Psychosocial beliefs of health providers' intention and behavior of offering HIV testing and counseling services: Estimating their relevance for intervention

BackgroundDiagnosis of people with HIV is vital in achieving the 95-95-95 global targets. The proportion of people with HIV who know they have HIV in Sudan is low. Promoting engagement of healthcare providers (HCPs) in offering HIV Testing and Counseling (HTC) services would improve the percentage of diagnosed people with HIV in the country. This study aims to assess the psychosocial beliefs associated with HCPs' intention and behavior to offer HTC services and their relevance for intervention. MethodsThis institutional cross-sectional study was conducted in Kassala State, from July 2019 to February 2020, among 438 healthcare providers from public health facilities. A self-administered questionnaire was used to assess behavior and intention to offer HTC services and related behavioral, normative, and control beliefs. Data were analyzed using R software. Confidence Interval Based Estimation of Relevance (CIBER) was used to estimate the relevance of the beliefs to interventions. ResultsThe CIBER analysis showed that the belief "It causes many worries for patients if I offer or counsel them about HIV test" was negatively associated with HCPs' intention and behavior to offer HTC services and a highly relevant belief for intervention. The belief "My manager thinks I should offer or counsel patients about HIV test" was positively associated with the behavior and intention to offer HTC services and was a relatively highly relevant belief. The control belief "Patients are at low risk of HIV and do not need offering or counseling about HIV test" was negatively associated with HCPs' intention and behavior and was relevant for intervention. The control belief "If I offered or counseled patients about HIV test, I would spend more time with them" was negatively associated with the intention and behavior of HCPs toward HTC services, with high relevance to target with intervention. The belief "My colleagues think I should offer or counsel patients about HIV test" was weakly associated with behavior and intention, and it is a low relevant belief for intervention. ConclusionDifferent psychosocial beliefs among healthcare providers can influence their intention and behavior to offer HTC services to patients. More relevant beliefs are required to be targeted with interventions to promote the intention and behavior of providing HTC services among health care providers

The association between stressful life events and breast cancer risk: a meta-analysis

The association between stressful life events and breast cancer risk: a meta-analysis. Duijts SF, Zeegers MP, Borne BV. Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. [email protected] Breast cancer is the most prevalent cancer in women in Western societies. Studies examining the relationship between stressful life events and breast cancer risk have produced conflicting results. The purpose of this meta-analysis was to identify studies on this relationship, between 1966 and December 2002, to summarize and quantify the association and to explain the inconsistency in previous results. Summary odds ratios and standard errors were calculated, using random effect meta-regression analyses, for the following categories: stressful life events, death of spouse, death of relative or friend, personal health difficulties, nonpersonal health difficulties, change in marital status, change in financial status and change in environmental status. The presence of publication bias has been explored, and sensitivity analyses were performed to identify heterogeneity, using calculation of the percentage of variability due to heterogeneity, meta-regression analyses and stratification. Only the categories stressful life events (OR = 1.77, 95% CI 1.31-2.40), death of spouse (OR = 1.37, 95% CI 1.10-1.71) and death of relative or friend (OR = 1.35, 95% CI 1.09-1.68) showed a statistically significant effect. Publication bias was identified in both stressful life events (p = 0.00) and death of relative or friend (p = 0.02). Sensitivity analyses resulted in the identification of heterogeneity in all categories, except death of spouse. The results of this meta-analysis do not support an overall association between stressful life events and breast cancer risk. Only a modest association could be identified between death of spouse and breast cancer risk. Copyright 2003 Wiley-Liss, Inc

Anxiety, Depression and Resilience among War-Affected and Non-War- Affected Sudanese Female University Students: A Comparative Study

