scholarly journals Development and initial validation of a simple tool to screen for partner support or opposition to HIV prevention product use

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242881
Author(s):  
Elizabeth E. Tolley ◽  
Seth Zissette ◽  
Andres Martinez ◽  
Thesla Palanee-Phillips ◽  
Florence Mathebula ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Partner Violence ◽  
Qualitative Data ◽  
Assessment Tool ◽  
Multiple Scales ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Male Partner ◽  
Partner Support ◽  
Initial Validation

In HIV prevention trials, male partners have influenced women’s ability to adhere to investigational products, including antiretroviral (ARV) containing vaginal rings. Validated scales can be useful tools to systematically measure complex constructs, such as those related to male partner engagement. Although multiple scales exist to assess physical, psychological and sexual violence within intimate relationships, fewer scales focus on supportive behaviors within these relationships. Our intervention involved development of a Healthy Relationship Assessment Tool (HEART) that assessed both positive and negative aspects of male partner involvement in women’s HIV prevention. We identified and refined 127 potential items, representing intimate partner violence, agency and social support. A structured survey, including potential items and other sociodemographic and behavioral variables was administered to former microbicide trial and non-trial participants. We conducted an exploratory factor analysis (EFA) to identify a reduced set of constructs and items to screen women who might experience social harms or benefits from vaginal ring use. We examined associations between constructs and with other survey variables to assess content and construct validity. In a subset of 10 women who participated in the survey and qualitative interviews, we used qualitative data to predict survey scores. We retained five constructs with theoretical relevance and good-to-strong reliability for the tool, including: Traditional Values; Partner Support; Partner Abuse & Control; Partner Resistance to HIV Prevention; and HIV Prevention Readiness. Predicted associations between HEART constructs, and correspondence between participants’ qualitative data and HEART scores were generally correct, while those between constructs and other sociodemographic variables were more mixed. Initial validation of the HEART tool was promising. The tool will be used during the CHARISMA pilot study at the Johannesburg MTN 025/HOPE site and validated as part of a randomized controlled trial of CHARISMA within a PrEP demonstration project. Beyond clinical trial settings, HEART could assist PrEP or antiretroviral treatment (ART) providers with an easy-to-administer tool to identify risk and tailor risk reduction, empowerment and adherence counseling for microbicides, PrEP or ART related services.

scholarly journals Thetha Nami : Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

2021 ◽  
Author(s):  
Maryam Shahmanesh ◽  
Nonhlanhla Okesola ◽  
Natsayi Chimbindi ◽  
Thembelihle Zuma ◽  
Nondumiso Mthiyane ◽  
...  
Keyword(s):  
South Africa ◽  
Health Promotion ◽  
Young People ◽  
Hiv Prevention ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Intervention Development ◽  
Participatory Development ◽  
Theory Of Change ◽  
Structured Interviews

Abstract Background: Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR) informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in rural KwaZulu-Natal (KZN). Methods: Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18-30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016-2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307).Results: Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me’). The intervention. included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components structured assessment tool to tailor health promotion and referrals; safe spaces and community advocacy to create an enabling environment; peer-mentorship and navigation of resources to improve retention in HIV prevention. Conclusion: Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

scholarly journals Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Shahmanesh ◽  
Nonhlanhla Okesola ◽  
Natsayi Chimbindi ◽  
Thembelihle Zuma ◽  
Sakhile Mdluli ◽  
...  
Keyword(s):  
South Africa ◽  
Health Promotion ◽  
Young People ◽  
Hiv Prevention ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Intervention Development ◽  
Participatory Development ◽  
Theory Of Change ◽  
Structured Interviews

Abstract Background Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN). Methods Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016–2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307). Results Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me’). The intervention included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components: structured assessment tool to tailor health promotion and referrals, safe spaces and community advocacy to create an enabling environment, and peer-mentorship and navigation of resources to improve retention in HIV prevention. Conclusion Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

scholarly journals Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care

2017 ◽  
Vol 67 (660) ◽  
pp. e507-e518 ◽  
Author(s):  
Barbara Clyne ◽  
Janine A Cooper ◽  
Fiona Boland ◽  
Carmel M Hughes ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Older Patients ◽  
Qualitative Data ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Inappropriate Prescribing ◽  
Adverse Outcomes ◽  
Mixed Methods Study ◽  
Negative Attitudes

