An Intersectional Perspective on Stigma as a Barrier to Effective HIV Self-Management and Treatment for HIV-Infected African American Women

Among those who are HIV-infected and striving to live well with HIV, African American women have poorer health outcomes and represent a higher portion of those women who die from HIV-related causes. Those health inequalities have been associated with the presence of social determinants of health such as stigma. This analytical review asserts that stigmas precipitated by gender, race, and class in the context of HIV-related stigma constitute substantial barriers to active engagement in HIV self-management, care, and treatment for HIV-infected African American women. The utility of the intersectionality framework for analyzing how these various stigmas interact to create unique determents to effective treatment and active self-management of HIV among African American women and for serving as a foundation for intervention development is presented

A CLARION Call for Embracing IPE as the Status Quo for Preparing Health Professionals to Engage in Interprofessional Health Research

Complex health conditions and the social-economic determinants that contribute to disease and injury incidence, prevalence, and health inequalities require multifaceted evidence-based interventions that only interprofessional research teams who collaborate across traditional disciplinary lines can generate. Interprofessionally driven and derived research evidence is the method of du jour. Nonetheless as a whole, health professionals who are often members of interprofessional health research teams are products of educational systems wherein they were educated in disciplinary silos. Health professionals that learn about, with, from, each other during their foundational education will be better prepared to function as interprofessional research team members. With the impetus of policy-makers, and accrediting bodies as well as support from funders, educational institutions are cautiously adopting interprofessional education (IPE). However, there remains a lack of empirical evidence about the downstream results of IPE, namely health and health systems outcomes. Thus, the IPE arena is ripe with opportunities for health and health services researchers

Nursing, Physical Therapy, and Cytotechnology Graduate and Undergraduate Students\u27 Attitudes Toward Teamwork Before and After Participation in an Interprofessional Education Experience

BACKGROUND Educating health professional (HP) students in environments wherein they can learn about, from, and with each other can prepare them for interprofessional collaborative practice (IPCP), which may positively impact patient safety and satisfaction (Brashers et al., 2015; Health Professions Accreditors Collaborative [HPAC], 2019). IPCP is characterized by effective communication, shared values, respect for diverse disciplines and teamwork among health professionals (IOM, 2015). However, professional silos in practice can foster competition rather than collaboration. Knowledge of HP roles and responsibilities is a primary tenet of IPCP (Interprofessional Educational Collaborative [IPEC], 2011). PURPOSE An interprofessional education (IPE) approach that combined book reading, a presentation by the author of the book, and small group discussion of a case study focused on patient safety was used to introduce students to HP roles and responsibilities and to highlight the benefits of IPCP. Patient safety is an effective platform for engaging students in IPE learning and exposing them to the benefits of teamwork and interprofessional collaboration as demonstrated in this study. METHOD Block randomization was used to assign graduate and undergraduate students (N=167) to interprofessional groups for the IPE learning, including case discussions. There were 20 groups of 8 students and one group with the remaining 7 students. The group compositions were reviewed and it was verified prior to data collection that each group had interprofessional representation of students based on their programs of study. Most students in our sample had two or more prior IPE experiences. Pre- and post-participation attitudes about teamwork were assessed using the Teamwork, Roles, and Responsibilities (TRR) subscale of the Interprofessional Attitudes Scale (IPAS). RESULTS There were significant changes in student attitudes toward teamwork (p \u3c .05) and significant differences in scores based on discipline, prior IPE learning and level (graduate or undergraduate) with moderate to large effect sizes. CONCLUSION This study demonstrates how IPE can be implemented through co-curricular learning to build upon prior IPE learning to improve both graduate and undergraduate students’ attitudes toward teamwork

Novel Interventions for HIV Self-Management in African American Women: A Systematic Review of mHealth Interventions

The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials atclinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. Atclinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender-specific mHealth interventions focusing on HIV-infected AA women are warranted for the future

Health Professions Students\u27 Attitudes Toward Teamwork Before and After an Interprofessional Education Co-Curricular Experience

Background: Effective interprofessional collaboration may positively impact clinical outcomes, patient satisfaction, and cost effectiveness. However, educational silos and discipline-specific socialization have reinforced each health profession’s independent values, attitudes, and problem-solving approaches. Methods and Findings: Students’ (N = 376) attitudes about teamwork were measured with the Interprofessional Attitudes Scale, Teamwork, Roles, and Responsibilities subscale using a pretest-posttest design. Experiential learning strategies and a case study approach were used to introduce students to the roles and responsibilities of the students’ disciplines. There was a positive mean difference in pretest-posttest measures (p \u3c .001) with a moderate effect size (r = .27). Conclusions: Providing opportunities for pre-licensure health sciences students to understand the roles and responsibilities of other disciplines through IPE co-curricular learning can enhance positive attitudes toward teamwork

The Relationship Between Physical Activity and Cardiorespiratory Fitness Among People Living With Human Immunodeficiency Virus Throughout The Life Span

BACKGROUND: People living with human immunodeficiency virus (PLHIV) are at an increased risk for developing cardiovascular disease (CVD). Physical activity and cardiorespiratory fitness in PLHIV are poorly understood. OBJECTIVE: The aims of this study were to describe physical activity and cardiorespiratory fitness by sex and age and to examine the association between physical activity and cardiorespiratory fitness in PLHIV, controlling for covariates. METHODS: Seven hundred two PLHIV participated in a cross-sectional study and completed validated measures of self-reported physical activity (7-day Physical Activity Recall) and cardiorespiratory fitness (6-minute walk test). Participants were recruited from 7 diverse sites in the United States and Thailand, and data were analyzed using descriptive statistics and multiple regression to examine the relationship between physical activity and cardiorespiratory fitness. RESULTS: On average, participants self-reported engaging in 115 minutes of, mostly light (75%), physical activity. Men reported twice the amount of physical activity as women (155 vs 73 minutes, P = .01). Participants\u27 ability to achieve their predicted 6-minute walk test distances was similar between men (68%) and women (69%) (P \u3e .01). For women, vigorous physical activity was associated with a 6.6% increase in cardiorespiratory fitness and being temporarily unemployed was associated with an 18% decline in cardiorespiratory fitness. Cardiorespiratory fitness increased with age (P \u3c .01). CONCLUSIONS: Weekly physical activity of people living with human immunodeficiency virus averaged 85 minutes of mostly light activity, well below the recommended 150 minutes of moderate activity. Vigorous physical activity was associated with improved cardiorespiratory fitness in women, but not men. Although PLHIV would benefit from interventions to increase physical activity, our data suggest a need to develop sex-specific physical activity strategies

Taking Be proud! Be responsible! to the Suburbs: A Replication Study

CONTEXT: An important phase of HIV prevention research is replicating successful interventions with different groups and in different settings. METHODS: Be Proud! Be Responsible!, a successful intervention originally targeting black urban males and carried out in nonschool settings, was presented in health classes at urban and suburban schools with diverse student bodies. A group-randomized intervention study, which included 1,357 ninth and 10th graders from 10 paired schools in a Midwestern metropolitan area, was conducted in 2000-2002. Half the schools received the intervention, and half received a general health promotion program. Students\u27 reports of their sexual behavior and selected cognitive mediators were analyzed immediately following the programs and four and 12 months later. RESULTS: Compared with students who received the control curriculum, students exposed to the intervention reported significantly greater knowledge of HIV, other STDs and condoms; greater confidence in their ability to control sexual impulses, to use condoms and to negotiate the use of condoms; and stronger intentions to use condoms. Stratified analyses revealed that the strongest intervention impacts were on knowledge and efficacy among males and students attending suburban schools. The intervention had no impact on sexual initiation, frequency of intercourse or condom use. CONCLUSIONS: Schools are a logical and viable setting for the dissemination and acquisition of information about HIV, including prevention strategies. However, the behavioral impact of an intervention may not be easily transferable when the program is taught outside a carefully controlled, nonschool setting

Nursing, Physical Therapy, and Cytotechnology Graduate and Undergraduate Students’ Attitudes Toward Teamwork Before and After Participation in an Interprofessional Education Experience

BACKGROUND Educating health professional (HP) students in environments wherein they can learn about, from, and with each other can prepare them for interprofessional collaborative practice (IPCP), which may positively impact patient safety and satisfaction (Brashers et al., 2015; Health Professions Accreditors Collaborative [HPAC], 2019). IPCP is characterized by effective communication, shared values, respect for diverse disciplines and teamwork among health professionals (IOM, 2015). However, professional silos in practice can foster competition rather than collaboration. Knowledge of HP roles and responsibilities is a primary tenet of IPCP (Interprofessional Educational Collaborative [IPEC], 2011). PURPOSE An interprofessional education (IPE) approach that combined book reading, a presentation by the author of the book, and small group discussion of a case study focused on patient safety was used to introduce students to HP roles and responsibilities and to highlight the benefits of IPCP. Patient safety is an effective platform for engaging students in IPE learning and exposing them to the benefits of teamwork and interprofessional collaboration as demonstrated in this study. METHOD Block randomization was used to assign graduate and undergraduate students (N=167) to interprofessional groups for the IPE learning, including case discussions. There were 20 groups of 8 students and one group with the remaining 7 students. The group compositions were reviewed and it was verified prior to data collection that each group had interprofessional representation of students based on their programs of study. Most students in our sample had two or more prior IPE experiences. Pre- and post-participation attitudes about teamwork were assessed using the Teamwork, Roles, and Responsibilities (TRR) subscale of the Interprofessional Attitudes Scale (IPAS). RESULTS There were significant changes in student attitudes toward teamwork (p \u3c .05) and significant differences in scores based on discipline, prior IPE learning and level (graduate or undergraduate) with moderate to large effect sizes. CONCLUSION This study demonstrates how IPE can be implemented through co-curricular learning to build upon prior IPE learning to improve both graduate and undergraduate students’ attitudes toward teamwork

Taking Be proud! Be responsible! to the Suburbs: A Replication Study

CONTEXT: An important phase of HIV prevention research is replicating successful interventions with different groups and in different settings. METHODS: Be Proud! Be Responsible!, a successful intervention originally targeting black urban males and carried out in nonschool settings, was presented in health classes at urban and suburban schools with diverse student bodies. A group-randomized intervention study, which included 1,357 ninth and 10th graders from 10 paired schools in a Midwestern metropolitan area, was conducted in 2000-2002. Half the schools received the intervention, and half received a general health promotion program. Students\u27 reports of their sexual behavior and selected cognitive mediators were analyzed immediately following the programs and four and 12 months later. RESULTS: Compared with students who received the control curriculum, students exposed to the intervention reported significantly greater knowledge of HIV, other STDs and condoms; greater confidence in their ability to control sexual impulses, to use condoms and to negotiate the use of condoms; and stronger intentions to use condoms. Stratified analyses revealed that the strongest intervention impacts were on knowledge and efficacy among males and students attending suburban schools. The intervention had no impact on sexual initiation, frequency of intercourse or condom use. CONCLUSIONS: Schools are a logical and viable setting for the dissemination and acquisition of information about HIV, including prevention strategies. However, the behavioral impact of an intervention may not be easily transferable when the program is taught outside a carefully controlled, nonschool setting

Health Professions Students' Teamwork Before and After an Interprofessional Education Co-Curricular Experience

Background: Effective interprofessional collaboration may positively impact clinical outcomes, patient satisfaction, and cost effectiveness. However, educational silos and discipline-specific socialization have reinforced each health profession’s independent values, attitudes, and problem-solving approaches. Methods and Findings: Students’ (N = 376) attitudes about teamwork were measured with the Interprofessional Attitudes Scale, Teamwork, Roles, and Responsibilities subscale using a pretest-posttest design. Experiential learning strategies and a case study approach were used to introduce students to the roles and responsibilities of the students’ disciplines. There was a positive mean difference in pretest-posttest measures (p \u3c .001) with a moderate effect size (r = .27). Conclusions: Providing opportunities for pre-licensure health sciences students to understand the roles and responsibilities of other disciplines through IPE co-curricular learning can enhance positive attitudes toward teamwork