Development of a culturally appropriate computer-delivered tailored internet-based health literacy intervention for spanish-dominant hispanics living with HIV

Background: Low health literacy is associated with poor medication adherence in persons with human immunodeficiency virus (HIV), which can lead to poor health outcomes. As linguistic minorities, Spanish-dominant Hispanics (SDH) face challenges such as difficulties in obtaining and understanding accurate information about HIV and its treatment. Traditional health educational methods (e.g., pamphlets, talking) may not be as effective as delivering through alternate venues. Technology-based health information interventions have the potential for being readily available on desktop computers or over the Internet. The purpose of this research was to adapt a theoretically-based computer application (initially developed for English-speaking HIV-positive persons) that will provide linguistically and culturally appropriate tailored health education to Spanish-dominant Hispanics with HIV (HIV¿+¿SDH).MethodsA mixed methods approach using quantitative and qualitative interviews with 25 HIV¿+¿SDH and 5 key informants guided by the Information-Motivation-Behavioral (IMB) Skills model was used to investigate cultural factors influencing medication adherence in HIV¿+¿SDH. We used a triangulation approach to identify major themes within cultural contexts relevant to understanding factors related to motivation to adhere to treatment. From this data we adapted an automated computer-based health literacy intervention to be delivered in Spanish.ResultsCulture-specific motivational factors for treatment adherence in HIV¿+¿SDH persons that emerged from the data were stigma, familismo (family), mood, and social support. Using this data, we developed a culturally and linguistically adapted a tailored intervention that provides information about HIV infection, treatment, and medication related problem solving skills (proven effective in English-speaking populations) that can be delivered using touch-screen computers, tablets, and smartphones to be tested in a future study.ConclusionUsing a theoretically-grounded Internet-based eHealth education intervention that builds on knowledge and also targets core cultural determinants of adherence may prove a highly effective approach to improve health literacy and medication decision-making in this group

Exploring the Efficacy of Social Media Based HIV Prevention Strategies for Hispanic College Students

Hispanics now constitute the largest ethnic minority group in the U.S. As the country’s fastest growing demographic, social welfare and public health professionals should focus on ameliorating health issues affecting this population. However, Hispanics continue to experience health disparities including high rates of HIV infection. Moreover, South Florida, is home to two counties with the highest per capita incidence of HIV in the U.S. Risks for HIV are heightened in college settings where individuals may have multiple partners and inconsistent condom use. As such, Hispanic college students in a minority serving institution in Miami, FL comprise an ideal group for the implementation of targeted prevention efforts to decrease health disparities related to HIV. This dissertation evaluated the implementation of an HIV prevention effort that utilized social media based technologies to engage Hispanic college students in HIV prevention conversations and services. This dissertation (1) evaluated the effectiveness of exposure to a social media based campaign using an experimental design and (2) provided a systematic review of the campaign’s content and user interactivity. Participants were recruited from students electing to receive free HIV testing on-campus as part of a SAMHSA-funded project. Hispanic young adults (ages 18-24 years) completed baseline and follow-up assessments—reporting demographic and background characteristics as well as perceptions and incorporation of HIV preventive behaviors. Participants were randomized to social media exposure (n=30) or control (n=30) conditions. The exposure condition received three updates per week in the form of social media post updates. Follow-up assessments occurred 4 weeks after HIV testing. Mixed ANOVA and logistic regression analysis were used to examine the impact of exposure over time by comparing mean scores of baseline and follow-up responses between conditions. This dissertation examined the following outcomes: awareness of HIV testing and prevention services, confidence of using condoms, perceived benefits of using condoms, and frequency of reported protected sex acts. While analyses revealed no statistically significant differences between groups, McNemar’s test results indicated a statistically significant increase in awareness of HIV prevention services on the university campus for participants in both study conditions (p\u3c .001). These exploratory results indicate further research is needed to determine the effectiveness of social media based strategies and how such technologies should be harnessed to achieve HIV prevention goals

