Samantha Stonbraker

Tools to measure health literacy among Spanish speakers: An integrative review of the literature

OBJECTIVE Health literacy measurement can help inform healthcare service delivery. The objective of this study is to identify validated tools to measure health literacy among Spanish speakers and to summarize characteristics that are relevant when selecting tools for use in clinical or research settings. METHODS An English and Spanish search of 9 databases was conducted between October 2014 and May 2015. Inclusion criteria were peer-reviewed articles presenting initial validation and psychometric properties of a tool to measure health literacy among Spanish speaking patients. Characteristics relevant to tool selection were reviewed and presented. RESULTS Twenty articles validating 19 instruments met inclusion criteria. Instruments were designed for use with Spanish speakers in numerous contexts and measured different health literacy skills such as reading comprehension or numeracy. Methods used to validate tools were inconsistent across instruments. CONCLUSION Although tools have inconsistencies and inefficiencies, many can be used for assessment of health literacy among Spanish speakers. PRACTICE IMPLICATIONS Healthcare providers, organizations, and researchers can use this review to select effective health literacy tools to indicate patients ability to understand and use health information so that services and materials can be more appropriately tailored to Spanish speaking patients.

Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting.

Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12–4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15–0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11–20.29 and 6.84 CI: 1.47–37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression.

Factors Associated with Health Information Seeking, Processing, and Use Among HIV Positive Adults in the Dominican Republic

Effective treatment and management of human immunodeficiency virus (HIV) depend on patients’ ability to locate, comprehend, and apply health information. This study’s purpose was to identify characteristics associated with these skills among HIV positive adults in the Dominican Republic. An information behavior survey was administered to 107 participants then three logistic regressions were conducted to identify characteristics associated with information seeking, processing, and use. Never having cared for someone who was sick was significantly associated with less information seeking, processing, and use. Males were more likely to be active information seekers and those who had attended the clinic for six or fewer years were less likely to actively seek information. Younger individuals had increased odds of higher information processing and those without comorbidities had increased odds of more information use. Results may inform researchers, organizations, and providers about how patients interact with health information in limited resource settingsResumenEl tratamiento y manejo eficaz del virus de inmunodeficiencia humana (VIH) depende en la habilidad de un paciente de encontrar, comprender y aplicar la información acerca de la salud. El objetivo de este estudio fue identificar las características asociadas con estas capacidades necesarias entre adultos VIH positivos en La República Dominicana. Se realizó una entrevista con 107 participantes sobre el comportamiento de la información de la salud para luego ser analizada mediante regresión logística para identificar las características asociadas con la búsqueda, el procesamiento y el uso de la información de la salud. Los resultados mostraron que no haber cuidado de alguien en estado grave de salud estuvo asociado significativamente con menos búsqueda, procesamiento y uso de la información de la salud. Hombres tuvieron más probabilidad de buscar información de forma activa y aquellos con seis o menos años recibiendo atención en la clínica tuvieron menos probabilidad de buscar información de forma activa. Los participantes con menos de 42 años tuvieron más probabilidad de procesar la información en una manera alta y los participantes sin comorbilidades tuvieron más probabilidad de usar la información. Estos resultados pueden informar investigadores, organizaciones y proveedores de salud sobre como pacientes puedan interactuar y beneficiarse con la información de la salud en lugares con bajo recursos.

Health-information needs of HIV-positive adults in Latin America and the Caribbean: an integrative review of the literature

ABSTRACT An assessment of information needs is essential for care planning for patients living with chronic diseases such as human immunodeficiency virus (HIV). The extent to which these assessments have been conducted in Latin America and the Caribbean (LAC) is unknown. The purpose of this study was, therefore, to identify, evaluate, and summarize what research has been conducted to examine patient perceptions of their health-information needs among adults living with HIV in LAC. Using an integrative review methodology, a literature search of six databases was conducted in April and May 2015. Inclusion criteria were peer-reviewed articles published in English or Spanish that assessed the information needs of HIV-positive patients living in LAC. The quality of included articles was assessed and relevant characteristics of each article were extracted, compared, and presented. Searches returned 1885 citations, 11 of which met inclusion criteria. Studies included were conducted in 8 of 33 countries, used multiple research designs, demonstrated varying needs between populations, and found numerous unmet information needs. Information about HIV in general, methods of infection transmission, antiretroviral medications, other sexually transmitted diseases, and effective coping mechanisms were the most commonly mentioned needs. Healthcare providers were the largest and most reliable source of health information for many participants and it was emphasized that in order for health education to be effective, programs should include both individual and group components. Patients indicated that they may have difficulty processing and using information through an incorrect understanding of medications, not changing risk behaviors, and by stating that information can be overwhelming or poorly communicated. Further research on information needs is warranted so that healthcare providers and organizations may provide the information patients need to appropriately manage their health.

