations theory as a robust approach to accelerating change. If diffusion occurs, peer group intervention may be more cost-effective than previously realized. Wider implementation of peer group interventions can help meet the global goal of reducing new HIV infections.
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Affiliation(s)
| | - Chrissie P N Kaponda
- Kamuzu College of Nursing, University of Malawi, Private Bag 1, Lilongwe, Malawi
| | - Diana L Jere
- Kamuzu College of Nursing, University of Malawi, Private Bag 1, Lilongwe, Malawi
| | - Linda L McCreary
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, IL 60612, Chicago, USA
| | - Kathleen F Norr
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, IL 60612, Chicago, USA
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Kim GS, Lee CY, Kim IS, Lee TH, Cho E, Lee H, McCreary LL, Kim SH. Dyadic Effects of Individual and Friend on Physical Activity in College Students. Public Health Nurs 2015; 32:430-9. [PMID: 25565084 DOI: 10.1111/phn.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Physical activity (PA) tends to decline throughout the college years, and close friends' influence is known to be an important factor in maintaining PA. This study examined the actor effect and partner effect between an individual and his/her friend regarding the influence of self-efficacy and social support on PA among Korean college students. DESIGN AND SAMPLE Cross-sectional survey data from 108 pairs of individual students and friends were analyzed. MEASURES The survey questionnaire measured PA, self-efficacy toward exercise, social support for PA, anxiety and depression, community environments, and perceived health status. Structural equation modeling with path analysis was conducted to test Actor-Partner Interdependence Model (APIM) explaining close relationships on PA. RESULTS One-sided partner effect that friends' perceived friend support was directly related to individual's PA (β = 0.20, p < .05) was revealed. Regarding actor effects, self-efficacy was directly related to higher levels of PA for individual and friend. Perceived health status was related to higher level of individuals' PA. CONCLUSIONS These results suggest a role for public health nurses in developing interventions for college-aged young adults that promotes friend support for PA as well as individual self-efficacy toward PA, to engage young adults in establishing lifelong health-promoting PA.
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Affiliation(s)
- Gwang Suk Kim
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Chung Yul Lee
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - In Sook Kim
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Tae Hwa Lee
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Eunhee Cho
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Hyeonkyeong Lee
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Linda L McCreary
- College of Nursing, Health Systems Science, University of Illinois at Chicago, Chicago, Illinois
| | - Su Hee Kim
- Department of Nursing, Graduate School of Yonsei University, Seoul, Korea
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Lee CK, Corte C, Stein KF, Finnegan L, McCreary LL, Park CG. Expected Problem Drinker Possible Self: Predictor of Alcohol Problems and Tobacco Use in Adolescents. Subst Abus 2015; 36:434-9. [PMID: 25551683 DOI: 10.1080/08897077.2014.988323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Alcohol and tobacco use commonly co-occur in adolescents. According to the cross-substance facilitation of information processing hypothesis, cognitive structures related to one substance increase use of another related substance through enhanced cognitive processing. In this study, the authors test this hypothesis by determining whether a problem drinker "possible self" in 8th grade predicts alcohol and tobacco use in 9th grade. METHODS A secondary data analysis of a 12-month longitudinal dataset was conducted. The outcome variables were alcohol consumption, alcohol problems, and tobacco use in 9th grade. The main predictor of interest was presence of an expected problem drinker possible self in 8th grade. Zero-inflated gamma regression, zero-inflated negative binomial regression, and logistic regression were used. RESULTS Among 137 adolescents, controlling for known family, parent, and peer determinants, and corresponding 8th grade behavior, having an expected problem drinker possible self in 8th grade predicted alcohol problems, but not level of alcohol consumption in 9th grade. Moreover, the expected problem drinker possible self in 8th grade predicted tobacco use in 9th grade, controlling for known determinants and concurrent alcohol problems. CONCLUSIONS Findings provide support for the cross-substance facilitation hypothesis, suggesting that interventions designed to modify the expected problem drinker possible self may reduce not only adolescent alcohol use but also tobacco use. Further studies are needed to determine whether smoking content is embedded in a drinking cognition or 2 separate but related drinking and smoking cognitions account for the association between alcohol and tobacco use.
