Tania B. Basta

Do intervention fidelity and dose influence outcomes? Results from the Move to Improve worksite physical activity program

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; chi(2) = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

HIV Provider Perspectives: The Impact of Stigma on Substance Abusers Living with HIV in a Rural Area of the United States

Recent literature has documented growing concerns related to access to HIV care services for rural individuals living with both HIV and a dual diagnosis of substance abuse. Previous research has investigated issues from a client perspective, but limited research has investigated provider perspectives of rural issues surrounding HIV and substance abuse. The purpose of this qualitative study was to examine issues that impact the ability of care providers to create sustainable linkages to care for dual diagnosed individuals who live in rural areas. In-depth interviews were conducted in late 2005 with 39 HIV service providers at 11 agencies that provided HIV-related services to individuals in rural areas of a Midwestern state in the United States. Findings suggest multidimensional stigma in the medical referral network as the leading factor that presents challenges to service providers in rural areas. The service providers reported verbal stigma in the form of insults, a loss of role/respect, and a global loss of resources such as poorer quality health care or no health care provided. The stigma is conceptualized in four themes: (1) staff of medical referral sources stigmatizing against rural dual-diagnosis clients, (2) physicians stigmatizing against rural dual-diagnosis clients, (3) medical specialists stigmatizing against rural dual-diagnosis clients, and (4) client-perceived stigma. These themes were expressed equally among all of the providers, regardless of geographic location, type of HIV-related organization, or job title.

Symptoms of Psychological Distress among African Americans Seeking HIV-Related Mental Health Care

The purpose of this study was to examine the prevalence of symptoms of psychological distress experienced by African Americans upon self-enrollment in HIV-related mental health care and to compare the symptoms in this sample to the Brief Symptom Inventory (BSI) normative sample, the instrument used in this study to assess symptoms of psychological distress. Data were collected from 575 African Americans living with HIV who self-enrolled at an HIV-related mental health clinic located in a large city in the southeastern United States. Nearly 20% of the sample reported a t score >/= 63 for both somatization and paranoid ideation, a level indicative of a need for further psychological evaluation. Compared to the normative sample, this sample had significantly lower levels (p < 0.05) of anxiety, depression, phobic anxiety, interpersonal sensitivity, and global severity index than the normative sample and had significantly higher levels of paranoid ideation and somatization than the normative sample. These results indicate that, overall, African Americans presented for mental health services with lower levels of symptoms of psychological distress than the normative sample. To that end, it is possible that African Americans living with HIV may underreport symptoms of psychological distress or may experience symptoms of psychological distress differently than other individuals. As a result, it is important that HIV-related service providers recognize these patterns of psychological distress and provide appropriate referrals to HIV-related mental health providers.

Psychological distress and engagement in HIV-related services among individuals seeking mental health care

Abstract In the US, HIV-related mental health care has been funded for its ability to help engage and retain individuals living with HIV into other components of HIV-related care and treatment. However, little is known empirically about the types of HIV prevention and care with which they are, or need to be, connected. To explore this, data were collected from 617 individuals upon their self-enrollment in HIV-related mental health care in a large US city with high rates of HIV infection. Nearly a third of the participants (n=195) were “minimally engaged” in care services, 53% were “moderately engaged” and 15.6% were “highly engaged”. There were significant differences between level of care engagement according to ones ethnicity, X 2(4, n=617)=38.05; p<.001; Cramers V=.18, with African-Americans and Latinos more likely to be highly engaged in care services compared to their Caucasian counterparts. Furthermore, individuals who were highly engaged in services had significantly lower levels of depression than their less engaged peers, F(2, 614)=8.18; p<.001; η2=.03. Results suggest that while ethnic minorities were engaged in a higher number of care services, they were enrolling in mental health care following enrollment in other care services. Given the numerous benefits of engaging in HIV-related mental health early in the course of infection, it is important that case managers and primary care physicians educate African-Americans and Latinos on the benefits of mental health care in order to facilitate earlier engagement in HIV-related mental health services.

Symptoms of psychological distress: a comparison of rural and urban individuals enrolled in HIV-related mental health care.

Over the past decade, the number of individuals who have been diagnosed with HIV in nonmetropolitan areas (population of less than 50,000 individuals) has increased; however, the majority of the research has been conducted in metropolitan areas. Even less research has examined the levels of psychological distress among rural individual living with HIV. The purpose of this study was to explore the nature and range of psychological distress symptoms experienced by individuals living in rural areas who had self-enrolled into HIV-related mental health care and to compare their levels of distress to their urban counterparts accessing care at the same clinic. Data were collected from 95 individuals who self-enrolled in HIV-related mental health at either a rural (n = 47) or urban (n = 48) clinic. All participants completed the Brief Symptom Inventory (BSI), the instrument used in this study to assess symptoms of psychological distress. Rural participants had significantly higher mean scores on the hostility dimension of the BSI, F(1, 93) = 8.77, p = 0.004, than their urban counterparts. Furthermore, the rural participants had a greater proportion of individuals who had a T-score >or=63, a level indicative of a need for further psychological evaluation, for generalized anxiety, hostility, and psychoticism. The results indicated that rural individuals presented with higher levels of symptoms of psychological distress than their urban counterparts. These differences may be reflective of situational circumstances in rural areas where access to care, social isolation, and perceived stigma may delay screening for, and treatment of, psychological distress.

A cross-cultural comparison of psychological distress among individuals living with HIV in Atlanta, Georgia, and Eldoret, Kenya.

Elevated psychological distress during HIV infection has been consistently correlated with negative HIV-related health outcomes in studies conducted in various regions of the world. This study was conducted to compare the nature and range of psychological distress among HIV-infected individuals who had sought mental health care as part of their HIV care in Kenya and the United States. The Brief Symptom Inventory (BSI) was completed by 234 individuals with HIV in Atlanta, Georgia, USA, and 284 in Eldoret, Kenya. The US-based sample expressed markedly higher levels of psychological distress symptoms on the anxiety, depression, interpersonal sensitivity, obsessive-compulsive, and psychoticism dimensions, as well as the overall global severity index. Substantial proportions of both the US and Kenya cohorts expressed higher levels of somatization and paranoid ideation that suggested further psychological evaluation. This study revealed psychological distress expression varied drastically among individuals who self-enrolled into HIV-related mental health care within two different care infrastructures.

Predictors of exercise stage of change among individuals living with HIV/AIDS.

BACKGROUND Although the transtheoretical model (TTM) is good at detecting motivation to alter behavior, one of the frequently cited methodological problems is related to the validity of the staging instruments. Few studies have examined the ability of the TTM constructs (decisional balance, self-efficacy, and processes of change) to predict the stages of change in healthy populations, and it has never been applied in this manner among individuals living with HIV/AIDS. PURPOSE To determine the accuracy of the TTM constructs to predict the stages of change for exercise behavior in individuals living with HIV/AIDS. METHODS Cross-sectional self-report data were collected from 208 individuals living with HIV/AIDS. RESULTS Predictive discriminant analysis classified individuals into the correct stages 42% of the time, which was 25% better than chance (Z = 6.79, P < 0.05). Precontemplation was predicted 48% of the time, contemplation 25% of the time, preparation 70% of the time, and maintenance 63% of the time. These four stages were all predicted better than chance alone; however, no one was accurately predicted in the action stage. CONCLUSIONS This was one of the first studies to examine the TTM in individuals living with HIV/AIDS, and the validity of the staging measure among individuals living with HIV/AIDS was supported. However, more research is needed to assess whether the action stage is appropriate for exercise behavior in this population segment.

Relationship of psychological distress and unprotected sex among individuals with HIV seeking mental health care.

This study examined the prevalence of sexual behavior and its relationship with psychological distress among individuals with HIV who were seeking mental health care. Upon self-enrollment in HIV-related mental health care, 845 participants completed self-assessments of demographics, psychological distress, and sexual behaviors. Participants were categorized by sexual risk as determined by their reported unprotected sexual activity within the previous 30 days: receptive anal or vaginal sex (high-risk), insertive anal or vaginal sex (moderate-risk), oral sex (low-risk), and no sex (no-risk). The majority of the sample was classified as no-risk, 11% low-risk, 5% moderate-risk, and 17% were high-risk. Levels of psychological distress did not differ across risk levels. Overall psychological distress levels were elevated, 19% of the sample expressed severe distress. Use of illicit drugs, alcohol, and no-AIDS diagnosis predicted high-risk sexual behaviors. A substantial proportion of the sample reported engaging in high-risk sexual behaviors, which signifies the need to further incorporate sex-related prevention efforts among HIV-infected populations.

Efficacy of an Educational Intervention to Increase Consent for HIV Testing in Rural Appalachia

This study sought to assess barriers and enhance readiness to consent to home and Planned Parenthood HIV testing among 60 out-patients from a mental health and substance abuse clinic in rural Appalachia. Testing barriers included not knowing where to get tested, lack of confidentiality, and loss of partners if one tested sero-positive. The intervention yielded lowered HIV stigma, increase in HIV knowledge, and agreement to take the HIV home test. These results are encouraging because they suggest that a brief educational intervention is a critical pathway to the success of the National Institutes on Drug Abuse’s Seek, Test, Treat, and Retain initiative in poor rural counties.

Lessons from Ebola: Sources of Outbreak Information and the Associated Impact on UC Irvine and Ohio University College Students.

Objectives. We examined the role of outbreak information sources through four domains: knowledge, attitudes, beliefs, and stigma related to the 2014 Ebola virus disease (EVD) outbreak. Methods. We conducted an online survey of 797 undergraduates at the University of California, Irvine (UCI) and Ohio University (OU) during the peak of the outbreak. We calculated individual scores for domains and analyzed associations to demographic variables and news sources. Results. Knowledge of EVD was low and misinformation was prevalent. News media (34%) and social media (19%) were the most used sources of EVD information while official government websites (OGW) were among the least used (11%). Students who acquired information through OGW had higher knowledge, more positive attitudes towards those infected, a higher belief in the government, and were less likely to stigmatize Ebola victims. Conclusions. Information sources are likely to influence students’ knowledge, attitudes, beliefs, and stigma relating to EVD. This study contains crucial insight for those tasked with risk communication to college students. Emphasis should be given to developing effective strategies to achieve a comprehensive knowledge of EVD and future public health threats.