3 research outputs found
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AIDS-related stigmatisation in the healthcare setting: a study of primary healthcare centres that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria
Objective: To assess AIDS stigmatising attitudes and behaviours by prevention of mother-to-child transmission (PMTCT) service providers in primary healthcare centres in Lagos, Nigeria. Design: Cross-sectional survey. Setting: Thirty-eight primary healthcare centres in Lagos, Nigeria. Participants: One hundred and sixty-one PMTCT service providers. Outcome measures PMTCT service providers' discriminatory behaviours, opinions and stigmatising attitudes towards persons living with HIV/AIDS (PLWHAs), and nature of the work environment (HIV/AIDS-related policies and infection-control guidelines/supplies). Results: Reported AIDS-related stigmatisation was low: few respondents (4%) reported hearing coworkers talk badly about PLWHAs or observed provision of poor-quality care to PLWHAs (15%). Health workers were not worried about secondary AIDS stigmatisation due to their occupation (86%). Opinions about PLWHAs were generally supportive; providers strongly agreed that women living with HIV should be allowed to have babies if they wished (94%). PMTCT service providers knew that consent was needed prior to HIV testing (86%) and noted that they would get in trouble at work if they discriminated against PLWHAs (83%). A minority reported discriminatory attitudes and behaviours; 39% reported wearing double gloves and 41% used other special infection-control measures when providing services to PLWHAs. Discriminatory behaviours were correlated with negative opinions about PLWHAs (r=0.21, p<0.01), fear of HIV infection (r=0.16, p<0.05) and professional resistance (r=0.32, p<0.001). Those who underwent HIV training had less fear of contagion. Conclusions: This study documented generally low levels of reported AIDS-related stigmatisation by PMTCT service providers in primary healthcare centres in Lagos. Policies that reduce stigmatisation against PLWHA in the healthcare setting should be supported by the provision of basic resources for infection control. This may reassure healthcare workers of their safety, thus reducing their fear of contagion and professional resistance to care for individuals who are perceived to be at high risk of HIV.Fulbright Scholar program, a program of the United States Department of State, Bureau of Educational and Cultural AffairsOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
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Developing the Refugee Barriers to Mental Healthcare Questionnaire Utilizing A Modified Delphi Method
Background: Trauma experienced among former refugees is a prevalent public health concern. Despite the high prevalence of mental health disorders (30%-60%), little has been done to address mental health concerns among former refugees post resettlement in the U.S. Many U.S., resettlement agencies use the Refugee Health Screener-15 (RHS-15) and refer former refugee clients to community mental health providers. Despite receiving referrals, former refugees often do not use o mental health services. Some common barriers include cultural and religious beliefs, lack of transportation, and cost of care. Specific Aims: To better understand barriers to mental health care utilization among former refugees and develop tools to inform the development of solutions by organizations that serve this population, this dissertation applied a community-based participatory research process. Research activities were conducted in partnership with former refugees and the International Rescue Committee (IRC), in Tucson, AZ. Aim 1 was to conduct qualitative interviews with 10 former refugees and 5 refugee resettlement agency staff to understand mental health concerns, coping mechanisms, and barriers for accessing mental health services among former refugees living in Arizona, Nevada, Utah, and Minnesota. Aim 2 was to develop the Refugee Barriers to Mental Health Care Questionnaire (RBMHQ) based on findings from Aim 1, existing tools, and the current literature and to pilot test it with 3 refugee resettlement agency staff. Aim 3 was to develop a final version of the RBMHQ using a modified Delphi method comprised of two Rounds of feedback from 16 experts in the field of former refugee mental health.
Methods: Interview data from Aim 1 were transcribed verbatim, de-identified, and thematically analyzed using the framework approach. For Aim 2, each barrier reported during interviews was written as an item in a draft of the RBMHQ. The draft RBMHQ was piloted with a sample of individuals who are familiar with former refugee populations. Participants of the pilot study were asked about the questionnaire structure, formatting, and overall burden. Suggestions for improvement were incorporated into the RBMHQ and accompanying materials in preparation for the Delphi Rounds. For Aim 3, two rounds of Delphi ratings were collected. Participants were sent an email with instructions for the questionnaire review process and a REDCap link. The link redirected participants to REDCap where they completed a demographic survey, reviewed a draft of RBMHQ items and responded to open ended questions. Participants were asked to repeat the process for Delphi Round 2. Descriptive analyses were conducted using SAS 9.4 to generate frequencies, medians, and interquartile ranges (IQR) to illustrate the spread of participant rating of barrier items. Highly rated barrier items were re-written in first person at a 6th-grade reading level and reviewed by community advisory board (CAB) members. CAB members were asked to review the content, clarity, structure, and flow of questions. The RBMHQ was subsequently sent to 2 former refugees for final cognitive testing and approval.
Results: For Aim 1, qualitative interview data revealed many complex barriers experienced by former refugees when interacting with the U.S. mental healthcare system. Barriers reported included language proficiency, gender norms, discordant health beliefs, stigma, poor screening, referral practices at resettlement agencies, and cost of healthcare among other challenges. For Aim 2, participants made suggestions to improve clarity and readability. Feedback included comments about changing the language, switching question order to improve low and prompts to clarify participant response choices. For Aim 3, two rounds of Delphi testing resulted in a final version of the RBMHQ. The final version consisted of 23 item that were grouped into 5 categories: 1) stigma, health, and cultural beliefs 2) trust and confidentiality, 3) provider office logistics and attitudes 4) community support, and 5) cost.
Conclusion: This dissertation identified barriers faced by former refugees’ post-mental health referrals and developed a questionnaire that may be administered by resettlement organizations to assess the types of barriers encountered by former refugees. Data collected using the RBMHQ may inform community, organizational, and societal level interventions to address barriers to mental healthcare among the vulnerable population of former refugees living in the U.S.Dissertation not available (per author's request