Adoption of mHealth among Latinos with Cardiometabolic Risk Factors

Purpose of the Study: The aim of this explanatory mixed methods study was to understand what factors motivate Latinos with cardiometabolic risk factors (CMRF) to use mHealth. Design and Methods: Data from N=101 participants (63=Female, 38=Male) in the cross-sectional survey and N=17 respondents in the semi-structured interviews were used to be analyzed and evaluated in the mixed methods phase. Survey items consisted of demographic information, clinical history, smoking and alcohol use, and predictors of mHealth use (Perceived health risks, Health Consciousness, Perceived usefulness, and mHealth literacy). In-depth interviews were conducted with Latinos with CMRF and transcripts of the interviews were analyzed for thematic content. Relationship between predictors of mHealth use was tested using regression and chi-squared analysis. Transcripts were analyzed using qualitative content analysis. Results: Health consciousness was found to be a statistically significant predictor of Perceived usefulness (β=0.24, P=0.050). Both Health consciousness and Perceived Usefulness were positively associated with mHealth use (β=0.15, P=0.151), (β=0.90, P=0.000) respectively. mHealth literacy moderated the relationship between Perceived usefulness and mHealth use (β=-2.05, P=0.046), and was related to both barriers and facilitators to mHealth use even though the interaction effect was negative. Seven major themes emerged with three facilitators of mHealth use: (1) Intrinsic motivation to learn how to improve health, (2) Availability of social resources, (3) Personalized features to meet their needs; and four barriers: (4) Lack of self-efficacy to operate devices, (5) Concern over affordability and financing mHealth, (6) Competing priorities lead to sedentary behaviors, and (7) Navigating a new country. Conclusion: In Latinos with CMRF, there is a strong awareness of perceived disease risk and the need to take care of oneself. mHealth was qualitatively reported as an important tool that can help with disease self-management. Yet, mHealth literacy was needed to moderate the relationship between how participants appreciate its utility and their actual uptake. Given that such barriers are unique to the Latino community, researchers should create mHealth interventions that are literacy focused, culturally tailored, and affordable since they all influence mHealth use and CMRF self-management

The Changing Roles of Community Health Workers

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts. This report provides a snapshot of the varied landscape of CHW programs to better understand how CHWs are integrating with the health system both in terms of the structural elements of these programs, and the relational elements of CHW-health system interaction that make integrated models succeed. Authors suggest that there is no blueprint for success; rather, there are certain unifying structural elements of various integration types, and certain useful mechanisms that enable the preservation of the CHW concept

Advancing the Science of Cancer in Latinos

This open access book is a collection of articles based on presentations from the 2020 Advancing the Science of Cancer in Latinos conference that gives an overview of conference outcomes. The vision of the conference has been to unite researchers, scientists, physicians and other healthcare professionals, patient advocates, and students from across the world to discuss research advancements, identify gaps, and develop actionable goals to translate basic research findings into clinical best practices, effective community interventions, and professional training programs to decrease cancer risks and eliminate cancer disparities for Latinos. This conference comes at an especially important time when Latinos – the largest and youngest minority group in the U.S. – are expected to face a 142% rise in cancer cases in the coming years. Disparities continue to impact this population in critical areas: access to preventive and clinical care, changeable risk behaviors, quality of life, and mortality. Each chapter summarizes the presentation and includes current knowledge in the specific topic areas, identified gaps, and opportunities for future research. Topics explored include: Applying an Exposome-Wide (ExWAS) Approach to Latino Cancer Disparities Supportive Care Needs and Coping Strategies Used by Latino Men Cancer Survivors Optimizing Engagement of the Latino Community in Cancer Research Latino Population Growth and the Changing Demography of Cancer Implementation Science to Enhance the Value of Cancer Research in Latinos A Strength-Based Approach to Cancer Prevention in Latinxs Overcoming Clinical Research Disparities by Advancing Inclusive Research Advancing the Science of Cancer in Latinos: Building Collaboration for Action will appeal to a wide readership due to its comprehensive coverage of topics ranging from basic science and community prevention research to clinical practice to policy. The book is an essential resource for physicians and other medical professionals, researchers, scientists, academicians, patient advocates, and students. It also will appeal to policy-makers, NCI-designated cancer centers, academic centers, state health departments, and community organizations

