Jessica G. Burke

Patient adherence to HIV medication regimens: A review of published and abstract reports

A literature search was conducted to collect published articles reporting correlates of HIV medication adherence or interventions designed to increase HIV medication adherence. Proceedings from seven HIV/AIDS-related conferences were searched for relevant abstracts. We found 18 descriptive studies in published articles and 57 in conference proceedings producing over 200 separate variables falling into four broad areas: (1) factors related to treatment regimen; (2) social and psychological factors; (3) institutional resources; and (4) personal attributes. More complex regimens were related to decreased adherence, but were often successfully mitigated by regimen aids. Social and psychological factors reflecting emotional adjustment to HIV/AIDS and provider support were related to adherence. Access to institutional resources was associated with better adherence. Personal attributes showed a mixed relationship; gender was not consistently related to adherence, but younger age, minority status, and a history of substance abuse were often related to non-adherence. The intervention search yielded 16 interventions employing a wide range of behavioral, cognitive and affective strategies. Evidence of effectiveness was weak. We conclude the abstracts are a useful source of information as part of a systematic review, particularly when available published literature is limited, if results and study characteristics are reported in an adequate and standard manner.

The Development of a Standardized Neighborhood Deprivation Index

Census data are widely used for assessing neighborhood socioeconomic context. Research using census data has been inconsistent in variable choice and usually limited to single geographic areas. This paper seeks to a) outline a process for developing a neighborhood deprivation index using principal components analysis and b) demonstrate an example of its utility for identifying contextual variables that are associated with perinatal health outcomes across diverse geographic areas. Year 2000 U.S. Census and vital records birth data (1998–2001) were merged at the census tract level for 19 cities (located in three states) and five suburban counties (located in three states), which were used to create eight study areas within four states. Census variables representing five socio-demographic domains previously associated with health outcomes, including income/poverty, education, employment, housing, and occupation, were empirically summarized using principal components analysis. The resulting first principal component, hereafter referred to as neighborhood deprivation, accounted for 51 to 73% of the total variability across eight study areas. Component loadings were consistent both within and across study areas (0.2–0.4), suggesting that each variable contributes approximately equally to “deprivation” across diverse geographies. The deprivation index was associated with the unadjusted prevalence of preterm birth and low birth weight for white non-Hispanic and to a lesser extent for black non-Hispanic women across the eight sites. The high correlations between census variables, the inherent multidimensionality of constructs like neighborhood deprivation, and the observed associations with birth outcomes suggest the utility of using a deprivation, index for research into neighborhood effects on adverse birth outcomes.

An Introduction to Concept Mapping as a Participatory Public Health Research Method

In this article, the authors introduce concept mapping as a useful participatory research method for public health researchers interested in generating hypotheses and developing theory. The authors first provide an overview of concept mapping, which combines qualitative approaches with quantitative analytical tools to produce visual displays of the relationship between ideas. Then, they present an illustrative research application of the method to the exploration of women’s perceptions of the relationship between residential neighborhood factors and intimate partner violence experiences. They give attention to the data collection and analysis procedures and to demonstrating the intricacies of using concept mapping for public health research purposes. Finally, the article concludes with a discussion of the unique contributions and challenges associated with concept mapping.

Women's lives after an HIV-positive diagnosis: disclosure and violence

Objectives: This research addresses four questions: (1) What role do health care providers play in womens disclosure to others of their HIV-positive status? (2) What are womens concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures? Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods. Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown. Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.

HIV/AIDS and Intimate Partner Violence: Intersecting Women's Health Issues in the United States

This article reviews 35 U.S. studies on the intersection of HIV and adult intimate partner violence (IPV). Most studies describe rates of IPV among women at risk or living with HIV/AIDS and identify correlates, using multiple types of convenience samples (e.g., women in methadone treatment, women in shelters or clinics), cross-sectional designs, and self-reported risk behaviors. HIV-positive women appear to experience any IPV at rates comparable to HIV-negative women from the same underlying populations; however, their abuse seems to be more frequent and more severe. The authors found only four relevant interventions and none addressed sexually transmitted HIV and partner violence risk reduction simultaneously. There is a critical need for research on (a) causal pathways and cumulative effects of the syndemic issues of violence, HIV, and substance abuse and (b) interventions that target IPV victims at risk for HIV, as well as HIV-positive women who may be experiencing IPV.

Neighbourhoods and mental well-being: What are the pathways?

