Basanti Majumdar

Effective/efficient mental health programs for school-age children: a synthesis of reviews

The prevalence of mental health problems, some of which seem to be occurring among younger cohorts, leads researchers and policy-makers to search for practical solutions to reduce the burden of suffering on children and their families, and the costs to society both immediate and long term. Numerous programs are in place to reduce or alleviate problem behaviour or disorders and/or assist positive youth development. Evaluated results are dispersed throughout the literature. To assess findings and determine common elements of effective childrens services, a literature search was undertaken for evidence-based evaluations of non-clinical programs for school-age children. Prescriptive comments aim to inform service-providers, policy-makers and families about best practices for effective services such as: early, long-term intervention including reinforcement, follow-up and an ecological focus with family and community sector involvement; consistent adult staffing; and interactive, non-didactic programming adapted to gender, age and cultural needs. Gaps are identified in our understanding of efficiencies that result from effective programs. Policy implications include the need to develop strategies for intersectoral interventions, including: new financing arrangements to encourage (not penalize) interagency cooperation and, to ensure services reach appropriate segments of the population; replication of best practices; and publicizing information about benefits and cost savings. In many jurisdictions legislative changes could create incentives for services to collaborate on service delivery. Joint decision-making would require intersectoral governance, pooling of some funding, and policy changes to retain savings at the local level. Savings could finance expansion of services for additional youth.

Community-Based, Culturally Sensitive HIV/AIDS Education for Aboriginal Adolescents: Implications for Nursing Practice

Research is an essential component of effective, evidence-based nursing practice. Limited scientific data have been published on Canadian Aboriginals, and even less information is available on HIV prevention efforts aimed at Aboriginal youth. The need for more research on HIV and AIDS among Aboriginals, and especially Aboriginal youth, is highlighted throughout the article as a means to improving prevention interventions for this vulnerable population. At the same time, insights gained from a culture-sensitive, HIV/AIDS educational program that targeted a group of Aboriginal adolescents from a local First Nations community in Ontario are discussed. Implications for future HIV/AIDS peer-based prevention efforts using the train-the-trainer technique are also considered.

An Exploration of Socioeconomic, Spiritual, and Family Support Among HIV-Positive Women in India

Through in-depth, tape-recorded interviews, this qualitative pilot study explored the feelings and concerns of 10 HIV-positive women, aged 18 to 70 years, and the socioeconomic, spiritual, and family support available to them in Kolkata, India. A qualitative approach of continuous comparative analysis of themes revealed that although heterosexual contact was the main source of infection, poverty and sexual violence were indirect social factors. These women experienced markedly less socioeconomic, spiritual, and family support after contracting the disease. In addition to worsening physical symptoms, emotional and mental anguish forced them into isolation, negatively affecting their mental health. Social isolation infiltrated their spiritual lives, producing feelings of helplessness about the future of their children. The identification of this process is important to nursing practice, as it highlights key areas of concern in the implementation of prevention programs and future research.

Culture, but more than culture: an exploratory study of the HIV vulnerability of Indian immigrants in Canada

Abstract Explanations of immigrant health that ascribe to culture a fundamental causal role neglect the broader structural and contextual factors with which culture intersects. Based on a qualitative study of Indian immigrants’ vulnerability to HIV in Canada, this paper presents a contextualised understanding of these individuals’ understanding of, perceptions about, and responses to the HIV risk in their post-immigration lives. The study reveals that although culture – both traditional values and the norms of the diaspora community – appears to have constrained Indian immigrants’ capacities to respond to the risk, this effect can be properly understood only by situating such constraint in the context of the settlement process that has shaped participants’ living conditions, including their relationship with the diasporic community in Canada. We argue that HIV vulnerability should be conceptualised as a health inequality associated with broader systems of power relations (eg socio-economic marginalisation, gender inequality, discrimination, and racism). This more holistic conceptualisation of the intersection of culture, integration, and HIV vulnerability will facilitate exploration of HIV prevention strategies, through which interconnected inequalities of gender, race, and access to knowledge and resources can be challenged.

Comparison of Self- and Faculty Directed Learning of Psychomotor Skills

This randomized controlled trial compared the effectiveness of self-directed learning (SDL) and faculty directed, demonstration-return-demonstration learning (DRD) for psychomotor clinical nursing skills and level of knowledge of second year baccalaureate nursing students. The self-directed learning approach of a university was compared to a community colleges approach of tutor demonstration-student return demonstration for students from the University. Data were collected using questionnaires measuring academic outcomes after the students were exposed to the different learning approaches. The data were compared for differences in grades in an objective structured clinical examination (OSCE). Findings indicated that students perceived there were differences in the learning process, however there were no differences of interest in most of the academic outcomes. While students did not differ on the total OSCE grade, students using the SDL method received higher grades in only one of the marker stations and students using the DRD method received higher grades in only one marker and one observer station. The group of students receiving the DRD method indicated that they were given enough help from faculty, were allowed sufficient practice time and expected that the SDL method would be more stressful. 30.8% of the students in the SDL group recommended their learning method to future second year students, while 100% of the DRD group recommended the DRD method. Although the outcome appeared not to differ, more students indicated satisfaction with the faculty-directed (DRD) approach.

Stigma as a Barrier to HIV Prevention among an Indian-Immigrant Population in Canada: A Qualitative Study

Purpose: To broaden understanding of the vulnerability to HIV of Indian immigrant communities in Canada. This study focused on the exploration of (a) selected population of Indian immigrants’ perceptions of HIV risk, risk behaviour, and utilization of HIV/AIDS-related services, and (b) the effects of cultural norms of these communities in shaping their capacity for and experiences of responding to HIV in Canada. Methods: A total of 24 semi-structured interviews were conducted with selected population of the Indian-immigrant community. Participants were recruited purposively through a South Asian Punjabi community health service. Each interview lasted from one to two hours and was conducted in English or Punjabi depending on the preference of the participant. Tapes were transcribed verbatim and translated to English. Interview transcripts were coded and analyzed using N-Vivo software. Final themes and sub-themes were decided on by consensus among researchers. Results: Participants discussed cultural taboos and stigma associated with any topic that was perceived to be connected to sexual behaviour. Participants identified that these cultural taboos and the resulting stigma has reduced opportunities for members of the Indian immigrant population to obtain accurate information related to HIV. Although participants agreed that knowledge of HIV was important for prevention, participants discussed a reluctance to talk openly about issues or to seek information publically. Conclusions: Social taboos that limit discourse around sexuality and sexual behaviour negatively impact the effectiveness of HIV prevention education efforts which have targeted mainstream Canadians. This study points to the need for innovative strategies that address social norms and influences among a diverse group of people who maintain close ties with family and friends living in India. Social network theory can provide guidance for carefully planned peer outreach initiatives which may provide an effective means to reach this underserved community.

HIV Prevention in an Aboriginal Community in Canada

Basanti Majumdar is a Professor, School of Nursing and Department of Family Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada. Dale Guenter is an Associate Professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada. Gina Browne is a Professor, School of Nursing, Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Ontario, Canada.