College of Nursing and Health Science

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Self-care behaviors and activities for managing HIV-related anxiety
(Lippincott, Williams & Wilkins, 2011-08-11) Kemppainen, Jeanne; Wantland, Dean; Voss, Joachim; Nicholas, Patrice; Kirksey, Kenn; Corless, Inge; willard, suzanne; Holzemer, William; Robinson, Linda; Hamilton, Mary Jane; Sefcik, Elizabeth; Sanzero Eller, Lucille; Huang, Emily; Arudo, John; Moezzi, Shahnaz; Rivero-Mendez, Marta; Rosa, Maria; Human, Sarie; Cuca, Yvette; Lindgren, Terri; Portillo, Carmen J; Maryland, Mary
The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.
A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH)
(BMC, 2012-03-13) Webel, Allison; Phillips, J. Craig; Dawson Rose, Carol; Holzemer, William; Chen, Wei-Ti; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Nokes, Kathleen; Kemppainen, Jeanne; Sefcik, Elizabeth; Brion, John; Eller, Lucille; Iipinge, Scholastika; Kirksey, Kenn; Wantland, Dean; Chaiphibalsarisdi, Puangtip; Johnson, Mallory O.; Portillo, Carmen; Corless, Inge; Voss, Joachim; Salata, Robert; Webel, Allison; Phillips, J. Craig; Dawson Rose, Carol; Holzemer, William; Chen, Wei-Ti; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Nokes, Kathleen; Kemppainen, Jeanne; Sefcik, Elizabeth; Brion, John; Eller, Lucille; Iipinge, Scholastika; Kirksey, Kenn; Wantland, Dean; Chaiphibalsarisdi, Puangtip; Johnson, Mallory O.; Portillo, Carmen; Corless, Inge; Voss, Joachim; Salata, Robert
Background Social capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS. Methods We recruited PLWH at 16 sites from five countries including Canada, China, Namibia, Thailand, and the United States. Participants (n = 1,963) completed a cross-sectional survey and data were collected between August, 2009 and December, 2010. Data analyses included descriptive statistics, factor analysis, and correlational analysis. Results Participant's mean age was 45.2 years, most (69%) identified as male, African American/Black (39.9%), and unemployed (69.5%). Total mean social capital was 2.68 points, a higher than average total social capital score. Moderate correlations were observed between self-reported physical (r = 0.25) and psychological condition (r = 0.36), social support (r = 0.31), and total social capital. No relationships between mental health factors, including substance use, and social capital were detected. Conclusions This is the first report to describe levels of total social capital in an international sample of PLWH and to describe its relationship to self-reported health in this population.
Mediators of antiretroviral adherence: A multisite international study
(Taylor and Franics Online, 2013-03) Corless, Inge; Guarino, Alessio; Nicholas, Patrice; Tyer-Viola, Lynda; Kirksey, Kenn; Brion, John; Dawson Rose, Carol; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Kemppainen, Jeanne; Nokes, Kathleen; Sefcik, Elizabeth; Voss, Joachim; Wantland, dean; Johnson, Mallory O.; Phillips, J. Craig; Webel, A.; Iipinge, Scholastika Ndatinda; Portillo, Carmen; Chen, Wei-ti; Maryland, M.; Hamilton, M.J.; Reid, P.; Hickey, D.; Holzemer, William; Sullivan, K.; Corless, Inge; Guarino, Alessio; Nicholas, Patrice; Tyer-Viola, Lynda; Kirksey, Kenn; Brion, John; Dawson Rose, Carol; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Kemppainen, Jeanne; Nokes, Kathleen; Sefcik, Elizabeth; Voss, Joachim; Wantland, dean; Johnson, Mallory O.; Phillips, J. Craig; Webel, A.; Iipinge, Scholastika Ndatinda; Portillo, Carmen; Chen, Wei-ti; Maryland, M.; Hamilton, M.J.; Reid, P.; Hickey, D.; Holzemer, William; Sullivan, K.
The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.
Use of a brief version of the self-compassion inventory with an international sample of people with HIV/AIDS
(Taylor and Francis Online, 2013-03-25) Kemppainen, Jeanne; Brion, John; Leary, Mark; wantland, dean; Sullivan, K; Nokes, Kathleen; Bain, Catherine A; chaiphibalsarisdi, puangtip; Chen, Wei-ti; Holzemer, William; Sanzero Eller, Lucille; Iipinge, Scholastika; Johnson, Mallory O; Portillo, Carmen; Voss, Joachim; Tyer-Viola, Lynda; Corless, Inge; Nicholas, Patrice; Dawson Rose, Carol; Phillips, J Craig; Sefcik, Elizabeth; Rivero-Mendez, Marta; Kirksey, Kenn; Kemppainen, Jeanne; Brion, John; Leary, Mark; wantland, dean; Sullivan, K; Nokes, Kathleen; Bain, Catherine A; chaiphibalsarisdi, puangtip; Chen, Wei-ti; Holzemer, William; Sanzero Eller, Lucille; Iipinge, Scholastika; Johnson, Mallory O; Portillo, Carmen; Voss, Joachim; Tyer-Viola, Lynda; Corless, Inge; Nicholas, Patrice; Dawson Rose, Carol; Phillips, J Craig; Sefcik, Elizabeth; Rivero-Mendez, Marta; Kirksey, Kenn
The objective of this study was to extend the psychometric evaluation of a brief version of the Self-Compassion Scale (SCS). A secondary analysis of data from an international sample of 1967 English-speaking persons living with HIV disease was used to examine the factor structure, and reliability of the 12-item Brief Version Self-Compassion Inventory (BVSCI). A Maximum Likelihood factor analysis and Oblimin with Kaiser Normalization confirmed a two-factor solution, accounting for 42.58% of the variance. The BVSCI supported acceptable internal consistencies, with 0.714 for the total scale and 0.822 for Factor I and 0.774 for Factor II. Factor I (lower self-compassion) demonstrated strongly positive correlations with measures of anxiety and depression, while Factor II (high self-compassion) was inversely correlated with the measures. No significant differences were found in the BVSCI scores for gender, age, or having children. Levels of self-compassion were significantly higher in persons with HIV disease and other physical and psychological health conditions. The scale shows promise for the assessment of self-compassion in persons with HIV without taxing participants, and may prove essential in investigating future research aimed at examining correlates of self-compassion, as well as providing data for tailoring self-compassion interventions for persons with HIV.