Objective: To investigate and compare mental health status between war-affected Darfuri and non-war-affected&nbsp; Omdurmani&nbsp; undergraduate&nbsp; students&nbsp; at&nbsp; Ahfad&nbsp; University&nbsp; for&nbsp; Women&nbsp; in&nbsp; Omdurman&nbsp; city, Sudan. Method:&nbsp; A&nbsp; cross-sectional&nbsp; study&nbsp; was&nbsp; used&nbsp; to&nbsp; assess&nbsp; and&nbsp; compare&nbsp; the&nbsp; anxiety,&nbsp; depression&nbsp; (HSCL-25) and resilience scores (Resilience Scale) and related demographic variables for 116 Darfuri and 299 Omdurmani students. Results: Overall&nbsp; anxiety,&nbsp; depression&nbsp; and&nbsp; resilience&nbsp; scores&nbsp; varied&nbsp; minimally&nbsp; between&nbsp; Darfuri&nbsp; and Omdurmani&nbsp; students.&nbsp; Depression&nbsp; scores&nbsp; were&nbsp; negatively&nbsp; related&nbsp; with&nbsp; resilience&nbsp; scores,&nbsp; but&nbsp; not&nbsp; with anxiety&nbsp; scores.&nbsp; Younger&nbsp; participants&nbsp; (15-20&nbsp; years)&nbsp; and&nbsp; those&nbsp; who&nbsp; had&nbsp; a&nbsp; parent&nbsp; deceased&nbsp; were&nbsp; more anxious, while those whose father was a blue-collar worker (indicating low socio-economic status) were more depressed, but also more resilient. Furthermore, participants whose tuition fees were paid by their parents (indicating a higher socio-economic status) scored lower on resilience. Conclusion: This study provides evidence of considerably high anxiety and depression scores, and moderate resilience levels amongst the sample. The results are discussed with a view of assistance in the development of a comprehensive multidimensional psychosocial counselling intervention.</p

Psychosocial beliefs related to intention to use HIV testing and counselling services among suspected tuberculosis patients in Kassala state, Sudan

BackgroundThere is limited information about the psychosocial sub-determinants regarding the use of HIV Testing and Counselling (HTC) services among suspected Tuberculosis (TB) patients in Sudan. This study aimed to assess the association between psychosocial beliefs and the intention to use HTC services and to establish the relevance of these beliefs for developing behaviour change interventions among suspected TB patients.MethodsSuspected TB patients (N=383) from four separate TB facilities completed a cross-sectional questionnaire which was based on the Reasoned Action Approach theory. Eligibility criteria included attending Tuberculosis Management Units in Kassala State as suspected TB patients and aged 18-64years. A Confidence Interval Based Estimation of Relevance (CIBER) analysis approach was employed to investigate the association of the beliefs with the intention to use HTC services and to establish their relevance to be targeted in behaviour change interventions.ResultsThe CIBER results showed the beliefs included in the study accounted for 59 to 70% of the variance in intention to use HTC services. The belief "My friends think I have to use HTC services" was positively associated with the intent to use HTC, and it is highly relevant for intervention development. The belief "I would fear to be stigmatized if I get a HIV positive result" was negatively related to the intention to use HTC services and was considered a highly relevant belief. The belief "If I use HTC services, health care providers will keep my HIV test result confidential" was strongly associated with the intention to use HTC services. However, the relevance of this belief as a target for future interventions development was relatively low. Past experience with HTC services was weakly associated with the intention to use HTC services.ConclusionThe intention to use HTC was a function of psychosocial beliefs. The beliefs investigated varied in their relevance for interventions designed to encourage the use of HTC services. Interventions to promote intention to use HIV testing and counselling services should address the most relevant beliefs (sub-determinants). Further study is needed to establish the relevance of sub-determinants of the intention to use HTC services for interventions development

Perceptions of Sudanese women of reproductive age towards HIV/AIDS and services for Prevention of Mother-to-Child Transmission of HIV

Access to antenatal HIV testing during pregnancy and the level of uptake of services for Prevention of Mother-to-Child Transmission (PMTCT) in Sudan are very low. This study aimed to obtain insights into the perceptions of Sudanese pregnant women toward HIV/AIDS and the use of PMTCT services. Methods: Ten focus group discussions (FGDs) with women of reproductive age were conducted at community settings in Khartoum (N = 121). Recruitment eligibility included living near or around a PMTCT site and being in the age range of 18-40 years. Out of 121 women who participated, 72 (61 %) were pregnant. Predefined themes were addressed in the theory-based interview scheme, which was derived from multiple socio-cognitive theories-i.e., the Extended Parallel Process Model, the Reasoned Action Approach and the socio-psychological view on stigma. Emerging themes were incorporated during data analysis. Results: Few women knew about the Mother to child transmission (MTCT) of HIV. No one indicated that MTCT might occur during labor. Most women believed that HIV/AIDS is a serious and fatal condition for them and also for their children. They believed they were susceptible to HIV/AIDS as a result of cesarean section, contaminated items (blood and sharp items) and husband infidelity. The usefulness and advantages of HIV testing were questioned; for some women it was perceived as an additional burden of anxiety and worry. Doctors were the most influential with regard to acceptance of HIV testing. The speed of the testing process and confidentiality were mentioned by some women as key factors affecting willingness to undergo HIV testing at a health facility during pregnancy. Conclusion: The study reveals that most of the women felt susceptible to HIV infection with perceived high severity; however, this perception has not translated into positive attitudes toward the importance of HIV testing during pregnancy. Because of anticipated stigma, women are not likely to disclose their HIV status. Further research should focus on gaining a more in-depth understanding of the psycho-social determinants and processes underlying the factors identified above. In addition, the adequate implementation of Provider Initiated Testing and Counseling (PITC) should be critically assessed in future research about PMTCT in Sudan

