Predictors of Nicotine Replacement Therapy Adherence: Mixed-Methods Research With a Convergent Parallel Design

BACKGROUND

Few studies have examined the effect of baseline attitudes toward nicotine replacement therapy (NRT) on its actual adherence in a smoking cessation intervention.

PURPOSE

This study (i) examined the predictability of baseline variables (quantitative data) on NRT adherence and (ii) explored the congruence of participants' statements about NRT products (qualitative data) during counseling sessions with their baseline attitudes.

METHODS

This is a mixed-methods research study using a convergent parallel design. Participants included 74 individuals in the treatment group who received behavioral counseling and combination NRT. A Poisson regression analysis was performed to identify baseline variables predicting NRT adherence. Thematic analysis was completed with a subset of participants (n = 38) who varied in NRT attitude scores and adherence. A joint display was created to integrate quantitative and qualitative data and discover convergence.

RESULTS

Approximately 59% of the participants (41/74) used NRT continuously for ≥5 weeks. Having negative attitudes toward NRT and depressive symptoms predicted NRT adherence even after controlling for education and anxiety symptoms. Thematic analysis revealed that NRT adherence is a learning process that consists of the following three distinctive but interrelated phases: (i) information needs, (ii) comprehensive readiness, and (iii) experiential learning. Of the 38 participants, 34 (89.5%) showed convergence between baseline attitude scores and statements about NRT made during counseling sessions.

CONCLUSIONS

Individuals who have negative attitudes toward NRT are less likely to use the products in a smoking cessation intervention. Counselors should assess attitudes toward NRT at baseline and address them proactively during counseling sessions.

Protocol for a randomized controlled trial of the Enhanced Smoking Cessation Approach to Promote Empowerment (ESCAPE) digitalized intervention to promote lung health in high-risk individuals who smoke

Low dose computed tomography (LDCT) is an effective screening test to decrease lung cancer deaths. Lung cancer screening may be a teachable moment helping people who smoke to quit, which may result in increased benefit of screening. Innovative strategies are needed to engage high-risk individuals in learning about LDCT screening. More precise methods such as polygenic risk scores quantify genetic predisposition to tobacco use, and optimize lung health interventions. We present the ESCAPE (Enhanced Smoking Cessation Approach to Promote Empowerment) protocol. This study will test a smoking cessation intervention using personal stories and a lung cancer screening decision-aide compared to standard care (brief advice, referral to a quit line, and a lung cancer screening decision-aide), examine the relationship between a polygenic risk score and smoking abstinence, and describe perceptions about integration of genomic information into smoking cessation treatment. A randomized controlled trial followed by a sequential explanatory mixed methods approach will compare the efficacy of the interventions. Interviews will add insight into the use of genomic information and risk perceptions to tailor smoking cessation treatment. Two-hundred and fifty individuals will be recruited from primary care, community-based organizations, mailing lists and through social media. Data will be collected at baseline, 1, 3 and 6-months. The primary outcomes are 7-day point prevalence smoking abstinence and stage of lung cancer screening at 6-months. The results from this study will provide information to refine the ESCAPE intervention and facilitate integration of precision health into future lung health interventions. Clinical trial registration number: NCT0469129T.

The Intersectionality of HIV-Related Stigma and Tobacco Smoking Stigma With Depressive and Anxiety Symptoms Among Women Living With HIV in the United States: A Cross-sectional Study

ABSTRACT

This study examined the intersectionality of HIV-related stigma, tobacco smoking stigma, and mental health among women living with HIV who were daily smokers. This secondary analysis used baseline data from 2 pilot smoking cessation studies. Participants received either an HIV-tailored or an attention-control intervention focused on smoking cessation as an outcome. There were significant positive relationships between HIV-related stigma and depressive and anxiety symptoms. In contrast, tobacco smoking stigma had no significant relationship with either of the symptoms when HIV-related stigma was controlled. However, there was a significant interaction effect (β = 1.37, p = .02) of tobacco smoking stigma with internalized HIV-related stigma on anxiety symptoms. Tobacco smoking stigma worsened anxiety symptoms for women who had high internalized HIV-related stigma. Health care providers should understand the effect of HIV-related stigma on mental health and address the intersectionality of HIV-related stigma with other socially disapproved behaviors, such as tobacco smoking.

