Catrin Evans

What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work

Abstract Increasing emphasis is being placed on the need for ‘structural interventions’ (SIs) in HIV prevention internationally. There is great variation in how the concept of SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. In this paper, we clarify and elucidate what constitutes a SI with particular reference to the structured distribution of power and to the role of communities. We summarise the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy, and present ethnographic case-study material from a sex workers HIV project in Kolkata, India, to illustrate the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of (1) attending to local complexities in the micro and macro-level structures that produce vulnerability; and (2) clarifying the meaning and role of communities within SIs.

Experiences of African Immigrant Women Living with HIV in the U.K.: Implications for Health Professionals

In the U.K. immigrant women from Africa constitute an increasingly large proportion of newly diagnosed cases of HIV. A significant minority of these are refugees and asylum seekers. Very little is known about their experiences of living with HIV/AIDS, their psychosocial needs or their views of health care provision. This paper reports the results of a qualitative study that explored these issues by interviewing eight African women living with HIV in the British city of Nottingham. Women’s ability to live positively with HIV was found to be strongly shaped by their migration history, their legal status, their experience of AIDS-related stigma and their Christian faith. Significantly, health services were represented as a safe social space, and were highly valued as a source of advice and support. The findings indicate that non-judgemental, personalised health care plays a key role in encouraging migrant African women to access psychosocial support and appropriate HIV services.

Screening for breast cancer among young Jordanian women: ambiguity and apprehension

AIMS The goal of this study was to understand young Jordanian womens attitudes towards breast cancer screening practices in order to improve young womens uptake of screening and early detection. BACKGROUND The incidence of breast cancer is increasing annually among younger Jordanian women; however, little is known about their attitudes towards breast cancer and associated screening practices. Young womens attitudes towards breast cancer must be taken into account when designing screening strategies and interventions specifically for this age group. Screening strategies must also acknowledge young womens cultural context; however, little is known about how culture shapes their understandings and practices. METHODS A qualitative interpretive approach was utilized to interview 45 young educated women about their breast cancer views and screening practices. Data were analysed thematically. FINDINGS AND DISCUSSION Four overlapping themes emerged: (i) young women should not think about it, (ii) absence of a role model, (iii) cultural shame of breast cancer, and (iv) cancer means death and disability. The study found high levels of apprehension and ambiguity related to breast cancer. This was associated with the perceived impact of a cancer diagnosis on a young womans social status and family role. Family support was perceived to be a necessary prerequisite for seeking treatment or screening. CONCLUSIONS Understanding young womens perception about screening and early detection of breast cancer is essential for policy makers and healthcare providers to design culturally appropriate and age-appropriate health promotion campaigns and services.

Implementing routine provider-initiated HIV testing in public health care facilities in Kenya: a qualitative descriptive study of nurses' experiences.

Abstract Routine “provider-initiated testing and counselling” (PITC) for HIV has been implemented amidst concern over how consent, confidentiality and counselling (the 3Cs) can be maintained in under-resourced health care settings. In Kenya, PITC has been rolled out since 2005, HIV prevalence is 7.1% and more than 86% of adults have not been tested. Kenyan nurses are the main cadre implementing PITC, but little is known about their experiences of incorporating HIV testing into everyday practice and the challenges faced in maintaining the 3Cs within their work environments. This study aimed to explore these issues and adopted a qualitative multi-method design using a convenience sampling approach. Two focus group discussions (total n=12) and 13 in-depth individual interviews were undertaken with nurses from 11 different public health care facilities in Nairobi and its surrounding areas (including in-patient and outpatient settings). Data were analysed thematically. Nurses identified a range of personal, client and health system challenges in the everyday application of PITC. These included (i) the contradictions of normalising a highly stigmatised disease and the difficulty in providing client-centred care within a routinised and target-oriented work culture; (ii) the challenge of dealing with ethically complex client situations in which the principles of the 3Cs could be difficult to uphold; and (iii) lack of time, resources, space and recognition within workplace environments (especially in-patient settings) that, likewise, led to problems with maintaining the 3Cs. In-patient nurses in particular identified problems associated with testing in a multi-disciplinary context, suggesting that other health professionals appeared to routinely flout the PITC guidelines. In conclusion, this study shows that the process of translating policy into practice is invariably complex and that more research is needed to explore PITC practices, particularly in in-patient settings. Nurses require supervision and support to negotiate the challenges and to fulfil their roles effectively.

After the Doctorate: A qualitative study investigating nursing research career development in Jordan

There is a dearth of research exploring the development of postdoctoral nursing research careers in non-Western contexts. This paper reports on a qualitative study of Jordanian graduates of UK PhD programs. Interviews were held with 16 graduates who worked in the nursing faculty of seven different universities in Jordan. Participants reported that their doctoral degree had equipped them with confidence and enthusiasm for developing a research career. Mentorship, leadership, and peer support were identified as essential to supporting ongoing research activity. Access to these sources of support was variable and participants also described a range of institutional and organizational structures that directly or indirectly discouraged them from developing research productivity. This research suggests that support for postdoctoral novice researchers is an important area for further attention - for Jordanian universities, for UK PhD supervisors (and their associated academic departments), and for the wider nursing community.

