Albanian Immigrants\u27 Experience and Attitude toward Health Care in Albania versus the USA

Purpose: To describe the experiences and attitudes of Albanian immigrants toward health care in Albania versus the United Stated (USA). Method: A cross-sectional descriptive survey using venue sampling was administered at the Albanian Festival in Worcester on June 5-7, 2015. The data was entered and analyzed using SPSS. Results: There were a total of 146 subjects eligible for analysis. Most subjects were female (52.7%) and the mean subject age was 41.6 with a range of 18-77 years old. Subjects moved to the USA at a mean age of 28.8 years with a range of 1-66 years old. Subjects have lived in the USA for a mean of 12.9 years, with a range of 3 months to 28 years. Categorical response items comparing health care in Albania versus the USA were statistically significant in favor of the USA health care system regarding comfort seeking care, care worth money, receiving preventative care, and having good communication with the doctor. Subgroup analysis of males vs. females showed a significant finding only on females receiving more preventative care. Continuous response items comparing health care in Albania versus the USA were statistically significant in favor of the USA health care system regarding the patient liking care received and trusting the doctors. Content analysis of the open-ended comments showed positive and negative perceptions of both health care systems. Conclusions: Our results show that Albanian Immigrants have an overwhelming positive experience and attitude toward the USA health care system in all categories including comfort seeking care, care being worth the money, having good communication with the doctor, trusting the doctors, receiving preventative care, and liking care received. These finding are important because they show that even though Albanian immigrants are exposed to under-funded and corrupt medical care in Albania, the majority does not allow this experience to influence the interaction with USA health care professionals. The findings from this study are applicable to the clinical setting in the USA and some recommendations can be made to USA health care providers about how to best approach Albanian immigrant patients.https://escholarship.umassmed.edu/capstones/1001/thumbnail.jp

Qualitative Description: A “How-To” Guide

This guide is based on multiple presentations we have given to doctoral students about the use of qualitative description (QD) and our own work using QD over the past 21 years. We were motivated to make this guide widely available due to the lack of adequate resources (manuscripts and textbooks) that cover QD. It is our hope that others will be open to this pragmatic approach, which is both creative and rigorous and can be useful for exploring phenomena from a qualitative perspective. Many published articles claim to use QD (e.g., approximately 3,600 in PubMed). However, guidelines for conducting a QD study are lacking. Kim et al. (2016) expressed a similar sentiment in their systematic review of studies that used QD. The lack of a rigorous systematic approach leads to inconsistencies in sampling procedures, inadequate sample sizes, and lack of theoretical or conceptual orientations to build knowledge. Research that uses QD is not intended to find underlying interpretive meanings or to describe the culture of a group; it is designed instead to describe the rich, truthful perspectives of those experiencing a specific and focused situation or phenomenon. The results of a QD study are expressed in common, easy-to-understand language. Therefore, it is especially useful when working with clinical populations, communities, and across different cultural groups. The QD approach provides rich description and makes an important contribution to knowledge development. We hope that this guide will become an essential reference for those interested in using this specific qualitative approach

An Analysis of Electronically Monitored Adherence to Antiretroviral Medications

Medication adherence studies increasingly collect data electronically, often using Medication Event Monitoring System (MEMS) caps. Analyses typically focus on summary adherence measures, although more complete analyses are possible using adaptive statistical methods. These methods were used to describe individual-subject adherence patterns for MEMS data from a clinical trial. Subjects were adaptively clustered into groups with similar adherence patterns and clusters were compared on a variety of subject characteristics. There were seven different adherence clusters: consistently high, consistently moderately high, consistently moderate, consistently moderately low, consistently low, deteriorating starting early, and deteriorating late. Compared to other subjects, subjects with consistently high and consistently moderately high adherence were more likely to be male, White, and older and to maintain during study participation a CD4 cell count over 500 and an HIV viral load of at most 400 copies/ml. These results demonstrate the effectiveness of adaptive methods for comprehensive analysis of MEMS data

Adjustment to chronic illness among HIV-infected women

PURPOSE: To identify factors that influence adjustment to chronic illness among HIV-infected women, using the cognitive appraisal model of stress and coping. DESIGN: Cross-sectional descriptive survey of 101 HIV-infected women living in the Northeastern United States, from December 1996 to December 1997. METHODS: During face-to-face interviews, the Meaning of Illness Questionnaire, Duke UNC Functional Social Support Questionnaire, HIV Symptom Experience Inventory and Medical Outcomes Study (MOS) Short Form Survey were used to measure appraisal of illness, social support, HIV symptom severity and adjustment to chronic illness. Hierarchical linear regression, path analysis, and procedures to test for mediation were performed. FINDINGS: The model variables explained 70% of the variance in adjustment to chronic illness. Symptom experience accounted for the greatest percentage of variance in adjustment (28%). Two of the three predicted relationships were supported as hypothesized: adjustment to chronic illness was directly influenced by appraisal of illness and by HIV-symptom experience. Social support was not found to have a direct effect on adjustment. Instead, appraisal of illness mediated the effect of social support on adjustment and symptom experience. HIV illness stage was not a significant predictor of adjustment. CONCLUSIONS: The cognitive appraisal model of stress and coping was useful for building knowledge on adjustment to chronic illness among HIV infected women. Interventions aimed at reframing negative appraisals have the potential to affect adjustment