<p>Factors Associated with Treatment Uptake Among Women with Acetic Acid/Lugol’s Iodine Positive Lesions of the Cervix in Cameroon</p>

Purpose

Treatment of cervical precancer is the primary aim in secondary prevention of cervical cancer. The purpose of this study was to examine factors associated with treatment uptake among women with acetic acid/Lugol’s iodine positive lesions identified by digital cervicography (DC) in a cervical cancer prevention program in Cameroon.

Patients and Methods

We conducted a cross-sectional survey of medical records from 2013 to 2018 of 755 women in Cameroon who screened positive with acetic acid/Lugol’s iodine in 2013.

Results

Of the 755 women, 422 (55.9%) had treatment/biopsy on the same day or followed up later, but only 344 (45.6%) received treatment/biopsy and 333 (44.1%) were lost to follow-up. Overall, 180 (52.3%) of the 344 women were treated/biopsied the same day they were screened, and 164 (47.7%) were treated/biopsied after the initial visit. Women aged 30–49 and HIV-positive women were significantly more likely to have received treatment or returned for treatment than women less than 30 and HIV-negative women. Of the 266 women who followed up at a later date, the lesions of 78 (29.3%) women regressed spontaneously without treatment. Women with low-grade lesions, HIV-negative women and women who had follow-up more than a year after the initial exam were significantly more likely to have spontaneous regression with regression rates of 30.6%, 32.1% and 62.2%, respectively (p<0.001). Age was not a significant determinant of spontaneous regression (p=0.149).

Conclusion

Efforts to increase treatment uptake are needed in this population, including adherence to same day “See and treat” policies.

Barriers and facilitators of follow-up among women with precancerous lesions of the cervix in Cameroon: a qualitative pilot study

Purpose

This pilot study explores the barriers to adherence to follow-up among women with cervical precancer in urban Cameroon. While follow-up of women with a positive screening of cervical precancer is the most important aspect of cervical cancer secondary prevention, women with cervical precancer do not adhere frequently to recommended follow-up schedule in Cameroon. The aim of the study was to explore and describe the barriers and facilitators to follow-up for cervical precancer among women infected and uninfected with HIV in Cameroon.

Participants and methods

A qualitative research design was used to answer the research questions. Participants included eight HIV-infected and -uninfected women diagnosed with cervical precancer and 19 nurses. Data were collected by in-depth individual patient interviews and focus groups with nurses. An interview guide with open-ended questions, using the social ecological model as a framework, included questions that addressed the complexities of the lives of individuals and professionals within a relational context. The interviews were audio-taped and transcribed verbatim in English language. Thematic analysis of data was completed with no epistemological or theoretical perspective underpinning the analyses.

Results

Four major themes emerged from the study. They were clinic, personal, and social barriers, and strategies to improve follow-up.

Conclusion

The use of reminder phone calls and fee reduction, coupled with peer counseling and navigation of women who have been diagnosed with cervical precancer, could be effective ways of improving adherence to follow-up. Further research is needed to explore the same phenomenon among women in rural areas, especially those who were initially attended to in mobile clinics.

A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call

Background

People living with HIV smoke at a rate three times that of the general population. This randomized controlled pilot trial tested the feasibility and acceptability of a video-call smoking cessation intervention in women living with HIV and its preliminary efficacy compared with a voice-call smoking cessation intervention. The study focused on women due to a paucity of studies among this population, and women are less likely than men to quit smoking when provided with conventional treatment.

Methods

Participants in both arms received an HIV-tailored smoking cessation intervention comprising eight 30-minute weekly counseling sessions in conjunction with active nicotine patches for 8 weeks. The only difference between the two arms was the delivery mode of the intervention: via either telephone-based video or voice call. Survival analysis and a Cox proportional hazard regression model were performed to identify factors predicting 6-month prolonged abstinence from smoking.

Results

A video-call intervention was almost 30% less feasible than a voice-call intervention because women in their 50s and 60s or poorer women living in some southern states did not have access to video-call equipment. However, those who received the video-call intervention were more likely to complete the study than those who had the voice-call intervention. There was no difference in the acceptability of the two interventions. A survival analysis revealed that those in the video arm were significantly more likely to maintain smoking abstinence over the 6-month follow-up period than those in the voice arm (log rank χ²=4.02, P<0.05).

Conclusion

Although a video-call intervention is less feasible than a voice-call intervention, the former seems to outperform the latter in achieving long-term smoking abstinence for women living with HIV, which may offer an advantage over establishing therapeutic alliance and visually monitoring their adherence to nicotine patches.