Erratum to: Developing a mHealth intervention to promote uptake of HIV testing among African communities in the UK: a qualitative study

BackgroundHIV-related mHealth interventions have demonstrable efficacy in supporting treatment adherence, although the evidence base for promoting HIV testing is inconclusive. Progress is constrained by a limited understanding of processes used to develop interventions and weak theoretical underpinnings. This paper describes a research project that informed the development of a theory-based mHealth intervention to promote HIV testing amongst city-dwelling African communities in the UK.MethodsA community-based participatory social marketing design was adopted. Six focus groups (48 participants in total) were undertaken and analysed using a thematic framework approach, guided by constructs from the Health Belief Model. Key themes were incorporated into a set of text messages, which were pre-tested and refined.ResultsThe focus groups identified a relatively low perception of HIV risk, especially amongst men, and a range of social and structural barriers to HIV testing. In terms of self-efficacy around HIV testing, respondents highlighted a need for communities and professionals to work together to build a context of trust through co-location in, and co-involvement of, local communities which would in turn enhance confidence in, and support for, HIV testing activities of health professionals. Findings suggested that messages should: avoid an exclusive focus on HIV, be tailored and personalised, come from a trusted source, allay fears and focus on support and health benefits.ConclusionsHIV remains a stigmatized and de-prioritized issue within African migrant communities in the UK, posing barriers to HIV testing initiatives. A community-based participatory social marketing design can be successfully used to develop a culturally appropriate text messaging HIV intervention. Key challenges involved turning community research recommendations into brief text messages of only 160 characters. The intervention needs to be evaluated in a randomized control trial. Future research should explore the application of the processes and methodologies described in this paper within other communities.

The needs and experiences of skin cancer patients: a qualitative systematic review with meta‐synthesis

Skin cancer incidence is increasing worldwide. This is an update of a previous review published in 2010 that identified only two studies and found that the needs and experiences of individuals with skin cancer were under‐researched. Our objective was to undertake a qualitative systematic review of the needs and experiences of people with a diagnosis of skin cancer. To update the previous review, the following databases were searched from 2010 to 30 November 2015: CINAHL PsycINFO, Medline and Embase. The methodological quality of the studies was assessed using the Joanna Briggs Institute Qualitative Assessment Review Instrument. The qualitative research findings were synthesized using a pragmatic meta‐aggregative approach. A total of 14 studies (16 papers) were included. Only three studies included patients with keratinocyte carcinoma. Overall, 15 categories were identified and these resulted in four overarching synthesized findings (SFs) from diagnosis (SF1), throughout treatment (SF2) and follow‐up (SF3), and then a fourth SF (SF4) that addressed patients’ satisfaction with their care and their relationship with healthcare professionals. Despite the fact that patients with keratinocyte carcinoma and melanoma can have a very different prognosis, they also share similar needs and concerns especially around the time of diagnosis and follow‐up/surveillance for new lesions. Healthcare professionals working with patients with skin cancer need to understand their psychosocial concerns and their information needs in order to design services appropriately. Future studies need to consider patients with keratinocyte carcinoma in addition to patients with melanoma.

The development of the nursing profession in a globalised context: A qualitative case study in Kerala, India

In the paper, we are looking at the relationship between globalisation and the professional project, using nursing in Kerala as an exemplar. Our focus is on the intersection of the professional project, gender and globalisation processes. Included in our analysis are the ways in which gender affects the professional project in the global south, and the development of a professional project which it is closely tied to global markets and global migration, revealing the political-economic, historical, and cultural factors that influence the shape and consequences of nurse migration. The phenomenon that enabled our analysis, by showing these forces at work in a particular time and place, was an outbreak of strikes by nurses working in private hospitals in Kerala in 2011-2012.

Looking back at the doctorate: A qualitative study of Jordanian graduates from PhD programs in the UK

Many countries develop their nursing capacity by sending nurses overseas to gain their doctorates. There is a lack of research on their subsequent experience and career development. Focusing on the Jordanian and UK contexts, this qualitative study explored the doctoral and postdoctoral experience. Interviews were held with 16 PhD nursing graduates in Jordan. The participants had studied in 12 different universities in the UK and now worked as faculty members in seven Jordanian universities. The data were analyzed thematically. The participants reported that the most difficult task (but also the most significant achievement) was the transition to autonomous scholarship. They also described a profound personal transformation as a result of living in another country. However, very few of them could cite examples of how they were using their skills now to influence their current practice within their faculty roles. This suggests a possible under-use of the skills, new perspectives, and enthusiasm that new doctoral graduates bring back home with them. Future research should focus on identifying ways to support and develop doctoral nursing graduates to maximize their potential on their return home.

Nurses in the Private Health Sector in Kerala: Any Lessons Learnt from Their Strikes in Recent Years?

This article analyses the series of strikes initiated by staff nurses in private hospitals in the state of Kerala. In spite of the growth of private sector health care institutions, working terms and conditions of nursing professionals are structured by a deeply iniquitous ethos. A number of strikes were organised that generated public interest and resulted in some potential long-term changes in the perspectives on health care professionals’ recruitment and terms of work. How did the nurses in the private sector negotiate their demand for better working conditions using strike as a strategy? What were the responses of the key stakeholders and the general public? It is obvious that gender mediated the negotiations between the state, private sector hospital managements and unions, on the one hand, and nurses who were predominantly women, on the other. In that case, what were the ways in which gender was factored into the discussions? This bears important implications for the regulation and governance of the private health care sector. This article thus argues that the legislation on clinical establishments should be expedited and any attempt to jeopardise it should be resisted; rather there should be collective efforts to work on the shortcomings of the Clinical Establishment (Registration and Regulation) Bill.