Kimberly Adams Tufts

Self-Care Behaviors of African American Women Living With HIV: A Qualitative Perspective

&NA; Significant numbers of African American (AA) women have been diagnosed with HIV over the past decade. HIV may be viewed as a chronic condition that can be actively managed through the use of self‐care behaviors, yet little is known about how these women define self‐care (SC) for themselves, and still less is known about what facilitates and hinders SC behaviors among these women. This article highlights the results of a qualitative research study undertaken with AA women living with HIV in a metropolitan city in the southeastern United States. The objective of this study was to systematically collect data about the SC experiences of these women. Focus group methodology was used. Content analysis of the data was conducted. Two primary domains emerged: do what the doctor says and living healthy. SC activities included seeking social support, managing disclosure, engaging in pampering, taking part in religious customs, and maintaining recovery.

Novel Interventions for HIV Self-management in African American Women: A Systematic Review of mHealth Interventions

&NA; The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV‐infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self‐management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self‐management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self‐management intervention, culturally relevant, gender‐specific mHealth interventions focusing on HIV‐infected AA women are warranted for the future.

Implications of the Virginia Human Papillomavirus Vaccine Mandate for Parental Vaccine Acceptance

In 2009, Virginia became the first state in the United States to enact a school vaccine mandate for the human papillomavirus (HPV), putting it at the forefront of the national HPV vaccine mandate controversy. It is critical to explore the public response and sensemaking where the mandate has already been enacted. Thus, we conducted 8 focus group discussions among 33 Virginia parents to explore how they conceptualized the virus and vaccine and their responses to the mandate. Findings suggest that many parents are skeptical of and reluctant to follow a state-mandated vaccine requirement, choosing instead to opt out of the vaccine until they decide the time is right for their daughter and/or until they feel confident in their knowledge about the virus, vaccine, and the impetus for the mandate. Study results can inform future legislation among states considering HPV-related mandates and aid in the development of health-promotion materials within the context of a state mandate.

Effectiveness of Health Education Teachers and School Nurses Teaching Sexually Transmitted Infections/Human Immunodeficiency Virus Prevention Knowledge and Skills in High School.

BACKGROUND We examined the differential impact of a well-established human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) curriculum, Be Proud! Be Responsible!, when taught by school nurses and health education classroom teachers within a high school curricula. METHODS Group-randomized intervention study of 1357 ninth and tenth grade students in 10 schools. Twenty-seven facilitators (6 nurses, 21 teachers) provided programming; nurse-led classrooms were randomly assigned. RESULTS Students taught by teachers were more likely to report their instructor to be prepared, comfortable with the material, and challenged them to think about their health than students taught by a school nurse. Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention, compared to controls. Yet, those taught by school nurses reported significant and sustained changes (up to 12 months after intervention) in attitudes, beliefs, and efficacy, whereas those taught by health education teachers reported far fewer changes, with sustained improvement in condom knowledge only. CONCLUSIONS Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students; however, teaching the technical (eg, condom use) and interpersonal (eg, negotiation) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have.

When intimate partner violence against women and HIV collide:Challenges for healthcare assessment and intervention

Abstract Intimate Partner Violence (IPV) and Human Immunodeficiency Virus (HIV) both constitute major public health issues that impact the overall health of women. IPV, including sexual assault, remains a persistent public health concern that has proven to be both difficult and significantly dangerous to prevent and treat. Based on data from UNAIDS more than 14.5 million women were living with HIV by the end of 2005. IPV and HIV are often interrelated. Exposure to IPV has been associated with an increased risk for contracting HIV and women who are living with HIV may be more likely to become victims of IPV. Implications: comprehensive care and services have to be offered in the context of where women seek health care. Screening and effective intervention for IPV are essential components of HIV‐related services including prevention programming, voluntary counseling and testing, and treatment. Including IPV‐related services into the context of HIV‐related services delivers the message that violence is not a taboo topic in the health‐care setting.

Adverse Health Effects of Spousal Violence Among Women Attending Saudi Arabian Primary Health-Care Clinics

This study aimed to investigate the frequency of spousal violence among Saudi women and document the related health effects and injuries, as well as their attitudes to gender and violence. Structured interviews were conducted with 200 ever-married women recruited from primary-care centres in Jeddah. Nearly half of the surveyed women (44.5%) reported ever experiencing physical violence from their spouse. Although 37 women (18.5%) had received violence-related injuries, only 6.5% had reported these injuries to a health-care provider. Victims of spousal violence had poor perceptions of their overall health, and reported pain or discomfort, antidepressant use and suicidal thoughts. Women mostly disagreed with the presented justifications for wife-beating. However, the association between gender attitudes and spousal violence was not significant. The results of this study support calls for integration of education about partner violence into health-care curricula to enhance the access and quality of services.