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Affiliation(s)
- Chia-Kuei Lee
- a College of Nursing , University of Illinois at Chicago , Chicago , Illinois , USA.,b School of Nursing , University of Rochester , Rochester , New York , USA
| | - Colleen Corte
- a College of Nursing , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Karen F Stein
- b School of Nursing , University of Rochester , Rochester , New York , USA
| | - Lorna Finnegan
- a College of Nursing , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Linda L McCreary
- a College of Nursing , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Chang G Park
- a College of Nursing , University of Illinois at Chicago , Chicago , Illinois , USA
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Lee CK, Corte C, Stein KF, Park CG, Finnegan L, McCreary LL. Prospective effects of possible selves on alcohol consumption in adolescents. Res Nurs Health 2014; 38:71-81. [PMID: 25545451 DOI: 10.1002/nur.21641] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 11/11/2022]
Abstract
Possible selves, cognitions about the self that reflect hopes, fears, and expectations for the future, are reliable predictors of health risk behaviors but have not been explored as predictors of adolescents' alcohol use. In a secondary analysis of data from 137 adolescents, we examined the influence of possible selves assessed in eighth grade on alcohol consumption (yes/no and level of use) in ninth grade. Having a most important feared possible self related to academics in eighth grade predicted alcohol abstinence in ninth grade. Among those who reported alcohol use, having many hoped-for possible selves and a most important hoped-for possible self related to academics in eighth grade predicted lower level of alcohol consumption in ninth grade. Interventions that foster the personal relevance and importance of academics and lead to the development of hoped-for possible selves may reduce adolescents' alcohol consumption.
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Affiliation(s)
- Chia-Kuei Lee
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY, 14642
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Lee YW, Dai YT, McCreary LL, Yao G, Brooks BA. Psychometric properties of the Chinese-version Quality of Nursing Work Life Scale. Nurs Health Sci 2014; 16:298-306. [PMID: 24635946 DOI: 10.1111/nhs.12099] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 11/28/2022]
Abstract
In this study, we developed and tested the psychometric properties of the Chinese-version Quality of Nursing Work Life Scale along seven subscales: supportive milieu with security and professional recognition, work arrangement and workload, work/home life balance, head nurse's/supervisor's management style, teamwork and communication, nursing staffing and patient care, and milieu of respect and autonomy. An instrument-development procedure with three phases was conducted in seven hospitals in 2010-2011. Phase I comprised translation and the cultural-adaptation process, phase II comprised a pilot study, and phase III comprised a field-testing process. Purposive sampling was used in the pilot study (n = 150) and the large field study (n = 1254). Five new items were added, and 85.7% of the original items were retained in the 41 item Chinese version. Principal component analysis revealed that a model accounted for 56.6% of the variance with acceptable internal consistency, concurrent validity, and discriminant validity. This study gave evidence of reliability and validity of the 41 item Chinese-version Quality of Nursing Work Life Scale.
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Affiliation(s)
- Ya-Wen Lee
- Department of Nursing, National Taiwan University, Taipei, Taiwan; Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
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Lee YW, Dai YT, McCreary LL. Quality of work life as a predictor of nurses' intention to leave units, organisations and the profession. J Nurs Manag 2013; 23:521-31. [PMID: 24238014 DOI: 10.1111/jonm.12166] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
Abstract
AIM To examine the relationships between quality of work life (QWL) and nurses' intention to leave their unit (ITLunit), organisation (ITLorg) and profession (ITLpro). BACKGROUND The high turnover rate among nurses presents a major challenge to health care systems across the globe. QWL plays a significant role in nurses' turnover. METHODS A descriptive cross-sectional survey design was conducted via purposive sampling of 1283 hospital nurses and administering the Chinese version of the Quality of Nursing Work Life scale (C-QNWL), a three-ITL-type scale questionnaire, and a demographic questionnaire for individual- and work-related variables. Descriptive data, correlations, and ordinal regression models were analyzed. RESULTS QWL predicted ITLpro and ITLorg better than ITLunit. Three QWL dimensions (work arrangement and workload, nursing staffing and patient care, and work-home life balance) were significantly predictive of all three ITL measures. However, the dimension of teamwork and communication was only predictive for ITLunit, not for ITLorg and ITLpro. CONCLUSIONS Different patterns of QWL dimensions are predictive of ITLunit, ITLorg, and ITLpro. IMPLICATIONS FOR NURSING MANAGEMENT The study provides important information to nurse administrators about the aspects of QWL that most commonly lead nurses to leave their units, organisations, and even the profession itself.