Clinical trial registration

ClinicalTrials.gov NCT02898597.

Ageism, Aging and HIV: Community Responses to Prevention, Treatment, Care and Support

Ageism, in the form of prejudice, stereotyping, and discrimination targeting older adults, represents a barrier to addressing the graying of the HIV epidemic. There is widespread misperception on the part of older adults themselves, as well as service providers and society in general that HIV risk is low as one ages. In addition, internalized ageism may play a role in poorer physical and mental health outcomes, as the negative stereotypes associated with aging become a self-fulfilling prophecy. A number of steps can be taken to address HIV and aging in the context of ageism with regard to: prevention, education, and outreach; treatment guidelines for older adults with HIV; funding to address the aging of the epidemic; engagement of communities, health and social service organizations, and other providers around mental health and social support, and addressing the needs of special populations. Caring for an aging population with HIV represents a challenge, which is exacerbated in low and/or middle-income countries that typically lack the infrastructure of high resource settings. How we address the aging-related issues of the HIV epidemic across regions and settings could serve as a model in dealing with aging in our society in general regardless of HIV status.

HIV Prevention, Stigma, and Care in Ho Chi Minh City and Da Lat Vietnam

PURPOSE

A four-week interdisciplinary student/faculty research project in Vietnam served as a focused experience in understanding Vietnamese healthcare structures, functions, outcomes.

DESIGN

Testing the validity and feasibility of a successful US HIV intervention program called Women's Voices Women's Lives© using group and individual interviews.

FINDINGS

Healthcare inequities and poverty were found to paralyze individual, family, and community mobilization in HIV testing while stigma is a key barrier to both testing and care seeking.

IMPLICATIONS

Vietnam has become a place where living with HIV infection challenges communities in a distinct socio-cultural context while incidence and prevalence rates continue to rise.

The Sistah Powah Structured Writing Intervention: A Feasibility Study for Aging, Low-Income, HIV-Positive Black Women

Purpose.

The purpose of this study was to test the feasibility and assess outcomes of health care adherence based on whether participants engage in particular risky behaviors relevant to general health or living with human immunodeficiency virus (HIV) infection and the frequency of these adherent behaviors. Health adherent behaviors include both self-advocacy and decreased stigma as underlying key components.

Design.

A randomized control trial comparing peer-led attention control support and intervention groups.

Setting.

Community-based women's drop-in center in an urban, black neighborhood of Boston, Massachusetts.

Subjects.

Aging, low-income, black women living with HIV infection.

Intervention.

Peer-led, small-group, structured writing using film clips from Women's Voices Women's Lives as a writing prompt.

Measures.

Demographic and outcome data that included adherence, self-advocacy, and stigma; collected at baseline, 6 weeks, and 6 months.

Analysis.

Repeated-measures analysis of variance scores were examined between groups and waves. Paired-sample t-tests were used to examine mean differences across time.

Results.

Sample included 110 women (intervention, n = 56; comparison, n = 54). Retention was 85.5%. Repeated-measures analysis indicated intervention group condom use (n = 69, F = 8.02, df = 1, p < .01) and safe sex (n = 71, F = 13.02, df = 1, p < .01) was higher than that of comparison group. A time effect was also found in the Silencing the Self Scale (n = 91, Pillai's trace = 7.21, df = 2, p < .01).

Conclusion.

This study demonstrates the feasibility of a tailored, peer-led, and culturally relevant interventions and tentative efficacy in populations affected by health disparities. Key limitations include no comparison intervention format with women who can't write and the need to test generalizability.

Palliative care and African American women living with HIV

It is challenging to develop and assess skills in a classroom setting, for graduate students particularly, in the area of quality improvement project plans that are real, relevant, and sensitive in a unique health care context. Although understanding significant issues related to palliative care needs of U.S. citizens through the interpretation of those who publish in this area is extremely helpful to students, it does not allow for an experience uniquely situated in realities faced by those living with life-threatening and chronic illness or in a time frame that is current. Graduate students in a Health Resources and Services Administration-funded program of study completed a secondary data analysis of digitally recorded conversations of African American women living with human immunodeficiency virus or acquired immune deficiency syndrome to identify consumer-driven palliative care needs and create possible quality improvement program solutions. This exercise supports the World Health Organization's advice to become palliative care leaders through engagement in clients' realities.