Impact of a quality improvement intervention on provider adherence to recommended standards of care for adults with type 2 diabetes mellitus

Purpose To report provider adherence to standards of care for adults with type 2 diabetes before and after a quality improvement (QI) intervention. Data sources Pre- and post intervention data were abstracted from 50 medical records of patients with type 2 diabetes in a small primary care practice. Conclusion There was a significant increase in the rates of foot and urine microalbumin screenings, documentation for dilated eye exams were not statistically significant. These findings demonstrated the effectiveness of using simple practice aids to reinforce adherence to the standards of care in diabetes. The failure to see a corresponding improvement in glycemic and blood pressure control is consistent with prior research and the need for more research in this area remain critical. Implications for practice Ethnic minorities are more likely to have worse control of their diabetes and more likely to receive all their care in the primary care setting, QI interventions targeting primary care providers have the potential to reduce disparities in diabetes care. Future research to determine whether cultural tailoring of diabetes QI interventions will produce additional benefits above those of generic diabetes QI interventions are needed.Purpose: To report provider adherence to standards of care for adults with type 2 diabetes before and after a quality improvement (QI) intervention. Data sources: Pre‐ and post intervention data were abstracted from 50 medical records of patients with type 2 diabetes in a small primary care practice. Conclusion: There was a significant increase in the rates of foot and urine microalbumin screenings, documentation for dilated eye exams were not statistically significant. These findings demonstrated the effectiveness of using simple practice aids to reinforce adherence to the standards of care in diabetes. The failure to see a corresponding improvement in glycemic and blood pressure control is consistent with prior research and the need for more research in this area remain critical. Implications for practice: Ethnic minorities are more likely to have worse control of their diabetes and more likely to receive all their care in the primary care setting, QI interventions targeting primary care providers have the potential to reduce disparities in diabetes care. Future research to determine whether cultural tailoring of diabetes QI interventions will produce additional benefits above those of generic diabetes QI interventions are needed.

An Intersectional Perspective on Stigma as a Barrier to Effective HIV Self-Management and Treatment for HIV-Infected African American Women

Among those who are HIV-infected and striving to live well with HIV, African American women have poorer health outcomes and represent a higher portion of those women who die from HIV-related causes. These health inequalities have been associated with the presence of social determinants of health such as stigma. This analytical review asserts that stigmas precipitated by gender, race, and class in the context of HIV-related stigma constitute substantial barriers to active engagement in HIV self-management, care, and treatment for HIV-infected African American women. The utility of the intersectionality framework for analyzing how these various stigmas interact to create unique determents to effective treatment and active self-management of HIV among African American women and for serving as a foundation for intervention development is presented.

Impact of a quality improvement intervention on provider adherence to recommended standards of care for adults with type 2 diabetes mellitus: Impact of a QI intervention on provider adherence

Purpose To report provider adherence to standards of care for adults with type 2 diabetes before and after a quality improvement (QI) intervention. Data sources Pre- and post intervention data were abstracted from 50 medical records of patients with type 2 diabetes in a small primary care practice. Conclusion There was a significant increase in the rates of foot and urine microalbumin screenings, documentation for dilated eye exams were not statistically significant. These findings demonstrated the effectiveness of using simple practice aids to reinforce adherence to the standards of care in diabetes. The failure to see a corresponding improvement in glycemic and blood pressure control is consistent with prior research and the need for more research in this area remain critical. Implications for practice Ethnic minorities are more likely to have worse control of their diabetes and more likely to receive all their care in the primary care setting, QI interventions targeting primary care providers have the potential to reduce disparities in diabetes care. Future research to determine whether cultural tailoring of diabetes QI interventions will produce additional benefits above those of generic diabetes QI interventions are needed.Purpose: To report provider adherence to standards of care for adults with type 2 diabetes before and after a quality improvement (QI) intervention. Data sources: Pre‐ and post intervention data were abstracted from 50 medical records of patients with type 2 diabetes in a small primary care practice. Conclusion: There was a significant increase in the rates of foot and urine microalbumin screenings, documentation for dilated eye exams were not statistically significant. These findings demonstrated the effectiveness of using simple practice aids to reinforce adherence to the standards of care in diabetes. The failure to see a corresponding improvement in glycemic and blood pressure control is consistent with prior research and the need for more research in this area remain critical. Implications for practice: Ethnic minorities are more likely to have worse control of their diabetes and more likely to receive all their care in the primary care setting, QI interventions targeting primary care providers have the potential to reduce disparities in diabetes care. Future research to determine whether cultural tailoring of diabetes QI interventions will produce additional benefits above those of generic diabetes QI interventions are needed.

Interview with Linda Burnes Bolton, RN, DrPH, FAAN

The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJ) jointly released the Future of Nursing: Leading Change, Advancing Health in October 2010 (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, 2010). The report outlined Nursing’s role in transforming the U.S. health care system and put forth a number of strategies for strengthening the nursing workforce and better preparing nurses to lead (RWJ, 2011a). The joint committee report contained four key messages: