852. Bridging the Gap in PrEP Provider Training: An Implementation Science Study

Abstract Background Training healthcare providers in a variety of clinical settings to deliver pre-exposure prophylaxis (PrEP) is a key component of the Ending the HIV Epidemic (EHE) initiative. Self-efficacy, the individual’s belief in their ability to carry out the steps of PrEP delivery, is a core part of provider training and necessary for successful PrEP implementation. We characterized self-efficacy among providers from family planning (FP) clinics that do not provide PrEP to inform provider training strategies. Methods We surveyed providers (any clinical staff who could screen, counsel, or prescribe PrEP) from FP clinics in 18 Southern states (Feb-June 2018, N=325 respondents from 224 clinics not providing PrEP) using contraception- and PrEP-specific self-efficacy questions (overall and grouped into PrEP delivery steps: screening, initiation, and follow-up). We compared self-efficacy scores (5-point Likert scale) by prescriber status, between PrEP delivery steps, and used linear mixed models to analyze provider-, clinic-, and county-level covariates associated with overall PrEP self-efficacy. Results Among 325 FP providers, self-efficacy scores were lowest in the PrEP initiation step, higher in follow-up, and highest in screening (p < 0.0001, Table). Mean overall PrEP self-efficacy scores were significantly higher among prescribers compared to non-prescribers (p < 0.0001). However, providers reported lowest self-efficacy regarding insurance navigation for PrEP with no significant difference by prescriber status. The mixed model demonstrated overall PrEP self-efficacy was positively associated with favorable PrEP attitudes among non-prescribers, PrEP knowledge among prescribers, and contraception self-efficacy in both groups, but was not associated with availability of insurance navigation on-site or other covariates (Figure). Provider Self-Efficacy along the PrEP Delivery Model stratified by prescriber status Conclusion FP providers reported low confidence in their ability to perform the steps that comprise PrEP initiation. Provider training focused on elements of PrEP initiation are critical to improve PrEP implementation and EHE initiatives. Alternatively, programs employing referral or telehealth models to support the PrEP initiation step can successfully bridge this gap. Disclosures All Authors: No reported disclosures

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Longitudinal Student Research Competency: Comparing Online and Traditional Face-to-Face Learning Platforms

Advances in Social Work ◽

10.18060/20870 ◽

2016 ◽

Vol 17 (1) ◽

pp. 44-58 ◽

Cited By ~ 5

Author(s):

Jodi Constantine Brown ◽

Hyun-Sun Park

Keyword(s):

Research Methods ◽

Self Efficacy ◽

Longitudinal Research ◽

Exploratory Research ◽

Face To Face ◽

Learning Platform ◽

Significant Difference ◽

Face To Face Learning ◽

Face To Face Instruction

This exploratory research compares longitudinal research self-efficacy and retention between a completely asynchronous Master of Social Work (MSW) online cohort and its traditional face-to-face counterpart. This study used a non-equivalent comparison groups design with two groups: online instruction only (n=16) and traditional face-to-face instruction (n=32), with pretest (Time 1), posttest (Time 2) and follow-up (Time 3) standardized measures of practice evaluation knowledge (PEKS) and research self-efficacy (RSES) in a beginning research methods course. Results indicate that students’ knowledge and research self-efficacy improved between pretest and posttest and remained significantly improved at follow-up one year later, with no significant difference between online learners and traditional face-to-face students. Students gain and maintain confidence in research methods and evaluation regardless of the learning platform utilized.

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Effectiveness of a home care teaching program for prostatectomized patients: a randomized controlled clinical trial

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2018012503421 ◽

2019 ◽

Vol 53 ◽

Author(s):

Luciana Regina Ferreira da Mata ◽

Cissa Azevedo ◽

Mariana Ferreira Vaz Gontijo Bernardes ◽

Tânia Couto Machado Chianca ◽

Maria da Graça Pereira ◽

...

Keyword(s):

Clinical Trial ◽

Home Care ◽

Self Efficacy ◽

Intervention Group ◽

Control Group ◽

Controlled Clinical Trial ◽

Teaching Program ◽

Significant Difference ◽

The Times

ABSTRACT Objective: To evaluate the effectiveness of a teaching program for hospital discharge of patients submitted to radical prostatectomy based on the self-efficacy construct of the Cognitive Social Theory. Method: A controlled clinical trial carried out on a 2-month follow-up of 68 prostatectomized men randomized into intervention group (n = 34) and control (n = 34). The intervention group received routine guidance from the service plus the teaching program. The control group only received routine guidance from the service. The data collection instruments were: sociodemographic and clinical questionnaire, self-efficacy scale, hospital depression and anxiety scale, household care knowledge questionnaire, and an item on satisfaction with a score of 1 to 5. Results: There was a significant difference between the intragroups for satisfaction (p<0.001) and knowledge (p<0.001) of the pre-test to the post-test. In the intervention group, there were significant changes between the times for anxiety (p=0.011) and knowledge (p<0.001). Conclusion: The teaching program with a combination of oral guidance, written instruction and telephone follow-up was effective in improving knowledge about home care and personal satisfaction. Brazilian Registry of Clinical Trials: RBR-5n95rm.

