Alison M. Colbert

A qualitative study of persons who are 100% adherent to antiretroviral therapy

Abstract This qualitative study examined the medication-taking behaviors and attitudes of participants determined to be 100% adherers to antiretroviral therapy from a NIH-funded study testing a 12-week telephone adherence intervention. Using open-ended questions, interviewers collected data on a sample of 13 informants, whose medication adherence to a randomly selected antiretroviral medication was 100%, based on a 30-day data collection using electronic event monitoring (EEM). The analysis revealed ‘successful medication management’ as the core category or main theme. The participants achieved success with medication adherence through managing specific areas (regimen, self and environment). By adopting realistic expectations and pragmatic attitudes, adherence is fostered when medication taking is a priority, when patients believe in the efficacy of their medications and when there is a strong patient/provider relationship. Future research is needed to develop tailored interventions using strategies identified by this population. Further in-depth examination of medication-taking behaviors in 100% adherers may be useful in developing individualized programs to maximize adherence to antiretroviral therapy in the clinical setting.

An Examination of the Relationships Among Gender, Health Status, Social Support, and HIV-Related Stigma

&NA; This secondary analysis used E. Goffmans (1963) model of stigma to examine how social support and health status are related to HIV stigma, after controlling for specific sociodemographic factors, and how these relationships differed between men and women living with HIV. Baseline data from 183 subjects in a behavioral randomized clinical trial were analyzed using multigroup structural equation modeling. Women reported significantly higher levels of stigma than men after controlling for race, history of injection drug use, and exposure category. HIV‐related stigma was negatively predicted by social support regardless of gender. The theorized model explained a significant amount of the variance in stigma for men and women (24.4% and 44%, respectively) and may provide novel and individualized intervention points for health care providers to effect positive change in perceived stigma for the person living with HIV. The study offers insight into understanding the relationships among gender, health status, social support, and HIV‐related stigma.

Functional health literacy, medication‐taking self‐efficacy and adherence to antiretroviral therapy

AIMS To report a study of the relationship between functional health literacy and medication adherence, as mediated by medication-taking self-efficacy, while controlling for the effect of key demographic variables (such as race, income and level of education). BACKGROUND Medication adherence is critical to successful HIV/AIDS self-management. Despite simplified regimens and the availability of tools to assist with medication-taking, adherence remains a challenge for many people living with HIV/AIDS. DESIGN Cross-sectional, secondary analysis. METHODS Data for this study of 302 adults living with HIV/AIDS who were taking antiretroviral medications were collected from January 2004-December 2007. Medication adherence was measured using electronic event monitors. Bivariate analyses and stepwise regression were conducted to examine the associations among functional health literacy, medication-taking self-efficacy and HIV medication adherence. RESULTS Overall, functional health literacy was much higher than expected; however, adherence in this sample was sub-optimal. Higher medication-taking self-efficacy was associated with higher medication adherence; however, functional health literacy was not significantly related to either medication adherence or self-efficacy beliefs. Hence, medication-taking self-efficacy did not mediate the relationship between functional health literacy and medication adherence. CONCLUSIONS Medication adherence continues to be an issue for people living with HIV/AIDS. Additional research is needed to understand the disparate findings related to functional health literacy and medication adherence in this and other studies examining this association.

Assessing Fidelity to an Intervention in a Randomized Controlled Trial to Improve Medication Adherence

Background:Behavioral intervention effectiveness in randomized controlled trials requires fidelity to the protocol. Fidelity assessment tools tailored to the intervention may strengthen intervention research. Objective:The aim of this study was to describe the assessment of fidelity to the structured intervention protocol in an examination of a nurse-delivered telephone intervention designed to improve medication adherence. Methods:Fidelity assessment included random selection and review of approximately 10% of the audiorecorded intervention sessions, stratified by interventionist and intervention session. Audiotapes were reviewed along with field notes for percentage of agreement, addressing whether key components were covered during the sessions. Visual analog scales were used to provide summary scores (0 = low to 5 = high) of interaction characteristics of the interventionists and participants with respect to engagement, demeanor, listening skills, attentiveness, and openness. Results:Four nurse interventionists delivered 871 structured intervention sessions to 113 participants. Three trained graduate student researchers assessed 131 intervention sessions. The mean percentage of agreement was 92.0% (±10.5%), meeting the criteria of 90% congruence with the intervention protocol. The mean interventionist interaction summary score was 4.5 ± 0.4, and the mean participant interaction summary score was 4.5 ± 0.4. Discussion:Overall, the interventionists successfully delivered the structured intervention content, with some variability in both the percentage of agreement and quality of interaction scores. Ongoing assessment aids in ensuring fidelity to study protocol and having reliable study results.

