José Côté

Factors Affecting Adherence to Antiretroviral Therapy in People Living with HIV/AIDS

Antiretroviral treatments have given hope to people living with HIV/AIDS and play a role in improving their quality of life. However, the effectiveness of these treatments is directly related to the level of adherence and commitment to them. Researchers have demonstrated that there are many factors that play an important role in adopting and maintaining adherence behavior. In this article, the authors present an indepth review of the literature and from this, enumerate the factors that link adherence behavior to the individual, the treatment, the illness, and the relationship with the health professional. An understanding of these factors is essential to develop interventions that will improve adherence to therapeutic regimens among people with HIV/AIDS.

Efficacy of interventions in improving adherence to antiretroviral therapy

The aim of this paper is to perform a critical review of the effectiveness of interventions for the purpose of enhancing adherence to antiretroviral therapy. The overall evaluation indicates that research is in its early stages. Although pilot studies provide support for the feasibility of their protocols, and preliminary results also suggest their capacity to improve adherence, only three major trials have reported significant improvement in adherence. The issues that will have to be addressed by future studies include: (a) the need for a theoretical and empirical understanding of the phenomena; (b) adoption of a format that fits the attributes of the population; (c) the use of multiple strategies involving key providers; (d) a concise and precise schedule governing the frequency and intensity of the intervention; (e) a careful selection of direct outcome; and (f) appropriate time measurement. In sum, greater efforts to design and evaluate interventions are needed to lead to an increase in adherence and improvement in treatment effectiveness.

Interventions for supporting nurse retention in rural and remote areas: an umbrella review.

ContextRetention of nursing staff is a growing concern in many countries, especially in rural, remote or isolated regions, where it has major consequences on the accessibility of health services.PurposeThis umbrella review aims to synthesize the current evidence on the effectiveness of interventions to promote nurse retention in rural or remote areas, and to present a taxonomy of potential strategies to improve nurse retention in those regions.MethodsWe conducted an overview of systematic reviews, including the following steps: exploring scientific literature through predetermined criteria and extracting relevant information by two independents reviewers. We used the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) criteria in order to assess the quality of the reports.FindingsOf 517 screened publications, we included five reviews. Two reviews showed that financial-incentive programs have substantial evidence to improve the distribution of human resources for health. The other three reviews highlighted supportive relationships in nursing, information and communication technologies support and rural health career pathways as factors influencing nurse retention in rural and remote areas. Overall, the quality of the reviews was acceptable.ConclusionsThis overview provides a guide to orient future rural and remote nurse retention interventions. We distinguish four broad types of interventions: education and continuous professional development interventions, regulatory interventions, financial incentives, and personal and professional support. More knowledge is needed regarding the effectiveness of specific strategies to address the factors known to contribute to nurse retention in rural and remote areas. In order to ensure knowledge translation, retention strategies should be rigorously evaluated using appropriate designs.

An Internet-Based Intervention (Condom-Him) to Increase Condom Use Among HIV-Positive Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial

Background In the recent years, the Internet has been used as a medium to find sexual partners and engage in risky sexual behavior. This has changed the way in which men having have sex with men (MSM) seek sexual partners and has increased the number of high-risk sexual encounters. Therefore, developers of human immunodeficiency virus (HIV)-prevention interventions have also started using the Internet as a viable medium to promote safe sexual behaviors. However, much of the efforts thus far have been aimed at HIV-negative rather than HIV-positive MSM. HIV-positive individuals continue to engage in risky sexual behaviors and thus constitute an important group in which HIV prevention strategies need to be addressed. Therefore, HIV prevention in HIV-positive MSM is a critical issue. Objective Condom-Him, an Internet-based intervention tailored to increase condom use among HIV-positive MSM, was developed with the aim of improving condom use, self-efficacy, and intentions to use condoms among these individuals. The acceptability and feasibility of this Internet-based intervention will be examined in a pilot study. Methods We will perform a randomized controlled parallel-group superiority trial. HIV-positive MSM who currently engage in unprotected anal sex will be recruited for the study. Participants will be randomly assigned using a one-to-one allocation ratio generated by the computer program. The researchers will be blinded to participant’s group assignment. Participants will be assigned either to use the Condom-Him intervention (experimental arm) or to view a list of websites containing HIV/AIDS related information (control arm). Self-administered questionnaires will be provided online before randomization (baseline) and two weeks after intervention (post-test). Results The study will include a total of 60 participants with 30 in each group. The results from this pilot study will provide further evidence for a larger study to examine the effectiveness of this intervention and will provide a cost-effective and widely accessible approach to HIV prevention for HIV-positive MSM. Conclusions Internet-based interventions for HIV-positive MSM, a population that has been under-represented in the efforts for positive prevention of HIV within Canada, have the potential to provide a cost-effective strategy, which influences the way in which information is accessed and provided to high-risk individuals. The advantages of an Internet-based intervention include the potential to provide consistency in the delivery of an intervention and the ability to disseminate the intervention to a wider population. Internet-based interventions are perceived as vital tools in combating HIV infection within the realm of social media. Therefore, it is important to determine the feasibility and acceptability of these interventions before implementing them. Trial Registration Clinicaltrials.gov: NCT01726153; http://clinicaltrials.gov/ct2/show/NCT01726153 (Archived by WebCite at http://www.webcitation.org/6Jljzip8B).

Web-Based Nursing Intervention for Self-Management of Pain After Cardiac Surgery: Pilot Randomized Controlled Trial

Background Most adults undergoing cardiac surgery suffer from moderate to severe pain for up to 6 days after surgery. Individual barriers and attitudes regarding pain and its relief make patients reluctant to report their pain and ask for analgesic medication, which results in inadequate pain management. More innovative educational interventions for postoperative pain relief are needed. We developed a Web-based nursing intervention to influence patient’s involvement in postoperative pain management. The intervention (SOULAGE-TAVIE) includes a preoperative 30-minute Web-based session and 2 brief face-to-face postoperative booster sessions. The Web application generates reflective activities and tailored educational messages according to patients’ beliefs and attitudes. The messages are transmitted through videos of a virtual nurse, animations, stories, and texts. Objective The aim of this single-blinded pilot randomized trial was to investigate the preliminary effects of a virtual nursing intervention (SOULAGE-TAVIE) to improve pain relief in patients undergoing cardiac surgery. Methods Participants (N = 60) were adults scheduled for their first cardiac surgery. They were randomly assigned to the experimental group using SOULAGE-TAVIE (n = 30) or the control group using usual care, including an educational pamphlet and postoperative follow-up (n = 30). Data were collected through questionnaires at the time of admission and from day 1 to day 7 after surgery with the help of a blinded research assistant. Outcomes were pain intensity, pain interference with daily activities, patients’ pain barriers, tendency to catastrophize in face of pain, and analgesic consumption. Results The two groups were comparable at baseline across all demographic measures. Results revealed that patients in the experimental group did not experience less intense pain, but they reported significantly less pain interference when breathing/coughing (P = .04). A severe pain interference with breathing/coughing (pain ranked ≥ 7/10) was reported on day 3 after surgery by 15% of the patients in the experimental group (4/27), as compared to 44% (7/16) in the control group. On day 7 after surgery, participants in the experimental group also exhibited fewer pain-related barriers as measured by the Barriers Questionnaire-II (mean 10.6, SD 8.3) than patients in the control group (mean 15.8, SD 7.3, P = .02). No difference was found for pain catastrophizing. However, in both groups, means revealed a lower tendency to catastrophize pain before surgery as measured by the Pain Catastrophizing Scale (control group mean 1.04, SD 0.74; experimental group mean 1.10, SD 0.95) and after surgery (control group mean score 1.19, SD 0.94; experimental group mean score 1.08, SD 0.99). Finally, the experimental group consumed more opioid medication (mean 31.2 mg, SD 23.2) than the control group (mean 18.8 mg, SD 15.3, P = .001). Conclusions This pilot study provides promising results to support the benefits of this new Web-tailored approach that can increase accessibility to health education and promote pain relief without generating more costs. Trial Registration Clinicaltrials.gov NCT01084018; http://www.clinicaltrials.gov/ct2/show/NCT01084018 (Archived by WebCite® at http://www.webcitation.org/6CoTBkIoT)