Predictors of organ donation registration among Dutch adolescents

BACKGROUND: In 1998, a new organ donor registration scheme was implemented in the Netherlands in order to increase the number of potential donors and to facilitate decisions and procedures concerning organ donation. However, registration rate and registration choices failed to meet the expectations. METHODS: A cross-sectional survey among a random sample of 1,731 Dutch adolescents of 18 and 19 years was conducted to study potential determinants of organ donor registration choices. RESULTS: Almost one fifth of the adolescents indicated that they did not return their organ donation registration form. Among subjects who registered, 57% were willing to donate their organs or tissues posthumously. More positive social influences, fewer negative outcome beliefs, and a low level of organ donation anxiety were significant predictors of returning a completed registration form and registration as an organ donor. In addition, religion was a significant predictor of returning a completed registration form, and positive outcome beliefs contributed to the prediction of registration as an organ donor. CONCLUSIONS: The results give clear suggestions for tailoring organ donation registration interventions to specific characteristics, beliefs, and misconceptions of adolescents. The results also suggest that it is important to encourage adolescents to discuss issues related to organ donation with their parents and friends in order to increase donor registration

Prospective evaluation of psychosocial adaptation to stoma surgery: the role of self-efficacy.

Self-efficacy, one's expectations regarding the ability to perform some specific task, was studied prospectively in the adaptation process of stoma patients. One week after surgery, stoma-related self-efficacy was assessed in 59 patients (26 cancer patients and 33 patients with benign diseases) who had undergone intestinal stoma surgery. Twenty-nine items concerning self-efficacy were formulated. Factor analysis with oblique rotation resulted in two factors: a social functioning-related self-efficacy factor and a stoma care-related self-efficacy factor. Psychosocial adjustment was assessed by means of the Psychosocial Adjustment to Illness Scale (PAIS-SR) at 4 and 12 months after surgery. The PAIS-SR renders one global adjustment score and (in this study) five subscores for adjustment to specific life domains: vocational environment, domestic environment, sexual relationship, social environment, and psychological distress. In a multiple regression analysis, the relevance of self-efficacy for later adjustment was determined after partialing out the effects of relevant sociodemographic and medical factors. Strong evidence was found for the important role of self-efficacy in the process of adapting to a stoma; stronger feelings of self-efficacy shortly after the operation predicted fewer psychosocial problems in the course of the first postoperative year. Stoma care-related self-efficacy appears especially important in the first phase after surgery. Social functioning-related self-efficacy explains significant proportions of the variances in PAIS-SR total score and PAIS-SR subscores, in both the short (4 months after surgery) and long runs (12 months after surgery). If patients expect to be able to take care of their stoma, their postoperative adjustment is relatively good. By strengthening patients' self-efficacy, this adaptation process may be accelerated, and the psychological and social burden can be lightened. (aut.ref.

Noncompliance with ocular hypotensive treatment in patients with glaucoma of ocular hypertension

OBJECTIVE: To summarize the available scientific evidence to support clinical decisions on how to deal with noncompliance in glaucoma patients. CLINICAL RELEVANCE: Insufficient reduction of intraocular pressure and progression of visual field (VF) loss in glaucoma patients due to noncompliance with topical treatment may result in unnecessary therapy, with additional risks and costs. METHODS/LITERATURE REVIEWED: We conducted a literature search in the databases MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane and reference lists. Thirty-four articles describing 29 original quantitative studies, in English, German, French, or Dutch, were included. Studies on noncompliance in drug trials were excluded. Two investigators independently selected the articles and abstracted their content, before negotiating their inclusion or exclusion. RESULTS: The proportions of patients who deviate from their prescribed medication regimen ranged from 5% to 80%. The impact of noncompliance on clinical outcome has not yet been established. There are no determinants sensitive and specific enough to identify potential noncompliers accurately. Patient knowledge and dose frequency can be used as starting points to improve compliance. A combination of patient education and prevention of forgetting doses seems to be successful in enhancing patient compliance. CONCLUSION: Noncompliance with hypotensive treatment is common among glaucoma patients. However, there is no strong evidence supporting a relation between noncompliance and progression of VF loss. Only a few guidelines for clinicians can be derived from the currently available literature. Future research should be guided by clinically relevant question