National HIV Prevention Conference

CDC NPIN 2009 National HIV Prevention Conference Presentation Web Library: "The library is a resource for those that were unable to attend the conference and for those that attended and want to share information with their colleagues. The library houses PDF versions of Plenary presentations and other presentations made by CDC and other federal agencies that you are able to view and download by Population, Track, or Plenary session. Only presentations for which the authors have given their permission for posting are included."Conference Website -- Abstract book -- Conference program -- CDC NPIN 2009 National HIV Prevention Conference Presentation Web Library (NHPC 2009 Webcasts)Convened by the Centers for Disease Control and Prevention.Mode of access: World Wide Web

Advancing the Science of Cancer in Latinos

This open access book is a collection of articles based on presentations from the 2020 Advancing the Science of Cancer in Latinos conference that gives an overview of conference outcomes. The vision of the conference has been to unite researchers, scientists, physicians and other healthcare professionals, patient advocates, and students from across the world to discuss research advancements, identify gaps, and develop actionable goals to translate basic research findings into clinical best practices, effective community interventions, and professional training programs to decrease cancer risks and eliminate cancer disparities for Latinos. This conference comes at an especially important time when Latinos – the largest and youngest minority group in the U.S. – are expected to face a 142% rise in cancer cases in the coming years. Disparities continue to impact this population in critical areas: access to preventive and clinical care, changeable risk behaviors, quality of life, and mortality. Each chapter summarizes the presentation and includes current knowledge in the specific topic areas, identified gaps, and opportunities for future research. Topics explored include: Applying an Exposome-Wide (ExWAS) Approach to Latino Cancer Disparities Supportive Care Needs and Coping Strategies Used by Latino Men Cancer Survivors Optimizing Engagement of the Latino Community in Cancer Research Latino Population Growth and the Changing Demography of Cancer Implementation Science to Enhance the Value of Cancer Research in Latinos A Strength-Based Approach to Cancer Prevention in Latinxs Overcoming Clinical Research Disparities by Advancing Inclusive Research Advancing the Science of Cancer in Latinos: Building Collaboration for Action will appeal to a wide readership due to its comprehensive coverage of topics ranging from basic science and community prevention research to clinical practice to policy. The book is an essential resource for physicians and other medical professionals, researchers, scientists, academicians, patient advocates, and students. It also will appeal to policy-makers, NCI-designated cancer centers, academic centers, state health departments, and community organizations

The theory, process, and outcomes of culturally adapted psychotherapy and psychosocial interventions

Massive demographic changes have coincided with rise of the importance of evidence-based treatment among the health sciences and widespread awareness of the failure of psychology to address and serve the mental health needs of historically underrepresented groups. Researchers, theorists, and clinicians demand that empirically supported treatments be adapted to better address and better fit clinical needs. Based on existing approaches in the literature, this dissertation presents a four-part model of cultural adaptation of psychological interventions and reviews 101 current culturally adapted empirically supported treatments through the lens of this model. The dissertation project comprehensively describes the current state of the field in terms of the theoretical bases, processes, and outcomes of culturally adapted psychotherapy and psychosocial interventions in the context of evidence-based practice, provides suggestions, and illuminates implications for future research and practice

Doctor of Philosophy

dissertationThe present research focuses on the need for culturally specific curriculum-based family intervention programs for Latino immigrant families residing in the United States. A review of the literature and direct practice experience with Latino families indicate that existing intervention programs do not adequately meet the needs of this population. Part one of the study provides a comprehensive review of the published work on existing curricula in use with U.S.-based Latino families to evaluate to what extent they are effective/evidence-based and culturally relevant. Part two of the study takes an in-depth look at one such program, Familias Unidas. Familias Unidas is a curriculum-based family intervention program tailored to meet the needs of the local Latino community. Program outcomes are evaluated using a pretest-posttest design. Also, outcome differences based on different levels of acculturation are explored. In the final part of the study, practitioners working with Latino immigrant families share their experiences through individual interviews and focus groups on their experiences implementing curriculum-based programs with Latino families. Overall findings and implications will be discussed as well as directions for future research. The research is presented in the form of three distinct scholarly manuscripts. Each manuscript has its own distinct research questions, contributes to the overall research in a unique way, and makes specific recommendations for practice, policy, and research. The three manuscripts together add to the knowledge base on curriculum-based programs as they apply to Latino families