The effect of prevention messages and self-efficacy skill building with inner-city women at risk for HIV infection

The purpose of this study was to examine the effect of gender-sensitive and culturally relevant HIV prevention film messages combined with self-efficacy and skill building exercises on self-reported safe sex behaviors, intentions, attitudes, and self-advocacy over time. A sample of 131 women of mixed ethnicity from inner-city Boston who were living in transitional housing participated in a 4-week pre/postmeasurement design. Results showed that, despite the short duration of the intervention, participants self-reported significantly more use of safe sex behaviors and being prepared for sexual intimacy after the intervention. The study validated use of an approach originally intended for African American women with other women at risk for HIV.

Primary Prevention of Skin Cancer in Children and Adolescents: A Review of the Literature

Although skin cancer is an easily preventable disease, self-directed prevention behaviors in children are difficult to achieve. The purpose of this article is to evaluate the status of primary prevention interventions and identify gaps in national and international research in order to make suggestions for further intervention design. A comprehensive search of MEDLINE, CINAHL, and PSYCHinfo databases was conducted to collect published research used in this review. The most effective interventions used multicomponent curricula administered over an extended period of time. Younger children were more receptive to interventions than were older children, who had stronger attitudes against sun-protective behaviors. Interventions in Australia have been more successful than interventions in North America and Europe. Further research needs to be conducted to create primary prevention interventions that address informational gaps. Specifically testing the dose and effect of individual educational components and bundling of components with reliable and valid outcome measures would help health care researchers define and measure the most effective way to battle social norms and attitudes of children and sun exposure.

Men's experiences viewing an HIV/AIDS prevention education film by and for women

The purpose of this study is to understand (a) the experience of men viewing the film Women's Voices Women's Lives (WVWL), a prevention education film for and by heterosexual African American women living with HIV/AIDS in the United States, and (b) the perceived needs of male viewers on how to best access effective HIV/AIDS prevention messages. A postviewing structured written survey was completed addressing the experience of viewing the film and HIV prevention services in the community, respectively (N = 16). Responses include stunning realization and anger that motivated viewers to get immediately screened for HIV. In addition, the men felt they were informed about HIV risk through the courage and candidness of the women describing their experience. Participants reported that a film similar to WVWL should be made for heterosexual/bisexual men. The authors conclude film prevention messages are a powerful means to convey health education ideas.

Nurse Experiences as Cancer Survivors: Part I—Personal

PURPOSE/OBJECTIVES

To uncover dimensions of nurses' personal experiences of cancer survivorship.

DESIGN

Interpretive, phenomenologic.

SETTING

Metropolitan area in the northeastern United States.

SAMPLE

25 RNs diagnosed with cancer. Average age was 50 years, and 20 participants were less than five years from initial diagnosis.

METHODS

Interviews. Analysis using methodology of Newman (1994, 1999) and Van Manen (1990).

MAIN RESEARCH VARIABLES

Nurses' personal experiences of cancer survivorship.

FINDINGS

Themes of the nurses' personal experiences of survivorship included the shock of becoming a patient and multifaceted dimensions of the treatment experience, including time, coordinating their own care, the struggle to maintain normalcy, uncertainty, nonclinical self-care strategies, and encounters with caring and uncaring providers. Participants identified the need for supportive relationships both in personal and professional arenas throughout the survivorship process. The cancer experience became an opportunity for change in priorities.

CONCLUSIONS

Although nurse cancer survivors experience similar personal vulnerabilities to those of non-nurses, their vulnerabilities often are affected by their knowledge of the healthcare process and content of care with which they are most familiar. They also are affected by what they know is at stake. This particular insider vulnerability is not cited often in research literature and, therefore, is not recognized as a particular type of need that should be addressed in cancer survivorship.

IMPLICATIONS FOR NURSING

Nurse patients need providers to be sensitive to their information and support needs, which may vary because of their professional experiences and personal resources. Findings suggest that nurse patients may need supportive approaches that target their unique vulnerabilities.

Nurse Experiences as Cancer Survivors: Part II—Professional

PURPOSE/OBJECTIVES

To uncover dimensions of nurses' professional experiences of cancer survivorship.

DESIGN

Interpretive, phenomenologic.

SETTING

Metropolitan area in the northeastern United States.

SAMPLE

25 RNs diagnosed with cancer. Average age was 50 years, and 20 participants were less than five years from initial diagnosis.

