Lance S. Rintamaki

Literacy, Social Stigma, and HIV Medication Adherence

BACKGROUNDPrior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated.OBJECTIVETo examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence.DESIGNStructured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ).PARTICIPANTSTwo hundred and four consecutive patients participated.RESULTSApproximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th–8th grade) or low (≤ 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3–8.7; pu2009<u20090.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3–7.7).CONCLUSIONSWhile low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.

Transgender patient perceptions of stigma in health care contexts.

Objectives:Transgender individuals, or those who cross or transcend sex categories, commonly experience stigma and discrimination. Anecdotal evidence indicates that this transphobia manifests in health care settings, but few studies address the forms of mistreatment experienced in this context. This study was designed to explore transgender patients’ experiences with health care. This brief report focuses on their negative experiences. Methods:A total of 152 transgender adults were recruited to complete an online questionnaire about their health care. Participants were asked if and how they had been mistreated, and responses were analyzed by qualitative content analysis. Results:Participants’ descriptions of mistreatment coalesced around 6 themes: gender insensitivity, displays of discomfort, denied services, substandard care, verbal abuse, and forced care. Conclusions:These findings provide insight into transgender patients’ perceptions of and sensitivity to mistreatment in health care contexts. This information might be used to increase providers’ cultural competency and inform their interactions with transgender patients.

Avoiding Health Information

This study investigated why and how individuals avoid health information to support the development of models of uncertainty and information management and offer insights for those dealing with the information and uncertainty inherent to health and illness. Participants from student (n = 507) and community (n = 418) samples reported that they avoided health information to (a) maintain hope or deniability, (b) resist overexposure, (c) accept limits of action, (d) manage flawed information, (e) maintain boundaries, and (f) continue with life/activities. They also reported strategies for avoiding information, including removing or ignoring stimuli (e.g., avoiding people who might provide health advice) and controlling conversations (e.g., withholding information, changing the subject). Results suggest a link between previous experience with serious illness and health information avoidance. Building on uncertainty management theory, this study demonstrated that health information avoidance is situational, relatively common, not necessarily unhealthy, and may be used to accomplish multiple communication goals.

Social Activism, Self-Advocacy, and Coping with Hiv Illness

Activist organizations are a relatively unique collective setting for people living with an HIV infection or AIDS. Communication within these organizations includes educational and motivational practices designed to facilitate change for the group and for its individual members. In this study, we examined differences between activist and nonactivist individuals (N = 174) with HIV or AIDS. Results demonstrated that, in comparison with nonactivists, activists (i) used more problem-focused coping and less emotion-focused coping, (ii) had greater knowledge of HIV-treatment information sources, and (iii) had greater HIV social network integration. We speculate that there are two reasons for these differences: (i) there are behavioral and psychological predisposing factors that lead to membership in an activist group, and (ii) the educational and motivational environments established through the relationships of activist group members (i.e., the social tasks of the collective) lead to changes in individuals.

Using Theoretical Constructs to Identify Key Issues for Targeted Message Design: African American Seniors' Perceptions About Influenza and Influenza Vaccination

African American seniors (65 and older) are less likely to be vaccinated against influenza than are non-Hispanic White seniors. There is a clear need for targeted messages and interventions to address this disparity. As a first step, 6 focus groups of African American seniors (Nu2009 =u2009 48) were conducted to identify current perceptions about influenza and influenza vaccination. Emergent thematic categories were organized using the 4 main constructs of the extended parallel process model. Susceptibility varied based on perceptions of individual health status, background knowledge, and age-related risk. Some participants saw influenza as a minor nuisance; others viewed it as threatening and potentially deadly. Participants discussed issues related or antecedent to self-efficacy, including vaccine accessibility and affordability. Regarding response efficacy, some participants had confidence in the vaccine, some questioned its preventive ability or believed that the vaccine caused influenza, and others noted expected side effects. Implications and recommendations for message development are discussed.