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Understanding Stigma: A Pooled Analysis of a National Program Aimed at Health Care Providers to Reduce Stigma towards Patients with a Mental Illness

Journal of Mental Health and Addiction Nursing ◽

10.22374/jmhan.v1i1.19 ◽

2017 ◽

Vol 1 (1) ◽

pp. e19-e29 ◽

Cited By ~ 4

Author(s):

Stephanie Knaak ◽

Andrew C H Szeto ◽

Aliya Kassam ◽

Arla Hamer ◽

Geeta Modgill ◽

...

Keyword(s):

Mental Illness ◽

Mixed Model ◽

Healthcare Providers ◽

Pooled Analysis ◽

Inverse Association ◽

Post Intervention ◽

Program Outcomes ◽

Behavioural Intentions ◽

Previous Diagnosis

Background and Objective: The problem of mental illness-related stigma within healthcare is an area of increasing attention and concern. Understanding Stigma is an anti-stigma workshop for healthcare providers that uses social contact as a core teaching element, along with educational and action-oriented components. The objective of our study was to determine the impact of this program on healthcare providers’ attitudes and behavioural intentions towards patients with a mental illness, and also to ascertain whether various participant and program characteristics affected program outcomes. Our paper reports the results of a pooled analysis from multiple replications of this program in different Canadian jurisdictions between 2013 and 2015. Material and Methods: We undertook a pooled analysis of six separate replications of the Understanding Stigma program. All program replications were evaluated using a non-randomized quasi experimental pre- post- follow-up design. The Opening Minds Scale for Health Providers (OMS-HC) was used as the main assessment tool. Study-level and individual-level meta-analysis methods were used to synthesize the data. First, the ‘metan’ command was used to show outcomes by study, using a forest plot. Then, a pooled dataset was produced and analyzed using a random intercept linear mixed model approach with each program being modelled as a random effect. Program and participant characteristics were examined as independent variables using this approach. These were each entered individually. Individual tests included pre to post change by program version (original or condensed), by occupation (nurses versus other healthcare providers), by gender, age, and previous diagnosis of a mental illness. Results: Program effect sizes ranged from .19 to .51 (Cohen’s d), with an overall combined effect size of .30. The results of the mixed model analysis showed the improvement from pre to post intervention was statistically significant for the total scale and subscales. Analysis of program and participant factors found that version type, healthcare provider type, gender, and previous diagnosis of a mental illness were all non-significant factors on program outcomes. A significant inverse association was revealed between increasing age and score change. Results also showed a significant positive linear relationship between baseline score and improvement from pre to post intervention. Maintenance of scores at follow-up was observed for participants who attended a booster session. Conclusion: The results are promising for the effectiveness of this brief intervention model for reducing stigmatizing attitudes and improving behavioural intentions among nurses and other healthcare providers.

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Effectiveness of Mindfulness-Based Cognitive Therapy in Sexual Self-Efficacy and Marital Satisfaction among Couples with Marital Conflicts

10.32592/ajnpp.2020.7.1.104 ◽

2019 ◽

pp. 29-36

Keyword(s):

