Process Evaluation of a Multilevel Intervention to Increase Rural, African American Participation in HIV/AIDS Clinical Trials

Background: While African Americans are disproportionately affected by the HIV/AIDS epidemic, they continue to be underrepresented in clinical trial research. This underrepresentation has led to a critical gap in research and limited access to state of the art treatment for their disease. To increase African American willingness to participate in clinical trials, Project EAST conducted a multilevel intervention that targeted rural providers and their HIV/AIDS clients. The dissertation study evaluated the implementation of this intervention. Methods: This study conducted the process evaluation of the intervention. Data sources included: (a) session audio recordings, (b) verbatim transcripts from sessions, facilitator debriefings, and participant focus group discussions, (c) narrative summaries from participant observation, (d) recruitment tracking forms, (e) attendance logs, and (f) community advisory board (CAB) meeting transcripts. All qualitative data were managed using ATLAS.ti. Findings: Intervention reach was 84% and 184% for clients and providers, respectively. Mean dose delivered scores were .88 for patient sessions and .97 for provider sessions. Attendance for each of the four client groups were .92, .86, .83, and .83, respectively and .97 and 1 for the two provider groups. Fidelity evaluated via facilitator debriefings was essential for identifying deviations from the curriculum. However, implementation checklists proved to be more comprehensive in capturing these deviations as they related to the quality and integrity of intervention delivery. Focus group data indicated clients had high satisfaction with: interactive activities, being in a group setting with other clients living with HIV/AIDS, facilitator characteristics, and an opportunity to discuss concerns and clarifications with a clinical trial expert. Providers also indicated high satisfaction with: interactive activities, facilitator characteristics, session content. These themes were convergent with facilitator perspectives on participant engagement Conclusions: The findings provide important insights regarding education about and accessibility to HIV/AIDS clinical trial opportunities for rural, African Americans and their local providers. As researchers work to establish best practices in recruitment, referral, and enrollment of racial and ethnic minorities in HIV/AIDS clinical trials, conducting a process evaluation can yield essential understanding and recommendations for comparable educational interventions to be undertaken in rural regions of the United States

Pathways to Institutional Transformation at HBCUs: Recommendations from HBCU Black Women STEM Faculty

Black women STEM faculty at historically Black colleges and universities (HBCUs) experience many barriers to promotion, tenure, and the attainment of leadership positions. Institutional transformation is essential in addressing these inequities. However, there is a lack of literature that addresses the pathways for institutional transformation at HBCUs. The purpose of this paper is to share Black women STEM faculty from HBCUs recommendations for institutional transformation. Inter-views were conducted with fifteen Black women STEM faculty at HBCUs. Find-ings revealed several themes including the need for: (1) institutional accountability and oversight, (2) investment in the representation of Black women in faculty and administration ranks, (3) leadership training and opportunities, (4) increased support for research scholarship, (5) opportunities for internal and external mentorship on scholarship and tenure, and (6) expanding student support services. Based on participants’ reflections recommendations are offered to facilitate institutional transformation that supports the advancement of Black women STEM faculty at HBCUs

Community-Based HIV Clinical Trials: An Integrated Approach in Underserved, Rural, Minority Communities

Although racial and ethnic minorities have disproportionately high rates of HIV infection, these groups are underrepresented in HIV-related clinical trials. This illustrates the need for more innovation in attempts to engage underrepresented populations in calls for interdisciplinary and translational research

Acceptability of a Mobile Health Unit for Rural HIV Clinical Trial Enrollment and Participation

Few rural minorities participate in HIV clinical trials. Mobile health units (MHUs) may be one strategy to increase participation. We explored community perceptions of MHU acceptability to increase clinical trial participation for rural minorities living with HIV/AIDS. We conducted 11 focus groups (service providers and community leaders) and 35 interviews (people living with HIV/AIDS). Responses were analyzed using constant comparative and content analysis techniques. Acceptable MHU use included maintaining accessibility and confidentiality while establishing credibility, community ownership and control. Under these conditions, MHUs can service rural locations and overcome geographic barriers to reaching major medical centers for clinical trials

HIV Interventions to Reduce HIV/AIDS Stigma: A Systematic Review

We reviewed the literature to determine the effectiveness of HIV-related interventions in reducing HIV/AIDS stigma. Studies selected had randomized controlled trial (RCT), pretest–posttest with a non-randomized control group, or pretest–posttest one group study designs in which HIV-related interventions were being evaluated, and in which HIV/AIDS stigma was one of the outcomes being measured. A checklist was used to extract data from accepted studies, assess their internal validity, and overall quality. Data were extracted from 19 studies, and 14 of these studies demonstrated effectiveness in reducing HIV/ AIDS stigma. Only 2 of these 14 effective studies were considered good studies, based on quality, the extent to which the intervention focused on reducing HIV/AIDS stigma, and the statistics reported to demonstrate effectiveness. Future studies to reduce HIV/AIDS stigma could improve by designing interventions that pay greater attention to internal validity, use validated HIV/AIDS stigma instruments, and achieve both statistical and public health significance