BackgroundPolypharmacy (≥5 medications) is common in older patients and is associated with adverse outcomes. Patients’ beliefs about medication can influence their expectations for medication, adherence, and willingness to deprescribe. Few studies have examined beliefs about prescribed medication among older patients with polypharmacy in primary care.AimTo explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs.Design and settingA mixed methods study utilising data from a randomised controlled trial aiming to decrease potentially inappropriate prescribing in older patients (≥70 years) in Ireland.MethodBeliefs were assessed quantitatively and qualitatively. Participants completed the Beliefs about Medicines Questionnaire by indicating their degree of agreement with individual statements about medicines on a 5-point Likert scale. Semi-structured qualitative interviews were conducted with a purposive sample of participants. Interviews were transcribed verbatim and a thematic analysis conducted. Quantitative and qualitative data were analysed separately and triangulated during the interpretation stage.ResultsIn total, 196 patients were included (mean age 76.7 years, SD 4.9, 54% male), with a mean of 9.5 (SD 4.1) medications per patient. The majority (96.3%) believed strongly in the necessity of their medication, while 33.9% reported strong concerns. Qualitative data confirmed these coexisting positive and negative attitudes to medications and suggested the importance of patients’ trust in GPs in establishing positive beliefs and potential willingness to deprescribe.ConclusionParticipants reported strong beliefs in medications with coexisting positive and negative attitudes. The doctor–patient relationship may have influenced beliefs and attitudes towards medicines, highlighting the importance of strong doctor–patient relationships, which need to be considered in the context of deprescribing.

Assessing Polyvictimization in a Family Justice Center: Lessons Learned From a Demonstration Project

2021 ◽  
pp. 088626052110279
Author(s):  
Danielle M. Romain Dagenhardt ◽  
Joshua Mersky ◽  
James “Dimitri” Topitzes ◽  
Erin Schubert ◽  
Amber E. Krushas
Keyword(s):  
Partner Violence ◽  
Assessment Tool ◽  
Qualitative Interviews ◽  
Lessons Learned ◽  
Assessment Tools ◽  
Measurement Development ◽  
Social Service Agencies ◽  
Promising Line ◽  
Assessment Procedures ◽  
The Impact

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

scholarly journals The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan

2020 ◽  
Vol 5 (3) ◽  
pp. e001946 ◽  
Author(s):  
Andrew Gibbs ◽  
Julienne Corboz ◽  
Esnat Chirwa ◽  
Carron Mann ◽  
Fazal Karim ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Depressive Symptoms ◽  
Randomised Controlled Trial ◽  
Partner Violence ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Intimate Partner ◽  
Household Decision ◽  
Intention To Treat ◽  
Randomised Controlled

IntroductionWe assessed whether the Women for Women International (WfWI) economic and social empowerment programme could reduce women’s experiences of intimate partner violence (IPV) and depression in Afghanistan.MethodsWe conducted a two-arm individually randomised controlled trial in six urban and peri-urban communities. Communities were selected by WfWI for being conflict affected and showing signs of economic vulnerability (eg, little or no education, living in extreme poverty). Individual eligibility were female, aged 18–49, able to consent to participate and one woman per household. At 22 months, three primary outcomes were assessed: past year physical IPV experience; past year severe IPV experience; depressive symptoms. There was no blinding to arms. We conducted an intention-to-treat analysis, controlling for age. We also conducted qualitative interviews at endline, analysed using thematic analysis.Results1461 women (n=933 married) were recruited and randomised. Retention at endline was n=1210 (82%). Primary outcomes were in the hypothesised direction, but showed no significant impacts: physical IPV (adjusted OR (aOR) 0.88 (0.62 to 1.23)), severe IPV (aOR 0.75 (0.50 to 1.11)) and depressive symptoms (β −0.35 (−1.19 to 0.48)). Women reported reduced food insecurity (β −0.48 (−0.85 to –0.12)), higher earnings (β 3.79 (0.96 to 6.61)) and savings (β 11.79 (9.95 to 13.64)). Women reported less gender-inequitable attitudes (β −0.89 (−1.15 to –0.62)), more household decision-making (β 0.35 (−0.04 to 0.74)) and increased mobility (aOR 1.78 (1.27 to 2.50)). Twenty-eight in-depth interviews were conducted.ConclusionThe intervention did not impact IPV or depression. The intervention did improve livelihoods, create more gender-equitable relationships and increase women’s mobility. Translating these gains into IPV and depression reduction is critical.Trial registration numberNCT03236948, registered 2 August 2017.

scholarly journals Evidence for use of a healthy relationships assessment tool in the CHARISMA pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261526
Author(s):  
Elizabeth E. Tolley ◽  
Andres Martinez ◽  
Seth Zissette ◽  
Thesla Palanee-Phillips ◽  
Florence Mathebula ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Partner Violence ◽  
Assessment Tool ◽  
Growth Models ◽  
Preliminary Evidence ◽  
Traditional Values ◽  
Partner Communication ◽  
Controlled Evaluation ◽  
Relationship Assessment ◽  
The Impact

