Nancy Van Devanter

Effect of an STD/HIV Behavioral Intervention on Women's Use of the Female Condom

OBJECTIVES This study assessed the effectiveness of a sexually transmitted disease (STD)/HIV behavior change intervention in increasing womens use of the female condom. METHODS A total of 604 women at high risk for STDs and HIV in New York City, Baltimore, Md, and Seattle, Wash, enrolled in a randomized controlled trial of a small-group, skills-training intervention that included information and skills training in the use of the female condom. RESULTS In a logistic regression, the strongest predictors of use were exposure to the intervention (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.8, 10.7), intention to use the female condom in the future (OR = 4.5; 95% CI = 2.4, 8.5), having asked a partner to use a condom in the past 30 days (OR = 2.3; 95% CI = 1.3, 3.9), and confidence in asking a partner to use a condom (OR = 1.9; 95% CI = 1.1, 3.5). CONCLUSIONS Clinicians counseling women in the use of the female condom need to provide information, demonstrate its correct use with their clients, and provide an opportunity for their clients to practice skills themselves.

Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics.

Background: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended. Goal: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea. Study: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus

Modeling Intervention Efficacy for High-Risk Women The WINGS Project

20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder. Results: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6–2.5) and 2.6 (95% CI, 1.3–5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7–193.5) and 4.6 (95% CI, 0.4–58.0). Conclusions: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.

Safer sex strategies for women: The hierarchical model in methadone treatment clinics

This study evaluates the effectiveness of two strategies—communication and condom skills training—for increasing condomprotected sex in a sample of 510 high-risk women ages 17 to 61. Baseline and 3- and 6-month postintervention interview data were gathered in three cities participating in a randomized trial of a six-session, group skill-building intervention. This analysis was conducted for the entire sample and for six subgroups categorized by age, single or multiple partners, and history of childhood sexual abuse. The dependent variable was the odds ratio of protected sex acts at each follow-up. Structural equation modeling was used to estimate effects for two intervention pathways. The pathway through condom skills increased the odds of protected sex for the intervention group (χ2 difference = 35, df = 2, p < .05) as well as for all subgroups. The pathways through communication were significant for the intervention group (χ2 difference = 23, df =3, p < .05) but fully effective only for participants under 30 and participants who reported childhood sexual abuse. The effectiveness of both pathways diminished at 6 months. WINGS demonstrates that condom skills training can increase protected sex for a heterogeneous group of women. Further research needs to examine how such skill training translates into use of condoms by male partners. To increase the duration of intervention effects, booster sessions may need to be incorporated.

Obstetric Fistula: What About Gender Power?

Women clients of a methadone maintenance treatment clinic were targeted for an intervention aimed to reduce unsafe sex. The hierarchical model was the basis of the single intervention session, tested among 63 volunteers. This model requires the educator to discuss and demonstrate a full range of barriers that women might use for protection, ranking these in the order of their known efficacy. The model stresses that no one should go without protection. Two objections, both untested, have been voiced against the model. One is that, because of its complexity, women will have difficulty comprehending the message. The second is that, by demonstrating alternative strategies to the male condom, the educator is offering women a way out from persisting with the male condom, so that instead they will use an easier, but less effective, method of protection. The present research aimed at testing both objections in a high-risk and disadvantaged group of women. By comparing before and after performance on a knowledge test, it was established that, at least among these women, the complex message was well understood. By comparing baseline and follow-up reports of barriers used by sexually active women before and after intervention, a reduction in reports of unsafe sexual encounters was demonstrated. The reduction could be attributed directly to adoption of the female condom. Although some women who had used male condoms previously adopted the female condom, most of those who did so had not used the male condom previously. Since neither theoretical objection to the hierarchical model is sustained in this population, fresh weight is given to emphasizing choice of barriers, especially to women who are at high risk and relatively disempowered. As experience with the female condom grows and its unfamiliarity decreases, it would seem appropriate to encourage women who do not succeed with the male condom to try to use the female condom, over which they have more control.

The Attending Nurse: An Evolving Model for Integrating Nursing Education and Practice

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for womens reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

The Association between Discrimination and the Health of Sikh Asian Indians

The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic “bedsides” where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.

Developing and Conducting a Dissertation Study Through the Community-Based Participatory Research Approach

OBJECTIVE We investigated the relationships between self-reported discrimination (SRD) and mental and physical health (self-reported physical health conditions and direct, physiologic measures [BMI, waist-to-hip ratio, and blood pressure]) among Sikh Asian Indians (AI), a group that may be particularly discriminated against because of physical manifestations of their faith, including a tendency to wear turbans or ethnic clothing. METHODS Sikh AIs (N = 196) were recruited from Sikh gurdwaras in Queens, New York. Data were collected on SRD, social support, and self-reported health, along with multiple direct physiological measures for cardiovascular health. RESULTS Participants who wore turbans/scarves reported higher levels of discrimination than those who did not wear turbans/scarves. As hypothesized, multiple regression analysis supported that discrimination is significantly associated with poorer self-reported mental (B = -.53, p < .001) and physical health (B = -.16, p = .04) while controlling for socioeconomic, acculturation, and social support factors. The study did not support an association between SRD and physiologic measures (elevated BMI, waist-to-hip ratio, and blood pressure). CONCLUSION Consistent with previous discrimination and health reports, this study demonstrated an inverse relationship between discrimination and health among Sikh AIs, an understudied yet high-risk minority population. Community-based efforts are also needed to reduce the occurrence or buffer the effects of discrimination experienced by Sikh AIs. (PsycINFO Database Record

Preventing HIV infection: The effects of community linkages, time, and money on recruiting and retaining women in intervention groups

The community-based participatory research (CBPR) approach can be an innovative and effective way to address health disparities. Doctoral students in the health sciences can benefit through structured CBPR training experiences in learning how to engage with communities, build community capacity, share resources, and implement CBPR studies. The objectives of this case study are to demonstrate ways in which one doctoral student aligned with academic mentors and a funded CBPR project to develop and implement a CBPR-focused doctoral dissertation study. The student partook in formal and informal CBPR learning experiences, built community and academic relationships, developed a research plan in collaboration with members of the community/academic partners, identified an appropriate setting and methods for recruitment/data collection, and increased the capacity and resources for all partners (the first author, community, and academic). In conclusion, CBPR-focused doctoral experiences are novel, pedagogical, and professional approaches that can lead to successful and effective community-based health research.