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Affiliation(s)
- Ya-Wen Lee
- Department of Nursing, College of Medicine, National Taiwan University, Changhua Christian Hospital, Changhua, Taiwan; Nursing Department, Changhua Christian Hospital, Changhua, Taiwan
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Abstract
BACKGROUND Valid assessment of family functioning can play a vital role in optimizing client outcomes. Because family functioning is influenced by family structure, socioeconomic context, and culture, existing measures of family functioning-primarily developed with nuclear, middle-class European American families-may not be valid assessments of families in diverse populations. The Family Effectiveness Measure was developed to address this limitation. OBJECTIVES The aim of this study was to test the Family Effectiveness Measure with data from a primarily low-income African American convenience sample using the Rasch measurement model. METHODS A sample of 607 adult women completed the measure. Rasch analysis was used to assess unidimensionality, response category functioning, item fit, person reliability, differential item functioning by race and parental status, and item hierarchy. Criterion-related validity was tested using correlations with five other variables related to family functioning. RESULTS The Family Effectiveness Measure measures two separate constructs: The Effective Family Functioning construct was a psychometrically sound measure of the target construct that was more efficient because of the deletion of 22 items. The Ineffective Family Functioning construct consisted of 16 of those deleted items but was not as strong psychometrically. Items in both constructs evidenced no differential item functioning by race. Criterion-related validity was supported for both. DISCUSSION In contrast to the prevailing conceptualization that family functioning is a single construct, assessed by positively and negatively worded items, use of the Rasch analysis suggested the existence of two constructs. Whereas the Effective Family Functioning scale is a strong and efficient measure of family functioning, the Ineffective Family Functioning scale will require additional item development and psychometric testing.
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Affiliation(s)
- Linda L McCreary
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois 60612-7350, USA.
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McCreary LL, Kaponda CPN, Davis K, Kalengamaliro M, Norr KF. Empowering peer group leaders for HIV prevention in Malawi. J Nurs Scholarsh 2013; 45:288-97. [PMID: 23590557 DOI: 10.1111/jnu.12031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE Behavioral change interventions using peer group leaders are effective and widely used, but few studies have examined how being a peer group leader affects the leaders. This study describes how participants felt being a peer group leader affected their lives. DESIGN This descriptive qualitative study interviewed 18 experienced peer group leaders who had conducted a multisession human immunodeficiency virus (HIV) prevention peer group intervention in rural Malawi. METHODS We used inductive content analysis and comparisons within and between cases. FINDINGS Three major themes were identified. All leaders said they experienced personal changes in their knowledge, attitudes, or HIV prevention behaviors. They described interacting with family, neighbors, and friends, and speaking at church or community meetings, to discuss HIV prevention issues. They increased their self-efficacy to engage others in sensitive HIV prevention issues, developed a self-identity as a change agent, and came to be recognized in their community as trustworthy advisors about HIV and acquired immunodeficiency syndrome. These three themes, taken together, form the meta-theme of psychological empowerment. CONCLUSION Being a peer group leader empowered the leaders as change agents for HIV prevention and had impacts in the community after the intervention ended, potentially increasing the long-term effectiveness and cost effectiveness of peer group interventions. CLINICAL RELEVANCE Healthcare workers and community volunteers who led HIV prevention sessions continued HIV prevention activities in the community and workplace after the program ended. Training health workers as volunteer HIV prevention leaders offers a strategy to bring HIV prevention to limited-resource settings, despite health worker shortages.
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Affiliation(s)
- Linda L McCreary
- Alpha Lambda, Research Assistant Professor, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
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Lee YW, Dai YT, Park CG, McCreary LL. Predicting Quality of Work Life on Nurses’ Intention to Leave. J Nurs Scholarsh 2013; 45:160-8. [DOI: 10.1111/jnu.12017] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Ya-Wen Lee
- Lambda Beta-at-Large, Doctoral candidate, Department of Nursing, College of Medicine; National Taiwan University & Supervisor of Nursing Department, Changhua Christian Hospital; Taiwan
| | - Yu-Tzu Dai
- Lambda Beta-at-Large, Professor, Department of Nursing, College of Medicine; National Taiwan University, & Supervisor of Nursing Department, National Taiwan University Hospital; Taipei Taiwan
| | - Chang-Gi Park
- Senior Research Specialist, College of Nursing; University of Illinois at Chicago; Chicago IL USA
| | - Linda L. McCreary
- Alpha-Lambda, Research Assistant Professor, Department of Health Systems Science; College of Nursing, University of Illinois at Chicago; Chicago IL USA
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Rongmuang D, Corte C, McCreary LL, Park CG, Miller A, Gallo A. Salience of physical appearance characteristics among young women in Thailand. Body Image 2011; 8:396-403. [PMID: 21768001 DOI: 10.1016/j.bodyim.2011.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 05/07/2011] [Accepted: 05/09/2011] [Indexed: 10/17/2022]
Abstract
Our aim in the present study was to identify key components of physical appearance among young Thai women. Free listings, focus groups and pile sorting were used. One-hundred twenty young women generated 78 unique physical appearance characteristics. Ninety-four nursing students validated these characteristics in focus groups and then sorted them into piles that reflected separate domains of physical appearance and labeled them. Salience analysis revealed that facial appearance (e.g., bright facial skin, high nose bridge, big eyes) was the most important domain, followed by body weight and shape, skin color and texture, hair (color, texture, length), and 'other' physical appearance (e.g., slender neck, slim fingers). This is the first study to identify aspects of physical appearance that are most salient to young Thai women and that may differ from women in other cultural contexts. These findings could be used to develop culturally grounded measures of physical appearance in Thai women.