The Forms and Functions of Peer Social Support for People Living With HIV

&NA; Peers may be important sources of coping assistance, but their impact can be better understood if we examine their influence across various contexts. Although social support studies focused on people living with HIV have examined peer support in various contexts, they do not comprehensively account for situations in which peer support might be provided. The specific aims of this study were to (a) describe the various forms and functions of peer support for people living with HIV and (b) validate the Dennis (2003) concept analysis of peer support within health contexts. Results indicate that peer support is a potentially important adjunct to clinical care for enhancing coping skills, thereby improving the psychosocial functioning of people living with HIV. It is important to (a) assess patient access to peer support, (b) provide opportunities for peer support in the clinical setting, and (c) enhance disclosure and support‐seeking skills to facilitate this benefit.

An Examination of Online Health Information Seeking by Deaf People

Research indicates that information seekers often turn to the Internet for health information; however, little is known about how Deaf people perceive, access, and utilize the Internet as a health information source. In this study, eight focus groups with Deaf participants (n = 39) were conducted to explore how Deaf people make use of (or avoid) the Internet as a health information source. Focus-group transcripts were analyzed using latent content and constant comparative techniques. Findings are presented using the model of online health information seeking and illustrate the reasons reported for both avoiding and utilizing the Internet as a health information source. In addition, findings illustrate the processes Deaf people navigate when accessing online health information, as well as the strategies they employ when doing so. This research underscores the need for continued investigation of access to and use of e-health resources by Deaf people.

Forms, functions, and foibles of humor used in AIDS service organizations.

&NA; Research has indicated that HIV service providers commonly use humor to cope with work‐related stress; however, little is known about the forms and functions of humor used by these professionals. In this study, 25 HIV service providers from five AIDS service organizations were interviewed about their use of humor. Participants described five primary types of humor as prevalent within AIDS service organizations and noted that humor served a variety of functions, which were either adaptive or maladaptive. Adaptive functions included boosting morale and reducing tension, whereas maladaptive functions ranged from masking emotions to alienating certain groups. Results emphasized the importance of context in the study of humor use and the need for continued investigations of the stress and coping of HIV service providers.

Advancing the Extended Parallel Process Model Through the Inclusion of Response Cost Measures

This study advances the Extended Parallel Process Model through the inclusion of response cost measures, which are drawbacks associated with a proposed response to a health threat. A sample of 502 college students completed a questionnaire on perceptions regarding sexually transmitted infections and condom use after reading information from the Centers for Disease Control and Prevention on the health risks of sexually transmitted infections and the utility of latex condoms in preventing sexually transmitted infection transmission. The questionnaire included standard Extended Parallel Process Model assessments of perceived threat and efficacy, as well as questions pertaining to response costs associated with condom use. Results from hierarchical ordinary least squares regression demonstrated how the addition of response cost measures improved the predictive power of the Extended Parallel Process Model, supporting the inclusion of this variable in the model.

Remembering the Legacy of Dale E. Brashers and His Contributions to Health Communication

On July 5, 2010, Dale E. Brashers, head of the Departmentof Communication at the University of Illinois at Urbana-Champaign and key figure in the field of health commu-nication, passed away in his university office. He was 50years old.Theimpactofthislossisstillexpanding,ripplingthroughthe field and the vast network of people who knew him ascolleague, mentor, or friend. For some, his death was noless painful than losing a parent, so special was this manto them. Equally severe is the loss to the field of healthcommunication, in which Brashers was a central and highlyvisible figure. His scholarly contributions, applied clinicalwork, mentorship of junior health communication scholars,and leadership in our national and international professionalorganizations all helped advance our discipline, broaden-ing its reach and increasing its visibility among the healthsciences. Although Brashers held some interest in groupsand argumentation (Jacobs, Brashers, & Dawson, 1996;Meyers & Brashers, 1999; Meyers, Brashers, & Hanner,2000; Rintamaki & Brashers, 2010), he is best known forhis methodological research and theoretical advancement ofuncertainty management. For these reasons, the 100