Marital Satisfaction ◽

Cognitive Therapy ◽

Marital Conflict ◽

Self Efficacy ◽

Intervention Group ◽

Analysis Of Covariance ◽

Control Group ◽

Marital Conflicts ◽

Significant Difference

Background: Marital conflict is a type of lack of ongoing meaningful agreement between spouses. The present study aimed to investigate the effectiveness of mindfulness-based cognitive therapy on sexual self-efficacy and marital satisfaction in couples with marital conflicts. Materials and Methods: This quasi-experimental study was carried out on the intervention and control groups with a pretest/posttest design and follow-up. The study population consisted of 30 females who referred to counseling centers in district 1 of Tehran, Iran, in 2018 through simple random sampling. The participants were randomly divided into two groups, each with 15 members. The intervention group received mindfulness-based cognitive therapy, and the control group received no intervention. Data collection tools were the questionnaires of sexual self-efficacy, marital satisfaction, and marital conflicts. The questionnaires were filled out by the participants before and after the intervention and 3 months later. The collected data were analyzed using repeated measurement analysis and analysis of covariance by SPSS software (version 22). Results: The results of the study showed that mindfulness-based cognitive therapy led to increased sexual self-efficacy (P<0.033) and marital satisfaction (P<0.003) in the intervention group; however, in the control group, there was no significant difference in pretest, posttest and follow-up scores. Conclusion: Based on the results, it can be concluded that mindfulness-based cognitive therapy can improve sexual self-efficacy and marital satisfaction in couples with marital conflicts.

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Self-Efficacy of the University Students’ Toefl Performance: Differences in the Test Skill and English Skills in Toefl

Jurnal Ilmiah Peuradeun ◽

10.26811/peuradeun.v8i3.386 ◽

2020 ◽

Vol 8 (3) ◽

pp. 497

Author(s):

Marisa Yoestara ◽

Zaiyana Putri

Keyword(s):

University Students ◽

Self Efficacy ◽

Quantitative Data ◽

Qualitative Data ◽

Total Sample ◽

P Value ◽

Significant Difference ◽

The University ◽

One Way Anova

This study aimed at reporting differences in terms of the university students’ TOEFL self-efficacy in the test skill and the English skills tested in TOEFL namely listening, structure, and reading. In conducting the study, the explanatory sequential mixed method was used as the study design, where the quantitative data from the survey was conducted first followed by the follow-up interview as the qualitative data. To collect the data in this study, a specifically designed self-efficacy questionnaire of TOEFL was distributed to the total sample of 200 university students across different disciplines from Syiah Kuala University and the University of Serambi Mekkah. The interview was then conducted with 3 selected students to have a deeper understanding of the study result. In terms of the data analysis, one-way ANOVA and t-test were used to describe the quantitative data, while the qualitative data was described and elaborated in words with detailed explanations. The result showed that there was a significant difference among the test skill and the English skills in TOEFL, where F= 13.61 (3, 796), p<0.05. The result also revealed that within the gender, only reading skill had a significant difference, where t198= -2.003, p <. 005, and within the language course participation, all the test skills and TOEFL skills were significantly different as the p-value of each skill was smaller than .005 (p< .005).

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Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053377 ◽

2018 ◽

Vol 94 (6) ◽

pp. 457-462 ◽

Cited By ~ 29

Author(s):

Matthew R Beymer ◽

Michelle A DeVost ◽

Robert E Weiss ◽

Rhodri Dierst-Davies ◽

Chelsea L Shover ◽

...

Keyword(s):

Los Angeles ◽

Mixed Model ◽

Linear Mixed Model ◽

Case Crossover ◽

Generalised Linear Mixed Model ◽

Significant Difference ◽

Before And After ◽

Within Subjects ◽

Sex With Men ◽

Exposure Prophylaxis

BackgroundPre-exposure prophylaxis (PrEP) is an effective method for reducing HIV incidence among at-risk populations. However, concerns exist over the potential for an increase in STIs following PrEP initiation. The objective of this study is to compare the STI incidence before and after PrEP initiation within subjects among a cohort of men who have sex with men in Los Angeles, California.MethodsThe present study used data from patients who initiated PrEP services at the Los Angeles LGBT Center between October 2015 and October 2016 (n=275). A generalised linear mixed model was used with a case-crossover design to determine if there was a significant difference in STIs within subjects 365 days before (before-PrEP period) and 365 days after PrEP initiation (after-PrEP period).ResultsIn a generalised linear mixed model, there were no significant differences in urethral gonorrhoea (P=0.95), rectal gonorrhoea (P=0.33), pharyngeal gonorrhoea (P=0.65) or urethral chlamydia (P=0.71) between periods. There were modest increases in rectal chlamydia (rate ratio (RR) 1.83; 95% CI 1.13 to 2.98; P=0.01) and syphilis diagnoses (RR 2.97; 95% CI 1.23 to 7.18; P=0.02).ConclusionsThere were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.