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Affiliation(s)
- Daravan Rongmuang
- Department of Health System Science, University of Illinois at Chicago, College of Nursing, United States.
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Jere DL, Kaponda CPN, Chimwaza A, Crittenden KS, Kachingwe SI, McCreary LL, Norr JL, Norr K. Improving universal precautions and client teaching for rural health workers: a peer-group intervention. AIDS Care 2011; 22:649-57. [PMID: 20229377 DOI: 10.1080/09540120903311458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Health workers can contribute to HIV prevention by minimizing HIV transmission in health facilities and increasing client teaching. We offered a peer-group intervention for Malawian rural health workers to build their universal precautions and teaching skills. A quasi-experimental design using independent sample surveys and observations compared health workers in an intervention and delayed intervention control district at baseline and at 15 and 30 months post-intervention. Controlling for demographic factors, the intervention district had more reported HIV teaching at 15 and 30 months and also had higher universal precautions knowledge and fewer needle stick injuries at 30 months. Observations at 15 and 30 months post-intervention showed higher levels of teaching in the intervention district. Observed glove wearing and hand washing were also higher at 30 months. This intervention should be made available for health workers in Malawi and provides a potential model for other high-HIV prevalence countries.
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Affiliation(s)
- Diana L Jere
- Nursing, Midwifery and Health Sciences Research Centre, Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
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Kaponda CPN, Norr KF, Crittenden KS, Norr JL, McCreary LL, Kachingwe SI, Mbeba MM, Jere DLN, Dancy BL. Outcomes of an HIV prevention peer group intervention for rural adults in Malawi. Health Educ Behav 2011; 38:159-70. [PMID: 21393624 DOI: 10.1177/1090198110378588] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention. Using multiple regressions controlling for six demographic factors, intervention district adults had significantly more favorable outcomes at 6- and 18-month evaluations for condom attitudes, self-efficacy for community prevention, self-efficacy for practicing safer sex, partner communication, using condoms ever in the past 2 months, and community prevention activities. Knowledge and hope for controlling the epidemic were significantly higher in the intervention district only at the 6-month evaluation; having a recent HIV test was significantly higher only at 18 months. Levels of stigma and the number of risky sex practices did not decrease when demographic factors were controlled. Expanding peer group intervention for HIV prevention would benefit rural adults.
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Mbeba MM, Kaponda CPN, Jere DL, Kachingwe SI, Crittenden KS, McCreary LL, Norr JL, Norr KF. Peer group intervention reduces personal HIV risk for Malawian health workers. J Nurs Scholarsh 2011; 43:72-81. [PMID: 21342427 PMCID: PMC3073810 DOI: 10.1111/j.1547-5069.2011.01384.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To test a peer group intervention to address personal HIV prevention needs of rural health workers in Malawi. DESIGN Using a quasi-experimental design, we compared district health workers in two districts of Malawi that were randomly assigned to either the intervention or delayed control condition. We used independent sample surveys at baseline, 15 months, and 30 months postintervention. Intervention district workers received a peer group intervention after the baseline; control district workers received the delayed intervention after final data collection. METHODS The 10-session intervention for primary prevention of HIV infection was based on the primary healthcare model, behavioral change theory, and contextual tailoring based on formative evaluation. Differences in HIV-related knowledge, attitudes, self-efficacy, and behaviors were analyzed using t tests and multiple regression controlling for baseline differences. FINDINGS Health workers in the intervention district had higher general HIV knowledge, more positive attitudes about condoms, higher self-efficacy for safer sex, and more involvement in community HIV prevention at both the 15-month and 30-month postintervention survey. At 30 months, intervention district workers also reported less stigmatizing attitudes toward persons living with AIDS, more HIV tests, and lower risky sexual behaviors. CONCLUSION The intervention should be sustained in current sites and scaled up for health workers throughout Malawi as part of a multisectoral response to HIV prevention. CLINICAL RELEVANCE Incorporating a peer group intervention focused on personal as well as work-related HIV prevention can reduce health workers' risky behaviors in their personal lives, potentially reducing morbidity and mortality and enhancing workforce retention. Reducing stigmatizing attitudes may also improve the quality of health services.