METHODS

Interviews. Data were analyzed using the methodology of Newman (1994, 1999) and VanManen (1990).

MAIN RESEARCH VARIABLES

Nurses' professional experiences of cancer survivorship.

FINDINGS

Professional experiences of cancer survivorship fell into five themes: (a) role ambiguity, (b) a deepening level of compassion for patients and others, (c) self-disclosure as a therapeutic intervention, (d) becoming an advocate for change, and (e) volunteerism.

CONCLUSIONS

Cancer survivorship was a factor in reshaping participants' clinical practice. Experiencing the role of the patient affirmed the necessity of compassionate care for these participants. Nurses experienced a deepening level of compassion for patients and used self-disclosure as a therapeutic intervention. During and shortly after treatment, role ambiguity (being both patient and nurse) could cause difficulties. Nurses took action to change their clinical environment through their influence on colleagues and the healthcare system and by working through other organizations to improve patient care.

IMPLICATIONS FOR NURSING

Nurse cancer survivors can benefit from the support of colleagues and healthcare providers and an appreciation of the challenge of being both a professional and a patient. The invitation for dialogue as they return to work may help with the challenges of role ambiguity as nurse cancer survivors. Based on this study, nurses value the opportunity to enhance care environments with their two-world knowledge through compassionate care, disclosure, advocacy, and volunteering, and coworkers need to appreciate each nurse's unique response to this potentially life-changing process. Nurses in all settings can learn from their cancer survivor colleagues who have been the recipients of care to reflect on their own clinical practice in the areas of advocacy, sensitivity to patient concerns, and care experiences.

Effective use of critique and dialogue at scholarly conferences

In this article, the authors offer a solution to a phenomenon identified as "silencing" among nurse colleagues during national, regional, and international scholarly conferences. Through an electronic anonymous survey, data were collected regarding perceptions of the structure and process at scholarly nursing conferences. The need for critique and dialogue while sharing research ideas or findings is identified as a means to encourage direct exchange at professional conferences. Based on an examination of the process of critique and dialogue, and theories that explain why honest and direct dialogue are sometimes subdued, the authors propose a model of constructive scholarly dialogue for conference participation. The goals of implementing this model are to make scholarly exchanges normative at nursing conferences, and to revise standard conference formats so that constructive critique and dialogue are encouraged actively. The likely outcomes include improved nursing science and professional development of nurses.

The Use of a Writing Group to Enhance Voice and Connection Among Staff Nurses

The aim of this study was to pilot test a group-writing intervention to decrease negative workplace behaviors. The pilot test demonstrated that cohesive and supportive relationships developed and allowed nurses to talk about important topics. The participants suggested that a writing group would be a forum that could be used by staff development educators to encourage nurses to support each other and develop their voices.

From silencing the self to action: experiences of women living with HIV/AIDS

Feminist literature has demonstrated that women often maintain behaviors that support silencing of their voices. The critical issue is whether the silencing experience is (a) a destructive process of burying feelings and needs, (b) a protective strategy to preserve personal and professional relationships which they value, (c) a coping mechanism to divorce themselves from an androcentric/ethnocentric health care culture, or all of these. The transition from silence to action may be a process of reacting to a threat to self (i.e., HIV/AIDS diagnosis) where gender normative behaviors become irrelevant and self-advocacy becomes paramount for survival. Alternatively, the transition may be a conscious process of gaining insight into past behaviors that have been learned and culturally supported and making purposeful changes. Data for this study were extracted for secondary analysis from data from a larger study on experiences and needs of persons living with HIV/AIDS. Data were obtained from transcripts from three focus groups (N = 14 women) and six individual interviews. Women ranged in age from 21 to 55; 9 were European American, 7 were African American, and 4 were Latina American. Data were content analyzed and organized using four categories proposed by Jack (1991): (a) externalized self-perception, (b) care as self-sacrifice, (c) silencing the self, and (d) the divided self. Data supported that women with HIV/AIDS reported all four categories of silencing behaviors, particularly early in the HIV trajectory. For some women, an HIV/AIDS diagnosis ignited them to speak for themselves and to shape their own lives based on feelings and needs. For others, peer or professional support or both was the catalyst for the transition from silence to action. Findings suggest interventions that would assist women in judging themselves by internal versus external standards, putting their own needs before the perceived needs of others, expressing themselves toward action rather than avoidance, and feeling comfortable expressing anger.