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Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118805441 ◽

2018 ◽

Vol 6 (11) ◽

pp. 232596711880544 ◽

Cited By ~ 1

Author(s):

Devon E. Anderson ◽

Katlyn S. Robinson ◽

Jack Wiedrick ◽

Dennis C. Crawford

Keyword(s):

Mixed Model ◽

Young Patients ◽

Growth Curves ◽

International Knee Documentation Committee ◽

Osteochondral Allograft ◽

Control Group ◽

Level Of Evidence ◽

Significant Difference ◽

Patient Reported

Background: Osteochondral allograft (OCA) transplantation has become a standard therapy for cartilage restoration in young patients. Purpose: To determine the efficacy of fresh OCA transplantation for focal cartilage lesions in patients aged ≥40 years compared with a group of patients aged ≤39 years. Study Design: Cohort study; Level of evidence, 3. Methods: A database was used to identify patients who underwent fresh OCA transplantation in the knee in a single-surgeon practice over a 10-year period and who completed baseline patient-reported outcome (PRO) questionnaires, including the International Knee Documentation Committee (IKDC); Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of Pain, Symptoms, Activities of Daily Living, Quality of Life (QOL), and Sports & Recreation; and Veterans RAND 12-Item Health Survey (VR-12). Patients who completed the same PRO measures at a minimum 12-month follow-up were categorized into 2 groups based on age at surgery and were observed longitudinally. Mixed-model regression was used to predict longitudinal growth curves for each PRO score while controlling for confounding patient and surgical variables. Results: The study group consisted of 38 patients with a mean age of 52.32 years (range, 40-69 years) and mean final follow-up of 44.47 ± 24.32 months. The control group consisted of 42 patients with a mean age of 27.19 years (range, 15-39 years) and mean final follow-up of 33.75 ± 19.53 months. A statistically significant improvement from baseline to final follow-up was seen for the IKDC score and all 5 KOOS subscores in both the study and the control groups ( P < .01 in 10 of 12 comparisons and P < .05 for the other 2 comparisons). Maximum improvements were seen in the KOOS QOL and Sports & Recreation subscores for both groups. There was no statistically significant difference between groups in the change from baseline to final follow-up or in differences at any time point in model-based longitudinal projections for any PRO score through 5 years. Conclusion: There was a significant improvement of outcomes for both groups, with no statistically significant difference between groups over longitudinal follow-up. The efficacy of fresh OCA transplantation in adults aged ≥40 years with a focal chondral lesion and without osteoarthritis is similar to that of younger adults, and benefits are greatest for the KOOS QOL and Sports & Recreation subscales, which reflect functional outcomes.

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1283. Attitudes and Practices Regarding HIV Post-Exposure Prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1146 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S462-S462

Author(s):

William Sherrerd-Smith ◽

Katie O’Connell ◽

Shanedeep Gill ◽

Alice Kisteneff ◽

Catherine Derber ◽

...

Keyword(s):

Emergency Department ◽

Unprotected Sex ◽

Post Exposure Prophylaxis ◽

Provider Education ◽

Post Exposure ◽

Attitudes And Practices ◽

Significant Difference ◽

Follow Up Care ◽

Exposure Prophylaxis

Abstract Background Research suggests nonoccupational Post Exposure Prophylaxis (nPEP) is underprescribed when indicated in the Emergency Department (ED). This study is an assessment of ED providers’ attitudes and practices regarding administration of HIV nPEP. Methods This was an anonymous survey based on literature review and modified Delphi technique. We approached 153 ED providers at work over a 4-month period from 5 hospital-based and 2 freestanding EDs with an annual census between 35,000 and 75,000 patients. The EDs are a combination of urban, suburban, and rural EDs. There were 152 completed surveys: 80 attendings, 27 residents, and 44 physician assistants. Results The majority of surveyed providers (133/149, 89.3%) believe it is their responsibility as an emergency provider to provide HIV nPEP in the emergency department (Figure 1). Although 91% (138/151) and 87% (132/151) of respondents are willing to prescribe nPEP to a patient in the ED for IV drug use and unprotected sex, respectively, only 40% (61/152) of participants felt they could confidently prescribe the appropriate regimen. Ultimately, only 25% (37/151) of participants prescribed nPEP in the last year. Number of years in practice, age, and gender did not result in a significant difference in nPEP administration. Respondents noted time (27%), access to follow-up care (26%), cost to patients (23%), patients’ perceived interest in HIV counseling (15%), and concern for ongoing risky behaviors (9%) as barriers to prescribing nPEP (Figure 2). 64% (95/149) of respondents feel that it is their responsibility as an ED provider to refer patients at risk of nonoccupational exposures for risk-reduction counseling. Conclusion This study identified an opportunity for HIV prevention in the emergency department. The majority of participants had not prescribed nPEP in the past 12 months. Although most were willing to prescribe nPEP and felt it was their responsibility, the majority of participants were not confident in prescribing it. Future interventions to increase the use of nPEP in the ED should target provider education, cost, access to follow-up care and counseling. Disclosures All authors: No reported disclosures.