Women with HIV infection: the three waves of scientific inquiry

Initial efforts to curtail the spread of HIV infection to women failed. Consequently, women are the fastest growing population newly infected with HIV. This article presents a historical look at the waves of scientific inquiry that directed research on HIV infection among women. The author proposes three distinct waves. Each has been shaped by movement within the scientific community away from traditional biomedical and public health approaches toward feminist strategies that embrace the social, political, and cultural forces that influence women\u27s health. These waves provide both valuable insights for nurses new to the field of HIV and a framework to guide future research on women with HIV infection

Psychometrics of a Brief Acculturation Scale for Hispanics in a Probability Sample of Urban Hispanic Adolescents and Young Adults

This article presents data in support of the reliability and validity of afour-item measure of acculturationfor Hispanics. The study has three strengths. First, this brief measure is evaluated with a probability sample of Hispanic adolescents and young adults (ages 15-24 years) living in urban, low-income households. Second, the sample contains both second-and third-generation Puerto Rican and Mexican American adolescents and young adults. Third, the acculturation measure was administeredas part ofaface-to-face interview. The four-item acculturation scale correlated highly with generation, length of time in the United States, subjective evaluation of acculturation, country of birth, and language chosen for the interview. The psychometric properties of this brief scale are comparable to those obtained for other published scales. Results support the use of this four-item measure of acculturation as a simple, inexpensive measure that involves minimal respondent burden.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67301/2/10.1177_07399863960181004.pd

Sexual functioning among HIV-infected women

The influence of HIV on sexual activity and functioning presents a unique set of issues. HIV transmissibility, partner disclosure, potential vertical transmission and, for some HIV-infected women, problems associated with illicit drug use, may affect sexuality. Few studies have examined HIV-infected women\u27s sexuality and none have studied the relationship between HIV symptoms, HIV illness stage, quality of life, meaning of illness and sexual functioning. This descriptive study examines sexual activity, sexual functioning and safer sex behavior among 101 HIV-seropositive women. Results indicate that (1) the majority of women continue to be sexually active after testing HIV positive, (2) sexual functioning does not change as a result of HIV disease progression, and (3) few women report that HIV itself caused worsening of their sexual functioning. Those women with better mental health, more positive meaning attributed to life with HIV infection, better quality of life, fewer HIV-related symptoms and who never used injection drugs had higher levels of sexual functioning. Greater focus on sexual functioning as an integral part of clinical assessment is needed. Patterns of sexual behavior among HIV-infected women require continued study as we search for more effective means to prevent secondary HIV transmission

HCV treatment decision-making substance use experiences and hepatitis C treatment decision-making among HIV/HCV Coinfected Adults

Hepatitis C virus (HCV) infection is a major source of morbidity and mortality among substance users and persons living with human immunodeficiency virus (HIV) infection. Treatment for chronic HCV infection involves complex decision-making. These decisions are even more complicated in persons with HIV and substance use related problems. A secondary analyses of qualitative data collected in the United States (2004-2005) with 31 HIV/HCV coinfected adults (48% women; mean age 44.7 years) revealed three themes related to substance use (substance use evolution, revolving door: going back out and reconstructing life) and two HCV treatment decision-making themes (HCV infection treatment issues: not a priority, fear, misinformation and get clean and try it). Study limitations and implications are discussed

Planning and implementing a statewide soccer HIV awareness and health promotion intervention for African-born men living in the United States

The increasing number of African-born individuals newly diagnosed with HIV in Massachusetts led to a grassroots effort to advocate for needed resources, policies, and programs. This article describes the African Health Cup (AHC), one of the major innovative programs developed by Africans For Improved Access (AFIA) in collaboration with community members

Pancreatitis Quality of Life Instrument: Development of a new instrument

Objectives: The goal of this project was to develop the first disease-specific instrument for the evaluation of quality of life in chronic pancreatitis. Methods: Focus groups and interview sessions were conducted, with chronic pancreatitis patients, to identify items felt to impact quality of life which were subsequently formatted into a paper-and-pencil instrument. This instrument was used to conduct an online survey by an expert panel of pancreatologists to evaluate its content validity. Finally, the modified instrument was presented to patients during precognitive testing interviews to evaluate its clarity and appropriateness. Results: In total, 10 patients were enrolled in the focus groups and interview sessions where they identified 50 items. Once redundant items were removed, the 40 remaining items were made into a paper-and-pencil instrument referred to as the Pancreatitis Quality of Life Instrument. Through the processes of content validation and precognitive testing, the number of items in the instrument was reduced to 24. Conclusions: This marks the development of the first disease-specific instrument to evaluate quality of life in chronic pancreatitis. It includes unique features not found in generic instruments (economic factors, stigma, and spiritual factors). Although this marks a giant step forward, psychometric evaluation is still needed prior to its clinical use