The last decade has seen an acceleration in research examining the impact of neighbourhood characteristics on a health outcomes. Yet, identifying specific pathways by which neighbourhoods affect mental well-being has received less attention. The article describes findings from a qualitative study conducted in Toronto, Ont., Canada, examining the pathways by which neighbourhood characteristics are related to mental well-being. Methods of concept mapping were used to answer our research questions. Participants identified over 100 neighbourhood characteristics grouped into six cluster that were important for either good or poor mental well-being. Clusters were rated in terms of their importance to mental well-being. Finally, participants drew diagrams describing how the neighbourhood factors and domains were contributing to poor and good mental well-being. Concept mapping provides unique contributions and challenges and may provide a useful means of examining specific pathways from neighbourhood to health outcomes.

The Process of Ending Abuse in Intimate Relationships: A Qualitative Exploration of the Transtheoretical Model

This article explores the suggestion that the transtheoretical model of behavior change is a promising conceptual framework for understanding how women end abuse in their intimate relationships. In-depth interviews were conducted with 78 women who were either currently in or had recently left abusive relationships. Women talked about the following five stages of behavior change: (a) nonrecognition (precontemplation), (b) acknowledgment (contemplation), (c) consideration of options (preparation), (d) selection of actions (action), and (e) use of safety strategies to remain free from abuse (maintenance). These results suggest that the model is consistent with how women describe surviving their abusive situations, and they have implications for both research and practice.

Socioeconomic domains and associations with preterm birth

Neighborhood socioeconomic effects on health have been estimated using multiple variables and indices. This inconsistent estimation approach makes comparison across geographic areas challenging. In this paper, we developed indices representing specific socioeconomic domains that can be reproduced in other areas to estimate elements of the neighborhood socioeconomic environment on health outcomes, specifically preterm birth. Using year 2000 U.S. census data and principal components analysis, socioeconomic indices were developed representing a priori - defined domains of education, employment, housing, occupation, poverty and residential stability. These socioeconomic indices were subsequently used in race-stratified multilevel logistic regression models of preterm birth in eight socioeconomically distinct study areas in the U.S. Maternal residence was obtained from birth records and was geocoded to census tracts. In maternal age and education adjusted models, living in tracts with high unemployment, low education, poor housing, low proportion of managerial or professional occupation and high poverty was associated with increased odds of preterm birth for non-Hispanic white women at most sites. Among non-Hispanic black women, similar associations were noted for tract-level low education, high unemployment, low occupation, and high poverty, but the effect estimates were generally smaller than those seen for white women. Increasing amounts of residential stability were not associated with preterm birth in these analyses. We combined the domain estimates across the eight study sites to produce pooled effect estimates for the socioeconomic domains on preterm birth. The research reported here suggests that specific neighborhood-level socioeconomic features may be especially influential to health outcomes. These socioeconomic domains represent potential targets for intervention or policy efforts designed to improve maternal and child health and reduce health disparities.

Ending intimate partner violence: an application of the transtheoretical model.

OBJECTIVE To examine the application of the transtheoretical model (TM) to womens experiences of ending intimate partner violence (IPV). METHODS Qualitative interviews were conducted with 23 abused women. RESULTS Women use 7 traditional processes of change. Women in early stages of change use cognitive processes. Women in later stages use behavioral processes. Consciousness-raising and social liberation appear in both early and later stages. Helping relationships are critical throughout. Decisional balance and self-efficacy are also related. CONCLUSIONS Women ending IPV do use the TM processes and constructs of change. These findings support the development and evaluation of a TM stage-based IPV intervention.

Uncovering neighbourhood influences on intimate partner violence using concept mapping

While neighbourhood influences on the risk of intimate partner violence have been reported, this body of research has suffered from a lack of strong theoretical and conceptual guidance, and few studies have examined the potential pathways from neighbourhoods to intimate partner violence. This paper used concept mapping methods with 37 women who were residents of Baltimore City to obtain cluster maps representing the important neighbourhood domains that affect the prevalence, perpetration, severity, and cessation of intimate partner violence. Domains important for intimate partner severity and perpetration differed from those important for cessation of intimate partner violence. Finally, diagrams of the domains, drawn by the concept mapping participants, illustrated the pathways by which neighbourhood characteristics potentially influence intimate partner violence severity, perpetration, and cessation. These results can be used to generate testable hypotheses regarding neighbourhood influences on intimate partner violence in future quantitative research and to inform the design of public health intimate partner violence programmes.