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Affiliation(s)
- Mary M Mbeba
- Nursing, Midwifery and Health Sciences Research Centre, Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
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McCreary LL, Kaponda CPN, Kafulafula UK, Ngalande RC, Kumbani LC, Jere DLN, Norr JL, Norr KF. Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box. Health Educ Res 2010; 25:965-78. [PMID: 20837655 PMCID: PMC2974837 DOI: 10.1093/her/cyq049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 08/13/2010] [Indexed: 05/29/2023]
Abstract
This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10-12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention.
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Gomez-Feliciano L, McCreary LL, Sadowsky R, Peterson S, Hernandez A, McElmurry BJ, Park CG. Active Living Logan Square: joining together to create opportunities for physical activity. Am J Prev Med 2009; 37:S361-7. [PMID: 19944936 DOI: 10.1016/j.amepre.2009.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 08/15/2009] [Accepted: 09/01/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Active Living Logan Square target audience is the community of the southwest corner of Logan Square, an urban Chicago community of 84,466 residents, mostly Latinos. Through the Active Living by Design (ALbD) initiative, the Logan Square Neighborhood Association leveraged its 48 years of existence in the neighborhood to create opportunities and build partnerships. INTERVENTION Activities addressed three primary goals: (1) enhance school environments and practices to support physical activity before, during, and after the school day; (2) encourage individuals and families to enjoy outdoor activities in their own communities; and (3) create safe, inviting places for activity that connect to surrounding communities. The partnership's participatory approach involved a variety of community stakeholders in developing and implementing affordable, accessible, culturally acceptable, and sustainable physical activities for children and their families. RESULTS The partnership successfully piloted Open Streets (temporary street closures) and advocated for development of the Bloomingdale Trail, an elevated rails-to-trails project. In schools, the partnership changed the culture at McAuliffe Elementary to support healthy behaviors through new policies, physical projects, and programs. LESSONS LEARNED Vital components of the project's success included a full-time coordinator with strong community ties; time to build healthy relationships within the partnership and community; the use of culturally relevant strategies; and flexibility to welcome complementary opportunities. CONCLUSIONS The partnership intentionally did not produce a single community-recognized campaign; instead, it chose to use limited resources to promote tangible programs and projects that led to sustainable and replicable changes that promote physical activity.
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Kaponda CPN, Jere DL, Chimango JL, Chimwaza AF, Crittenden KS, Kachingwe SI, McCreary LL, Norr JL, Norr KF. Impacts of a peer-group intervention on HIV-related knowledge, attitudes, and personal behaviors for urban hospital workers in Malawi. J Assoc Nurses AIDS Care 2009; 20:230-42. [PMID: 19427600 PMCID: PMC4177099 DOI: 10.1016/j.jana.2008.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 12/22/2008] [Indexed: 11/21/2022]
Abstract
This report describes the effects of a peer-group intervention on Malawian urban hospital workers' HIV-related personal knowledge, attitudes, and behaviors. More than 850 clinical and nonclinical hospital workers received the intervention. Evaluation used independent surveys of a sample of workers at baseline (N = 366) and postintervention (N = 561). Compared with the baseline survey, after the intervention, workers had higher knowledge of HIV transmission and prevention; more positive attitudes including more hope, less stigmatization of persons with HIV, more positive attitudes toward HIV testing and condom use, and higher self-efficacy for practicing safer sex and for community prevention; more reported recent personal HIV tests, more discussion of safer sex with partners, and more reported community HIV prevention activities. However, health workers' risky sexual behaviors did not differ at baseline and postintervention. The intervention should be strengthened to support more sexual risk reduction and be made available to all health workers in Malawi.
