Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and-exposed children

Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya. Methods: Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIV-infected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed. Results: Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care. Conclusion: The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended

Psychosocial factors underlying physical activity

© 2007 Zhang et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Factors Influencing the Intention of Getting the HPV Vaccine among College Women: An Application of the Reasoned Action Approach

Purpose: Although at high risk for contracting HPV, less than half of college women have been vaccinated. The purpose of the current study was to examine underlying factors influencing college women’s intention to get the HPV vaccine using the Reasoned Action Approach (RAA). Methods: Data were collected from two different samples of college women at a large Mid-west university via two phases. In Phase 1, a salient-belief elicitation survey based on the RAA was utilized to collect quantitative and qualitative data from 43 college women. Phase 1 data were then utilized to create a quantitative closed-ended instrument, which was administered to a large sample (n=279) of female college students in Phase 2. Results: Results indicated that the perceived consequences of getting the vaccine, such as protection against HPV and cervical cancer, were primary determinants influencing intention to get the HPV vaccine. Participants perceived healthcare providers and mothers as salient referents influencing their vaccination decisions. Attitude towards the act and perceived norm were the major predictors of intention to get a vaccine. Conclusions: Results suggest the importance of attitudes and perceived norms (especially mothers and healthcare providers) in predicting intention to get the HPV vaccine. Utilizing theory-based approaches to design interventions may be beneficial to increase vaccination rates among college women. Such interventions could focus on the attitudes and perceived norms of college students’ regarding getting the HPV vaccine

Beliefs about Staying Home: Findings from a Nationally Representative Probability Sample of U.S. Adults in the Early Days of the COVID-19 Epidemic

Understanding the beliefs about staying home is essential to inform stay-at-home policies to mitigate COVID-19 and future epidemics. This study (1) identified the salient advantages, disadvantages, and facilitating beliefs about staying home, and (2) examined the relationship between these beliefs and intention. U.S. adults from a nationally representative probability-based household panel completed an online reasoned action approach belief elicitation from April 10-20, 2020, about one month after stay-at-home guidelines were implemented. First, we conducted an inductive content analysis to reveal salient beliefs about staying home. We identified eight advantages, 12 disadvantages, and 12 facilitators that broadly spanned across health domains: individual, population, interpersonal, occupational, financial, and leisure health. Then, we conducted three regression analyses, one for each of the three sets of beliefs, predicting intention to stay home for the next month from worker status and belief mentioned. In these regression analyses, four advantages, four disadvantages, and four facilitators made independent contributions to explaining intention. The breadth of the elicited beliefs suggests that COVID-19 is perceived to have impacted many dimensions of our lives, and that interventions need to be just as broad. Communication and educational interventions could help people understand the benefits of staying home to themselves, to their families, and to the wider community. Programs that keep essential supplies available could help people stay home. Structural interventions with financial safety nets and policies that help people stay employed during an epidemic might address people’s concerns about the impact of staying home on their financial and occupational health

An Evidence Review of Gender-Integrated Interventions in Reproductive and Maternal-Child Health

Evidence-based behavior change interventions addressing gender dynamics must be identified and disseminated to improve child health outcomes. Interventions were identified from systematic searches of the published literature and a web-based search (Google and implementer's websites). Studies were eligible if an intervention addressed gender dynamics (i.e., norms, unequal access to resources), measured relevant behavioral outcomes (e.g., family planning, antenatal care, nutrition), used at least a moderate evaluation design, and were implemented in low- or middle-income countries. Of the 23 interventions identified, 22 addressed reproductive and maternal-child health behaviors (e.g., birth spacing, antenatal care, breastfeeding) that improve child health. Eight interventions were accommodating (i.e., acknowledged, but did not seek to change gender dynamics), and 15 were transformative (i.e., sought to change gender dynamics). The majority of evaluations (n=12), including interventions that engaged men and women to modify gender norms, had mixed effects. Evidence was most compelling for empowerment approaches (i.e., participatory action for maternal-child health; increase educational and economic resources, and modify norms to reduce child marriage). Two empowerment approaches had sufficient evidence to warrant scaling-up. Research is needed to assess promising approaches, particularly those that engage men and women to modify gender norms around communication and decision making between spouses

A Community-Based Intervention Designed to Increase Preventive Health Care Seeking Among Adolescents: The Gonorrhea Community Action Project

Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents

Beliefs Underlying Eating Better and Moving More

The reasoned action approach has been used to identify the determinants of a behavior to be modified by social and behavioral interventions. Information on the specific beliefs underlying behavioral decisions is vital to intervention design. More attention is needed on the salient belief elicitation—a critical step in a theory-based formative research process. This article considers the methodological issues involved in conducting a salient belief elicitation with special attention to an elicitation that allows the comparison of results across several behaviors and priority groups. The author uses the behaviors underlying overweight and obesity as her central example. To support the development of interventions to improve cardiovascular health and to explore methods for a comparative analysis of salient belief elicitations, semistructured interviews were conducted with 243 adults from two rural and two urban worksites in Indiana and 344 students from three middle schools in rural Indiana. Content and frequency analyses identified the modal salient beliefs underlying several eating and physical activity behaviors. Illustrative results are presented, and recommendations for salient belief elicitation are discussed. </jats:p