Introduction The CHARISMA intervention, nested within the MTN-025/HOPE vaginal ring trial in Johannesburg, South Africa, seeks to facilitate women’s use of HIV prevention products by promoting partner dialogue and mitigating intimate partner violence (IPV). We developed “HEART”, a lay counselor-administered relationship assessment tool, for the CHARISMA pilot. The five-scale tool assesses participants’ endorsement of Traditional Values (TV), her HIV Prevention Readiness (HPR) and levels of partner support (PS), abuse and control (PAC), and resistance to HIV prevention (PR), guiding decisions about which of three counselling modules to offer (partner communication/A; ring disclosure/B; and IPV prevention/C). Methods We correlated baseline scores on HEART subscales with a) independent measures of relationship stability, disclosure and IPV to assess construct validity, and b) with specific modules offered to determine how HEART was used in the pilot. We examined changes in HEART scores at three and six months. Finally, we ran separate growth models for each subscale to examine changes in scores, accounting for partnership changes and counseling module(s) received. Results Baseline HEART scores correlated as predicted among subscales and with other measures. Reliabilities for four subscales were 0.75 or higher. Women who disclosed study participation and ring use scored higher on PS and lower on PR. Women experiencing IPV scored lower on PS, and higher on PAC and PR. During the pilot, 82% of women received one and 17% received two or more modules; over half received the IPV module. Women with higher PAC and PR scores were more likely to receive the IPV than the communication or disclosure modules. Over time, the TV, PAC and PR scores decreased, and PS score increased. Receiving the IPV module was associated with a decreased PAC score. Conclusions These data offer preliminary evidence for HEART construct and predictive validity and support its further evaluation to guide implementation and monitor the impact of the CHARISMA intervention in a randomized controlled evaluation.

Measuring Acceptability and Engagement of the Keep It Up! Internet-based HIV Prevention Randomized Controlled Trial for Young Men who have Sex with Men (Preprint)

2018 ◽  
Author(s):  
Krystal Madkins ◽  
David Moskowitz ◽  
Kevin Moran ◽  
Trey Dellucci ◽  
Brian Mustanski
Keyword(s):  
High School ◽  
Randomized Controlled Trial ◽  
Hiv Prevention ◽  
Controlled Trial ◽  
P Values ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Intervention Acceptability ◽  
Intervention Content ◽  
Sex With Men

BACKGROUND Since 2010, HIV diagnoses among men who have sex with men (MSM) have remained stably high while decreasing for heterosexual men and women. The burden of infection has disproportionately impacted younger MSM of color relative to other populations. Despite the increased risk, there are few HIV prevention programs targeted to diverse and young MSM. The Keep It Up! (KIU!) online intervention was created to address the HIV prevention needs of this population. OBJECTIVE The objective of this study was to examine the acceptability and engagement of KIU!, and explore any differences by demographics, within the context of a randomized controlled trial (RCT). METHODS Between May 2013 and December 2015, 445 participants were randomized into the intervention arm of the KIU! RCT. Data were taken from the baseline assessment, KIU! 2.0 intervention modules, and immediate post-test assessments of intervention acceptability and engagement. Outcomes of interests were qualitative and quantitative measures of intervention acceptability and engagement as well as process measures (i.e., star ratings of intervention content and paradata on time spent in intervention). RESULTS Participants were an average of 24 years old, 62.9% (280/445) identified as a racial or ethnic minority, 86.5% (385/445) identified as gay, and 84.3% (375/445) reported having at least some college education. Most participants rated the intervention content highly (4 out of 5 stars) and gave the intervention an average acceptability score of 3.5 out of 4. Compared to White participants, Black participants found the intervention more useful (p = .03), engaging (p < .001), and acceptable (p = .001); Latino participants found the intervention more engaging (p = .03); and “other” non-White participants found the intervention more engaging (p = .008) and acceptable (p = .02). Participants with high school or less education found the intervention more useful, engaging, and acceptable, and were more likely to give intervention content a five star rating than college educated participants (p-values = .047, <.001, .002, .01 respectively) or those with graduate degrees (p-values = .04, .001, < .001, .004 respectively). White participants showed the most variation between education levels and reporting positive attitudes towards the intervention. Among Black participants, graduate degree-earning participants spent significantly more time on the intervention than high-school or less educated participants (p = .02). CONCLUSIONS Overall, participants gave the intervention high acceptability and engagement ratings; but it was most acceptable and engaging to participants who were younger, identified as racial and ethnic minorities, had less education, and lived in the South. As these are all groups with greater burden of HIV infection, the KIU! intervention is promising as a primary HIV prevention tool. Future implementations of KIU! are needed to assess its acceptability outside of the highly controlled environment of an RCT. CLINICALTRIAL RCT# NCT01836445

scholarly journals Pediatric Residents and Interns in an Italian Hospital Perform Improved Bibliographic Searches when Assisted by a Biomedical Librarian