Assessment of risk factors for sexually transmitted infections in high-risk communities in Santo Domingo and La Romana, Dominican Republic

Abstract Background This study assesses the prevalence of sexually transmitted infections and risk factors among key populations living in La Romana and Santo Domingo, Dominican Republic: pregnant adolescents, men who have sex with men, trans women, sugar cane field (batey) residents, transactional sex workers, and people living with HIV. This work is based on a preliminary analysis of batey data collected in La Romana. Methods In 2017, 203 participants, aged 18–60 years, were recruited from eight bateys systematically selected using time-location sampling. Informed consent was obtained, and a 40 min questionnaire was administered. Blood, urine, Papanicolaou samples, and oral/anal swabs were used to test for HIV, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), gonorrhoea, chlamydia, Trichomonas vaginalis, Ureaplasma spp, and Mycoplasma genitalium , and Papanicolaou (cervical) samples were collected. Participants with positive results received free treatment, when available, follow-up and education. Findings Of 203 participants, 131 (65%) were women and 161 (79%) were Spanish-speaking. One ( T vaginalis , and 60 (30%) participants were positive for Ureaplasma spp. 116 (88%) of 132 women underwent Papanicolaou testing. 21 (18%) women had abnormal Papanicolaou results, and 36 (31%) women were positive for human papillomavirus (HPV); of those, 25% of women had HPV16, 8% of women had HPV18/45, and 67% of women had indeterminate high-risk type. 19 (9%) participants were HBV positive. Two bateys were disproportionately affected: nine (33%) of 27 participants in Batey 1 and eight (32%) of 25 participants in Batey 2. Interpretation The prevalence of HBV infection was disproportionately higher than those found in Central and Latin America. In response, Clinica de Familia La Romana and the Dominican Ministry of Health established an HBV vaccination and prevention programme for affected bateys, and this is underway. In terms of HIV, the prevalence was lower ( vs 3%) when compared to that previously reported in bateys. Targeted HIV prevention programmes conducted by Clinica de Familia La Romana and others might have helped curb HIV infection. The prevalence of high-risk HPV and other sexually transmitted infections in this study needs to be further explored. Overall, these results highlight the need for more research, for targeted prevention initiatives, and improved access to testing and treatment for sexually transmitted infections. Funding David E Rogers Fellowship, NY Academy of Medicine Bioreference Laboratories.

Cervical cancer screening among transactional female sex workers in the Dominican Republic

Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18–54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8–14.5) or daily (AOR 4.9, 95% CI: 1.5–16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0–1.5) were significantly associated (p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.

Clinical nursing and midwifery research in Latin American and Caribbean countries: A scoping review

AIM To identify and describe published, nursing-led and midwifery-led, clinical research that has been conducted in Latin America and the Caribbean. BACKGROUND Peer-reviewed published research may correspond to and elucidate countrys realities, priorities, and needs. DESIGN A 6-stage scoping review methodology was used to search scientific databases using an applied search strategy. DATA SOURCES Five databases were searched for articles published in English, Spanish, or Portuguese conducted in a Latin American or Caribbean country between January 1, 2006 and June 14, 2016. REVIEW METHODS Articles were independently considered for inclusion by 2 researchers, data extracted, and study characteristics described. RESULTS Of 6922 articles identified, 404 were included. The majority were conducted in Brazil (90.6%) followed by Chile (2.5%). Most were nurse-led (95.8%) and were implemented in hospitals (48.6%). Studies frequently explored patient knowledge or characterized patient populations (61.3%) and commonly assessed chronic disease (19.3%) or maternity/child health outcomes (15.9%). CONCLUSION Findings revealed a large number of publications but an uneven geographical distribution of nurse-led clinical research and an evident gap of midwifery-related research in Latin America and the Caribbean. Results may be used to build research agendas to promote nursing and midwifery research capacity and further establish evidence-based practice.

Information, communication, and online tool needs of Hispanic family caregivers of individuals with Alzheimer’s disease and related dementias

ABSTRACT Purpose: To identify the information and communication needs of Hispanic family caregivers for individuals with Alzheimer’s Disease and Related Dementias (ADRD) and the manner in which online tools may meet those needs. Methods: We conducted 11 participatory design sessions with 10 English- and 14 Spanish-speaking urban-dwelling Hispanic family caregivers and gathered data using a survey, collage assemblage, and audio and video recordings. Four investigators analyzed transcripts of audio recordings with a coding framework informed by several conceptual models. Results: Participants had an average age of 59.7 years, were mostly female (79.2%), and had cared for a family member with ADRD for an average of 6.5 years. All participants accessed the Internet at least once a week with 75% ≥ daily. Most used the Internet to look up health information. All participants reported caregiver attributes including awareness of the disease symptoms or behaviors. The majority reported information needs/tasks (91.7%), communication needs/tasks (87.5%), and need for online tools (79.2%). Conclusion: Hispanic caregivers of individuals with ADRD reported key information and communication needs/tasks. Only Spanish-speaking participants reported Internet and technology use deficits suggesting the requirement for further technology support. Data show a need for online tools to meet the needs of caregivers.

What the rest of the world should know about HIV: Perceptions from adults living with HIV in the Dominican Republic

Samantha Stonbraker, PhD, MPH, RN, is a Postdoctoral Fellow, Columbia University School of Nursing, New York, New York, USA, and the Director of Research at Cl ınica de Familia, La Romana, Dominican Republic. (*Correspondence to: Slb2201@cumc.columbia.edu). Adriana Arcia, PhD, RN, is an Assistant Professor of Nursing, Columbia University School of Nursing, New York, New York, USA. Mina Halpern, MPH, is the Executive Director at Cl ınica de Familia, La Romana, Dominican Republic. Elaine Larson, PhD, RN, FAAN, CIC, is the Associate Dean for Research, Columbia University School of Nursing, and Professor of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA.