What makes some campaigns more effective than others?: An analysis of three mass media PSI HIV/AIDS campaigns in Kenya.

This study included interviews with campaign planners at a major social marketing organization in Kenya and an examination of three comprehensive HIV/AIDS health campaigns produced by the planners. Thematic and qualitative content analysis of these data addressed three research questions: (1) To what extent did the campaign creators consider health behavior change models, socio-cultural, and group identity concerns of their target audiences when designing the health campaigns? (2) To what extent did the campaigns reflect the major principles of campaign design? And (3) to what extent did the themes in the campaigns reflect the socio-cultural and group identity concerns of the target audiences? Results indicated that the planners did not formally consider theory or socio-cultural and group identity concerns that are important in collectivist African societies like Kenya. The campaigns fit the planners' goals of avoiding fear appeals, considering barriers and benefits to behavior change, providing a sense of self-efficacy, and appealing to subjective norms. Several principles of effective campaign design were also identified. However, thematic analysis of the campaigns revealed the presence of cultural beliefs/practices (e.g., gender norms) that can be barriers to behavior change. These results suggest that the campaigns would have benefited from formal attention to structural and cultural factors that may have served as barriers to adoption of the targeted behavior. Accordingly, the discussion focuses on a polymorphic approach to health behavior change theory that would ensure full consideration of these factors. An ecological approach to campaign analysis is outlined as a model for future research on health communication campaigns

Lessons Learned from Implementing Unconscious Bias Training at an Academic Medical Center

Introduction. In 2018, our Midwestern university medical center began offering unconscious bias training. Each session concluded with a standard evaluation. We analyzed two years of data that focused on three areas: 1) whether demographic differences or amount of prior knowledge on the topic influenced the training experience; 2) what participants liked best about the training; and 3) whether participants’ stated intentions to apply their learning at the end of the training aligned with institutional goals of the training. Methods. Participants attended sessions open to the campus community pre-scheduled by the Office for Diversity, Equity, and Inclusion and posted on its website. Chi-square tests were utilized to test associations between outcomes and questionnaire responses. Outcome measures included race/ethnicity, prior knowledge level, and overall rating of the training. Thematic analysis was used to code comments and establish themes from two open-ended survey questions. Results. Significant differences were found by race and ethnicity for all questionnaire responses; each were p < 0.001. Those who reported they had advanced/expert knowledge on the topic were less likely to report the training increased their knowledge, and those who reported their race as White/Caucasian tended to give the training the highest overall rating, as did heterosexuals. Through thematic analysis, participants valued the interactive nature of the training sessions, the use of storytelling, and the safety of the learning environment. Participants’ intention to apply their learning indicated they had gained general awareness of bias and settings where it might influence their work. Conclusions. In an effort to foster a better working and learning environment for those who are underrepresented in the health professions, training was provide that may not have met the expectations of all participants. At the same time, participants who identified as White clearly increased their awareness of bias. Therefore, it is recommended to move away from one-size-fits-all unconscious bias training and develop a robust training continuum to provide ongoing advancement for diverse audiences

Promoting Healthy Behavior from the Pulpit: Clergy Share Their Perspectives on Effective Health Communication in the African American Church

African Americans continue to suffer disproportionately from health disparities when compared to other ethnicities (ACS 2010; CDC 2007). Research indicates that the church and the pastor in the African American community could be enlisted to increase effectiveness of health programs (Campbell et al. in Health Edu Behav 34(6):864–880, 2007; DeHaven et al. in Am J Public Health 94(6):1030–1036, 2004). The objective of this study was to investigate African American pastors’ perceptions about health promotion in the church and how these perceptions could serve as a guide for improving health communication targeting African Americans. Semi-structured interviews with African American clergy revealed that pastors feel strongly about the intersection of health, religion and spirituality; they also believe that discussing health screening and other health issues more frequently from the pulpit and their own personal experiences will ultimately impact health behavior among congregants. This study suggests that African American clergy see themselves as health promoters in the church and believe this communication (i.e., pastor-endorsed health information materials) will impact health behavior among underserved and minority populations

Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study.

BackgroundAt-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya.MethodsWe conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources.ResultsMost providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before-possibly-learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier.DiscussionWhile overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges

Infant HIV testing at birth using point-of-care and conventional HIV DNA PCR: an implementation feasibility pilot study in Kenya

Abstract Background Infant HIV diagnosis by HIV DNA polymerase chain reaction (PCR) testing at the standard 6 weeks of age is often late to mitigate the mortality peak that occurs in HIV positive infants’ first 2–3 months of life. Kenya recently revised their early infant diagnosis (EID) guidelines to include HIV DNA PCR testing at birth (pilot only), 6 weeks, 6 months, and 12 months postnatal and a final 18-month antibody test. The World Health Organization (WHO) approved point-of-care (POC) diagnostic platforms for infant HIV testing in resource-limited countries that could simplify logistics and expedite infant diagnosis. Sustainable scale-up and optimal utility in Kenya and other high-prevalence countries depend on robust implementation studies in diverse clinical settings. Methods We will pilot the implementation of birth testing by HIV DNA PCR, as well as two POC testing systems (Xpert HIV-1 Qual [Xpert] and Alere q HIV-1/2 Detect [Alere q]), on specimens collected from Kenyan infants at birth (0 to 2 weeks) and 6 weeks (4 to < 24 weeks) postnatal. The formative phase will inform optimal implementation of birth testing and two POC testing technologies. Qualitative interviews with stakeholders (providers, parents of HIV-exposed infants, and community members) will assess attitudes, barriers, and recommendations to optimize implementation at their respective sites. A non-blinded pilot study at four Kenyan hospitals (n = 2 Xpert, n = 2 Alere q platforms) will evaluate infant HIV POC testing compared with standard of care HIV DNA PCR testing in both the birth and 6-week windows. Objectives of the pilot are to assess uptake, efficiency, quality, implementation variables, user experiences of birth testing with both POC testing systems or with HIV DNA PCR, and costs. Discussion This study will generate data on the clinical impact and feasibility of adding HIV testing at birth utilizing POC and traditional PCR HIV testing strategies in resource-limited settings. Data from this pilot will inform the optimal implementation of Kenya’s birth testing guidelines and of POC testing systems for the improvement of EID outcomes. Trial registration ClinicalTrials.gov, NCT03435887. Registered 26 February 2018

Implementation planning for community-based point-of-care HIV testing for infants: Recommendations from community leaders in Kenya.

BackgroundEarly infant diagnosis (EID) establishes the presence of HIV infection in HIV-exposed infants and children younger than 18 months of age. EID services are hospital-based, and thus fail to capture HIV-exposed infants who are not brought to the hospital for care. Point-of-care (POC) diagnostic systems deployed in the community could increase the proportion tested and linked to treatment, but little feasibility and acceptability data is available.MethodsSemi-structured interviews (n = 74) were conducted by a Kenyan team with community members (Community Health Workers/Volunteers [CHW/CHV], Traditional Birth Attendants [TBAs], community leaders) and parents of HIV-exposed infants at four study sites in Kenya to elicit feedback on the acceptability and feasibility of community-based POC HIV testing.ResultsParticipants described existing community health resources that could be leveraged to support integration of community-based POC HIV testing; however, the added demand placed on CHW/CHV could pose a challenge. Participants indicated that other potential barriers (concerns about confidentiality, disclosure, and HIV stigma) could be overcome with strong engagement from trusted community leaders and health providers, community sensitization, and strategic location and timing of testing. These steps were seen to improve acceptability and maximize the recognized benefits (rapid results, improved reach) of community-based testing.ConclusionCommunity members felt that with strategic planning and engagement, community-based POC HIV testing could be a feasible and acceptable strategy to overcome the existing barriers of hospital-based EID

&apos;&apos;Positive Examples&apos;&apos;: A Bottom-Up Approach to Identifying Best Practices in HIV Care and Treatment Based on the Experiences of Peer Educators

Abstract Literature describing the roles and activities of peers working in HIV care is limited. Evaluations of the impact of peer-based behavior-change interventions reveal mixed results, due in part to varied program aims, structure, evaluation mechanisms, and training. Peers themselves are important resources to address these concerns and lay the groundwork for developing improved programs and evaluation strategies. This qualitative article describes peer support in HIV care and treatment from the perspective of 23 HIV-positive peers across the United States. Peers reported that peer characteristics (HIV-status, common experiences, and self-care) enable them to engage clients. Peers also required flexibility to respond to client needs, and their activities spanned four types of social support: informational, emotional, instrumental, and affiliational. We recommend peer programs and evaluations accommodate the broad scope of peer work by acknowledging the need for flexibility and activities that are not always directly related to clients&apos; HIV care and treatment