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Affiliation(s)
- Chrissie P N Kaponda
- Nursing, Midwifery and Health Sciences Research Center, Kamuzu College of Nursing, University of Malawi
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McCreary LL, Crittenden KS, Dancy BL, Ferrans CE, Qiong Fu, Smith E. Psychometric Evaluation of the Family Effectiveness Measure Among Low-Income African American Single-Parent Families. West J Nurs Res 2008. [DOI: 10.1177/0193945908323315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - Qiong Fu
- University of Illinois at Chicago
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McElmurry BJ, McCreary LL, Park CG, Ramos L, Martinez E, Parikh R, Kozik K, Fogelfeld L. Implementation, outcomes, and lessons learned from a collaborative primary health care program to improve diabetes care among urban Latino populations. Health Promot Pract 2008; 10:293-302. [PMID: 18344318 DOI: 10.1177/1524839907306406] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A collaborative primary health care service demonstration program was conducted to improve diabetes care among limited English-proficient (LEP) Latino patients. The intervention provided a multilevel approach aimed at patients and health care providers: Community health workers (CHWs) were mobilized to offer diabetes education in Spanish to LEP Latino diabetes patients, and health professions students and providers were offered intensive Spanish language training and cultural competency workshops. Positive outcomes for patients included a significant decrease in HbA1c. Health care providers reported improved patient communication and greater appreciation for cultural influences on health. Collaborating institutions realized ongoing benefits from expansion of CHWs' role and incorporation of cultural and language classes into health professions students' and house officers' training programs. Lessons learned included the importance of working together at every stage to identify and provide for the CHWs' training and support needs and to link the program's intervention with evaluation of multilevel outcomes.
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Affiliation(s)
- Beverly J McElmurry
- Global Health Leadership Office, University of Illinois at Chicago College of Nursing, in Chicago, Illinois 60612-7350, USA
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Talashek ML, Kaponda CPN, Jere DL, Kafulafula U, Mbeba MM, McCreary LL, Norr K. Identifying what rural health workers in Malawi need to become HIV prevention leaders. J Assoc Nurses AIDS Care 2007; 18:41-50. [PMID: 17662923 DOI: 10.1016/j.jana.2007.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Indexed: 11/24/2022]
Abstract
Health workers have high potential as HIV prevention leaders, but health system and individual barriers limit their impact. This descriptive qualitative study identified the HIV prevention needs of rural health workers to use as a basis for tailoring an HIV/AIDS risk-reduction intervention. Data included interviews with 9 health administrators, 22 focus groups with 200 health workers, and 12 observations of caregivers in two rural districts. Health system barriers identified included lack of essential supplies, staff shortages, overcrowded facilities, and lack of training. Individual barriers included hopelessness, stigmatizing attitudes, knowledge gaps, and risky personal behaviors. Health workers also expressed willingness to be HIV prevention leaders and role models. Most results agree with previous African studies. Personal risky behaviors and willingness to be HIV prevention leaders have not been previously reported. Results provide insights for developing effective interventions and health policies to address health workers' HIV prevention needs.
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Abstract
Most nurse researchers are embedded in research ethics guidelines based predominantly on the ethical principles of autonomy, beneficence, and justice. They are oriented toward protecting the rights of individual research participants. However, in cross-cultural, community-based, and international projects, further examination is required of community rights, as an entity in and of itself, to acknowledge and protect the community's rights. We suggest that communitarian philosophy is a perspective for the researcher to use in examining cross-cultural and international ethical questions. To show this assertion, dilemmas in community research are examined by using case studies and existing research ethics guidelines. Specific recommendations are offered for nursing scientists in practice, educational, and research settings seeking to balance the rights of the individual with those of the community.
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Affiliation(s)
- Elissa Dresden
- University of Illinois at Chicago College of Nursing, 60612-7350, USA
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Abstract
As the number of HIV-positive women of childbearing age continues to rise, and treatments available to manage HIV become more accessible, the issue of HIV-positive women's reproductive decision making is gaining importance for nurses in AIDS care. Nurses and other health professionals care for these women as they decide whether to bear children. The decision whether to have children is complex and influenced by a number of individual and societal factors, creating an ethical tension between the interests of HIV-positive women and those of society. This article proposes a six-step, context-based advocacy process for nurses and other health professionals who interact with HIV-positive women of childbearing age. The advocacy process described is grounded in a review of literature on HIV/AIDS, factors influencing HIV-positive women's reproductive choices, and nursing advocacy. The proposed advocacy process enables nurses to support women's self-determination and decision making in a way that is informative and empowering.
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