The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale

AIM This paper is a report of a study to evaluate the construct validity of the four-dimensional Caring Nurse-Patient Interaction-Short Scale using confirmatory factor analysis. BACKGROUND Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse-Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse-Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. METHOD A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse-Patient Interaction Short Scale was performed. FINDINGS As expected with large samples and models, the chi-squared-associated P-value was statistically significant (chi2 = 811.43, d.f. = 224, P < 0.01). However, the other indices reached acceptable levels with 0.054 for the standardized root mean-squared residuals, 0.070 for the root mean-square error of approximation, 0.88 for the goodness of fit index, 0.98 for the comparative fit index and 0.97 for the normal fit index. The factor loadings for all items with their hypothesized factor were > or = 0.48 and statistically significant at the 0.01 level. CONCLUSION The Caring Nurse-Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle-range theory during the construct validity process and still reflects Watsons theory while offering a structure that is testable in clinical research.

A randomized trial of a cognitive coping intervention for acutely ill HIV-positive men.

BackgroundPeople who are HIV-positive now live longer when they have contracted AIDS, and nursing interventions can help improve their quality of life. ObjectivesTo test the effects of an intervention based on developing cognitive coping skills as compared to one focused on facilitating the expression of emotions. Both interventions were intended to help regulate emotional response to an exacerbation of HIV-related symptoms. MethodIn a randomized, controlled trial, 90 hospitalized HIV-positive men were randomly assigned to one of three groups: cognitive, expression, or control. The intervention was administered on three consecutive days in 20–30 minute sessions. Preintervention and postintervention data were gathered on mood, distress, and anxiety. ResultsBoth interventions produced a beneficial effect on negative affect (cognitive group p = .002, expression group p = .011), and immediately following the first daily session (p = .001). No change in positive affect was produced by either intervention. Paired t tests indicated a decrease in distress (p = .039), specifically, of intrusive ideation (p = .03), for the cognitive group, which also experienced a decrease in anxiety from immediately before to immediately after each session. Conversely, the expression group experienced an increase in anxiety (p = .018). DiscussionThe cognitive coping skills nursing intervention was effective in helping to regulate HIV-positive persons’ emotional responses to advanced disease. This nursing intervention is feasible for use by skilled practitioners providing daily care.

Glycaemic control and self-management behaviours in Type 2 diabetes: results from a 1-year longitudinal cohort study.

To better understand the associations between changes in self‐management behaviours and glycaemic control.

A nursing virtual intervention: real-time support for managing antiretroviral therapy.

Based on a philosophy of empowerment, we developed the HIV Treatment, Virtual Nursing Assistance and Education intervention to equip persons living with HIV for managing their daily antiretroviral therapies. In this article, we describe the project and the process of developing it, which was carried out in three phases: (1) development of the interventions clinical content, (2) generation of a multimedia presentation, and (3) implementation of our Web application via computer interface. The HIV Treatment, Virtual Nursing Assistance and Education consists of four interactive sessions at the computer, animated by a virtual nurse that takes the individual through the learning process about the capabilities necessary for taking the treatment. This information and strategies provided by the virtual nurse are specifically adapted to the participant, according to the responses he/she supplies. The virtual intervention approach, still experimental, is intended to be complementary with the actual clinical follow-up and has been developed in the context of reorganizing services and of the scarcity of resources. While we anticipate direct positive outcomes among the HIV clientele, it is also highly probable that this virtual support application will have ramifications among different clienteles who must also contend with the daily challenges of their health conditions.

Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial

BackgroundLiving with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I’immunodéficience Humaine–Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV.Methods/designA convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context.DiscussionCarrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services.Trial registrationCE 11.184 / NCT 01510340