2013 ◽  
Vol 8 (1) ◽  
pp. 76
Author(s):  
Mathew Stone
Keyword(s):  
Teaching Hospital ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Intervention Group ◽  
Real Life ◽  
Boolean Logic ◽  
Bibliographic Databases ◽  
Control Group ◽  
Pediatric Residents ◽  
Clinical Scenarios

A Review of: Gardois, P., Calabrese, R., Colombi, N., Lingua, C., Longo, F., Villanacci, M., Miniero, R., & Piga, A. (2011). Effectiveness of bibliographic searches performed by paediatric residents and interns assisted by librarian. A randomised controlled trial. Health Information and Libraries Journal, 28(4), 273-284. doi: 10.1111/j.1471-1842.2011.00957.x Objective – To establish whether the assistance of an experienced biomedical librarian delivers an improvement in the searching of bibliographic databases as performed by medical residents and interns. Design – Randomized controlled trial. Setting – The pediatrics department of a large Italian teaching hospital. Subjects – 18 pediatric residents and interns. Methods – 23 residents and interns from the pediatrics department of a large Italian teaching hospital were invited to participate in this study, of which 18 agreed. Subjects were then randomized into two groups and asked to spend between 30 and 90 minutes searching bibliographic databases for evidence to answer a real-life clinical question which was randomly allocated to them. Each member of the intervention group was provided with an experienced biomedical librarian to provide assistance throughout the search session. The control group received no assistance. The outcome of the search was then measured using an assessment tool adapted for the purpose of this study from the Fresno test of competence in evidence based medicine. This adapted assessment tool rated the “global success” of the search and included criteria such as appropriate question formulation, number of PICO terms translated into search terms, use of Boolean logic, use of subject headings, use of filters, use of limits, and the percentage of citations retrieved that matched a gold standard set of citations found in a prior search by two librarians (who were not involved in assisting the subjects) together with an expert clinician. Main Results – The intervention group scored a median average of 73.6 points out of a possible 100, compared with the control group which scored 50.4. The difference of 23.2 points in favour of the librarian assisted group was a statistically significant result (p value = 0.013) with a 95% confidence interval of between 4.8 and 33.2. Conclusion – This study presents credible evidence that assistance provided by an experienced biomedical librarian improves the quality of the bibliographic database searches performed by residents and interns using real-life clinical scenarios.

Does high-variation training facilitate transfer of training in paediatric transthoracic echocardiography?

2020 ◽  
pp. 1-7
Author(s):  
Colin J. McMahon ◽  
Sarah Gallagher ◽  
Adam James ◽  
Aoife Deery ◽  
Mark Rhodes ◽  
...  
Keyword(s):  
Transfer Of Training ◽  
Assessment Tool ◽  
Qualitative Interviews ◽  
Training Group ◽  
Variation Theory ◽  
Cardiac Lesion ◽  
Cumulative Score ◽  
Hands On ◽  
Performance Report ◽  
Technical Proficiency

Abstract Background: Factors that facilitate transfer of training in paediatric echocardiography remain poorly understood. This study assessed whether high-variation training facilitated successful transfer in paediatric echocardiography. Methods: A mixed-methods study of transfer of technical and interpretive skill application amongst postgraduate trainees. Trainees were randomised to a low or high-variation training group. After a period of 8 weeks intensive echocardiography training, we video-recorded how trainees completed an echocardiogram in a complex cardiac lesion not previously encountered. Blinded quantitative analysis and scoring of trainee performance (echocardiogram performance, report, and technical proficiency) were performed using a validated assessment tool by a blinded cardiologist and senior cardiac physiologist. Qualitative interviews of the trainees were recorded to ascertain trainee experiences during the training and transfer process. Results: Sixteen trainees were enrolled in the study. For the cumulative score for all three components tested (echocardiogram performance, report, and technical proficiency), χ2 = 8.223, p = .016, which showed the high-variation group outperformed the low-variation group. Two common themes which assisted in the transfer emerged from interviews are as follows: (1) use of strategies described in variation theory to describe abnormal hearts, (2) the use of formative live feedback from trainers during hands-on training. Conclusion: Training strategies exposing trainees to high-variation training may aid transfer of paediatric echocardiography skills.

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