Narratives of Black Women STEM Faculty: Breaking Barriers to Promote Institutional Transformation at Historically Black Colleges and Universities

Women faculty at Historically Black Colleges and Universities (HBCUs), experience many barriers. HBCUs’ rich histories of advancing racial equity have often outweighed a focus on gender equity, with issues at the intersection of race and gender receiving minimal attention. This study highlights the need for institutional transformation at HBCUs by identifying the structural factors that promote and inhibit Black women STEM faculty advancement. Interviews (n=15) were conducted with HBCU Black women STEM faculty using the Life Interview approach. The three major themes related to barriers included: (a) greater likelihood of having their expertise questioned, (b) increased pressure to work harder, and (c) sexism, racism, and gendered racism. This study expands upon existing research in the literature by focusing on an understudied population, Black women STEM faculty at HBCUs. Findings suggest that to advance institutional transformation diversity, equity, and inclusion goals, colleges and universities must establish infrastructures that include supports of benefit to the professional advancement of all faculty

Development of a Multilevel Intervention to Increase HIV Clinical Trial Participation Among Rural Minorities

Minorities are disproportionately affected by HIV/AIDS in the rural Southeast; therefore, it is important to develop targeted, culturally appropriate interventions to support rural minority participation in HIV/AIDS research. Using Intervention Mapping, we developed a comprehensive multilevel intervention for service providers (SPs) and people living with HIV/AIDS (PLWHA). We collected data from both groups through 11 focus groups and 35 individual interviews. Resultant data were used to develop matrices of behavioral outcomes, performance objectives and learning objectives. Each performance objective was mapped with changeable, theory-based determinants to inform components of the intervention. Behavioral outcomes for the intervention included: (a) Eligible PLWHA will enroll in clinical trials; and (b) SPs will refer eligible PLWHA to clinical trials. The ensuing intervention consists of four SPs and six PLWHA educational sessions. Its contents, methods and strategies were grounded in the theory of reasoned action, social cognitive theory, and the concept of social support. All materials were pretested and refined for content appropriateness and effectiveness

Silent Endurance and Profound Loneliness: Socioemotional Suffering in African Americans Living With HIV in the Rural South

We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering—the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole

Community-Based HIV Clinical Trials: An Integrated Approach in Underserved, Rural, Minority Communities

BACKGROUND: Although racial and ethnic minorities have disproportionately high rates of HIV infection, these groups are underrepresented in HIV-related clinical trials. This illustrates the need for more innovation in attempts to engage underrepresented populations in calls for interdisciplinary and translational research. OBJECTIVES: Eleven focus groups and 35 interviews were conducted with people living with HIV/AIDS (PLWHA) to explore the perspectives of rural community leaders, service providers, and PLWHA about bringing HIV-related research, including clinical trials, into rural communities. METHODS: Over a period of 3 months in spring 2007, we collected qualitative data from three sources: Community leaders, service providers, and PLWHA. Text data were analyzed using the constant comparative method and content analysis techniques of theme identification. RESULTS: Respondents want an integrated approach to HIV research that builds trust, meets community needs, and respects their values. They conceptualize HIV research as part of a broader spectrum of HIV testing, prevention, and care, and suggest integrating HIV trials with existing community services, organizations, and structures, engaging various segments of the community, and conducting research using a personal approach. CONCLUSIONS: These findings support calls for more relevant, translational, and engaged research. An integrated approach may be an important innovation to transform the research enterprise to meet these goals and more directly improve the health of individuals

A gender approach to work ability and its relationship to professional and domestic work hours among nursing personnel

The association between working hours and work ability was examined in a cross-sectional study of male (N = 156) and female (N = 1092) nurses in three public hospitals. Working hours were considered in terms of their professional and domestic hours per week and their combined impact; total work load. Logistic regression analysis showed a significant association between total work load and inadequate work ability index (WAI) for females only. Females reported a higher proportion of inadequate WAI, fewer professional work hours but longer domestic work hours. There were no significant differences in total work load by gender. The combination of professional and domestic work hours in females seemed to best explain their lower work ability. The findings suggest that investigations into female well-being need to consider their total work load. Our male sample may have lacked sufficient power to detect a relationship between working hours and work ability. (c) 2008 Elsevier Ltd. All rights reserved