Self-care among Filipinos in the United States who have hypertension

BACKGROUND Despite the strong literature on the influence of self-care on hypertension (HTN) diagnosis, there is a notable lack of studies that explore self-care among Filipino immigrants in the United States (US) who have HTN. AIM To determine the levels of and relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care among first generation Filipino immigrants in the US who have HTN. DESIGN A cross-sectional correlational design was used to determine the relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care using the Transactional Model of Stress and Coping. One hundred and sixty-three community-dwelling first-generation Filipino immigrants participated in the study. METHODS Data on HTN self-care, acculturation, acculturative stress, HTN self-efficacy, and patient activation were collected. RESULTS The study results revealed that HTN self-efficacy and patient activation significantly contributed to the regression model that accounted for 29.5% of the variance in HTN self-care for this sample. Further analysis revealed that patient activation had a mediating role between HTN self-efficacy and HTN self-care. CONCLUSIONS Findings from this study revealed that HTN self-efficacy and patient activation were associated with self-care behaviors associated with HTN management for this sample. CLINICAL RELEVANCE Findings from this study highlight the importance of addressing HTN self-efficacy and patient activation in improving HTN self-care for this population.

Justice denied: low submission rates of sexual assault kits and the predicting variables

Following sexual assaults, victims are advised to seek health care services with forensic evidence collected and packaged in sexual assault kits (SAKs). This large (N = 1,874), retrospective study examined rates of SAK submissions by law enforcement to the state crime laboratory for analysis from 2010 to 2013 at four sites in a Western state in the United States with established sexual assault nurse examiner (SANE) programs. Variables of legal and extralegal characteristics in sexual assault cases were explored through generalized estimating equations (GEE) modeling to determine what factors statistically predicted SAK submissions. For submitted SAKs, the length of time between the dates of assault and dates of submission was categorized, and bivariate and multivariate analyses were calculated to discover legal and extralegal characteristics affecting time of submission. The study sites represented 40% of the state’s law enforcement agencies and 65% of the state’s population. Out of the 1,874 SAKs in the study, only 38.2% were submitted by law enforcement to the state crime laboratory for analysis. When SAK submissions were examined based on time between assaults and submission dates, 22.8% were submitted within a year of the assault and 15.4% were submitted more than a year after the assault following media and community pressure for law enforcement agencies to submit SAKs in storage. Significant variability of SAK submission rates and the time submitted from the assault dates were found between the sites. Site location was found to be the main determinant of whether or not SAKs were submitted. The lack of SAK submissions for analysis results in justice denied for victims and raises public safety concerns. The finding that the location in which the sexual assault occurred was the primary factor on SAK submissions represents an inequity of justice.

Strengthening the science of forensic nursing through education and research.

1Director, Forensic Graduate Programs, School of Nursing, Duquesne University, Pittsburgh, PA 2 Robert Wood Johnson Faculty Scholar, Assistant Professor, School of Nursing, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 3 526 Fisher Hall, School of Nursing, Duquesne University, Pittsburgh, PA 4Associate Professor, Robert Wood Johnson Nurse Faculty Scholar, Director, Advanced Practice Forensic Nursing Program, William F. Connell School of Nursing, Boston College,140 Commonwealth Avenue, Chestnut Hill, MA 5 Safe Place, Child Advocacy Center, 24 N Walnut Street Ste 200, Hagerstown, MD

Rural Postpartum Women With Substance Use Disorders

The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.

The Nurse-Engineer: A New Role to Improve Nurse Technology Interface and Patient Care Device Innovations

PURPOSE The purpose of this article is to describe two innovative biomedical engineering and nursing collaborations designed to educate a new cadre of professionals and develop new knowledge and innovations (robots, patient care devices, and computer simulation). ORGANIZING CONSTRUCT Complex health problems demand a highly skilled response that uses teams of professionals from various disciplines. When the biomedical engineering lens is expanded to include the practical perspective of nursing, opportunities emerge for greater technology-nurse interface and subsequent innovation. A joint nursing-engineering degree program provides the ideal preparation for a well-informed nurse-engineer who can explore new and innovative solutions that will improve care and patient outcomes. APPROACH A review of the literature provides the background on innovation and engineering in nursing and a rationale for the development of two innovative joint degrees, as well as a description of those programs. FINDINGS These innovative programs will advance healthcare-related technology and maximize the potential contribution of the nursing profession in the design and implementation of creative solutions. They also have the potential to increase the skills and knowledge for students enrolled in biomedical engineering or Bachelor of Science in nursing programs individually, providing them with interdisciplinary training and exposure. CLINICAL RELEVANCE Important patient care improvement opportunities are missed when nurses are not actively engaged in patient care device innovation and creation. Innovative nurse and engineer collaborations are needed in various forms to leverage nurse ingenuity and create patient care innovations.

Women in Transition: Experiences of Health and Health Care for Recently Incarcerated Women Living in Community Corrections Facilities

Health priorities of women after incarceration remain poorly understood, constraining development of interventions targeted at their health during that time. We explored the experience of health and health care after incarceration in a focused ethnography of 28 women who had been released from prison or jail within the past year and were living in community corrections facilities. The womens outlook on health was rooted in a newfound core optimism, but this was constrained by their pressing health-related issues; stress and uncertainty; and the pressures of the criminal justice system. These external forces threatened to cause collapse of womens core optimism. Findings support interventions that capitalize on womens optimism and address barriers specific to criminal justice contexts.