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1292. HIV Pre-Exposure Prophylaxis (PrEP) Implementation at Silom Community Clinic in Bangkok, Thailand, 2016–2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1125 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S394-S395

Author(s):

Vanessa Kung ◽

Sarika Pattanasin ◽

Chaiwat Ungsedhapand ◽

Wipas Wimonsate ◽

Michael Thigpen ◽

...

Keyword(s):

Descriptive Analysis ◽

Computer Assisted ◽

National Guidelines ◽

Community Clinic ◽

Voluntary Counseling And Testing ◽

Counseling And Testing ◽

Prep Implementation ◽

Sex With Men ◽

Exposure Prophylaxis

Abstract Background Since 2014, the Thailand National Guidelines have recommended pre-exposure prophylaxis (PrEP) to prevent HIV among persons at risk. In March 2016, Silom Community Clinic (SCC) began PrEP provision to men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand. Methods SCC staff routinely counseled MSM and TGW attending HIV voluntary counseling and testing about PrEP. If clients believed that they were at substantial risk of HIV and were interested in PrEP, they could receive PrEP after screening that included HIV and renal function testing. Eligible clients received a 30-day supply of daily oral tenofovir-emtricitabine costing 800 Baht (30 USD), and completed a baseline computer-assisted self-interview (CASI) on knowledge and behaviors. At every 3-month follow-up, PrEP clients had a CASI on adherence; if they were interested in discontinuation of PrEP, they completed a CASI that included reasons for discontinuation. We conducted a descriptive analysis of baseline and follow-up CASI results. Results From March 2016 to February 2018, 192 clients were prescribed PrEP, and 80 (42%) continued PrEP for at least 6 months. The median age of clients starting PrEP was 31 years (range, 17–67 years), and 98% were MSM. Overall, most (77%) reported at least 1 of four risk behaviors in the last 3 months; among the 148, 120 (81%) had a sex partner with unknown or positive HIV status, 99 (67%) had anal sex without a condom, 22 (15%) reported an STI, and 16 (11%) received money or goods in exchange for sex. Among the 166 clients who returned for at least one follow-up visit, 135 (81%) completed the CASI at the last follow-up visit; of those, 106 (78%) reported 100% adherence to daily PrEP in the last 7 days, and 126 (93%) reported ≥80% adherence in the last 30 days. Of the 36 clients who discontinued PrEP and completed CASI, 33% reported the reason for discontinuation was no current HIV risk (33%); most (69%) reported that they would consider PrEP in the future. Conclusion Most PrEP users reported adherence to daily PrEP, and almost one half of those starting PrEP continued through month six. PrEP use at SCC is dynamic, and commonly started and stopped based on self-assessed risk. Regular review of PrEP implementation, with a focus on client needs, will optimize use of this prevention approach. Disclosures All authors: No reported disclosures.

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Investigating the Functions of Self-Talk: The Effects of Motivational Self-Talk on Self-Efficacy and Performance in Young Tennis Players

The Sport Psychologist ◽

10.1123/tsp.22.4.458 ◽

2008 ◽

Vol 22 (4) ◽

pp. 458-471 ◽

Cited By ~ 47

Author(s):

Antonis Hatzigeorgiadis ◽

Nikos Zourbanos ◽

Christos Goltsios ◽

Yannis Theodorakis

Keyword(s):

Self Efficacy ◽

Mixed Model ◽

Control Group ◽

Significant Group ◽

Tennis Players ◽

Self Talk ◽

And Performance ◽

Viable Mechanism ◽

Experimental Group

The purpose of the current study was to examine the effects of motivational self-talk on self-efficacy and performance. Participants were 46 young tennis players (mean age 13.26, SD 1.96 years). The experiment was completed in five sessions. In the first session, participants performed a forehand drive task. Subsequently, they were divided into an experimental and a control group. Both groups followed the same training protocol for three sessions, with the experimental group practicing self-talk. In the final session, participants repeated the forehand drive task, with participants in the experimental group using motivational self-talk. Mixed model ANOVAs revealed significant group by time interactions for self-efficacy (p < .05) and performance (p < .01). Follow-up comparisons showed that self-efficacy and performance of the experimental group increased significantly (p < .01), whereas self-efficacy and performance of the control group had no significant changes. Furthermore, correlation analysis showed that increases in self-efficacy were positively related to increases in performance (p < .05). The results of the study suggest that increases in self-efficacy may be a viable mechanism explaining the facilitating effects of self-talk on performance.

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