Effect of aerobic exercise on mitochondrial DNA and aging
(Science Direct, 2013-05-16) Eluamai, Anusha; Brooks, Kelly
The aging process occurs at different rates among different tissues. The complication of the definition of aging is due to the occurrence of various diseases that modify body functions and tissue structure. Advances in medicine and public health have considerably increased life expectancy over the past 200 years. An enormous effort has recently been expended to understand how the aging process is regulated at the molecular and cellular levels with hopes to find a way to extend maximal life span. There are several determinants of life span, but one common thread that has emerged in a variety of species from yeast to rodents is regulation of life span by mitochondria. Mitochondria decay that occurs with age cannot be counteracted unless physical activity is enhanced. As the frontiers of understanding the senescence and life span increases, the countermeasures for reducing aging senescence has brought to light the effectiveness of enhanced physical activities in aging individuals. Regular aerobic exercise may increase healthy life expectance and prolong life through beneficial effects at the mitochondrial level.
Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America
(BMC, 2013-08-08) Phillips, J. Craig; Webel, Allison; Dawson Rose, Carol; Corless, Inge; Sullivan, Kathleen M; Voss, Joachim; wantland, dean; Nokes, Kathleen; Brion, John; Chen, Wei-ti; Iipinge, Scholastika; Sanzero Eller, Lucille; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Johnson, Mallory O.; Maryland, Mary; Kemppainen, Jeanne; Portillo, Carmen; chaiphibalsarisdi, puangtip; Kirksey, Kenn; Sefcik, Elizabeth; Reid, Paula; Cuca, Yvette; Huang, Emily; Holzemer, William; Phillips, J. Craig; Webel, Allison; Dawson Rose, Carol; Corless, Inge; Sullivan, Kathleen M; Voss, Joachim; wantland, dean; Nokes, Kathleen; Brion, John; Chen, Wei-ti; Iipinge, Scholastika; Sanzero Eller, Lucille; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Johnson, Mallory O.; Maryland, Mary; Kemppainen, Jeanne; Portillo, Carmen; chaiphibalsarisdi, puangtip; Kirksey, Kenn; Sefcik, Elizabeth; Reid, Paula; Cuca, Yvette; Huang, Emily; Holzemer, William
Background Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations.
Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV
(Taylor and Francis Online, 2013-10-04) Sanzero Eller, Lucille; Rivero-Mendez, Marta; Voss, Joachim; Chen, Wei-ti; chaiphibalsarisdi, puangtip; Iipinge, S.; Johnson, Mallory O.; Portillo, Carmen; Sullivan, K.; Tyer-Viola, Lynda; Kemppainen, Jeanne; Dawson Rose, Carol; Sefcik, Elizabeth; Nokes, Kathleen; Phillips, J. Craig; Nicholas, P.K.; Holzemer, William; Webel, A.R.; Brion, J.M.; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Voss, Joachim; Chen, Wei-ti; chaiphibalsarisdi, puangtip; Iipinge, S.; Johnson, Mallory O.; Portillo, Carmen; Sullivan, K.; Tyer-Viola, Lynda; Kemppainen, Jeanne; Dawson Rose, Carol; Sefcik, Elizabeth; Nokes, Kathleen; Phillips, J. Craig; Nicholas, P.K.; Holzemer, William; Webel, A.R.; Brion, J.M.
The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = −0.154), education (r = −0.106), work status (r = −0.132), income adequacy (r = −0.204, self-esteem (r = −0.617), HIV symptom self-efficacy (r = − 0.408), and self-kindness (r = − 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.
A multinational study of self-compassion and human immunodeficiency virus-related anxiety
(wILEY, 2013-12) Kemppainen, Jeanne; Johnson, M.O.; Phillips, J. Craig; Sullivan, Kathleen M; Corless, Inge; Reid, Paula; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Sefcik, Elizabeth; Chen, Wei-ti; Kirksey, Kenn; Voss, Joachim; Rivero-Mendez, Marta; Tyer-Viola, Lynda; Dawson Rose, Carol; Webel, Allison; Nokes, Kathleen; Portillo, Carmen; Holzemer, William; Sanzero Eller, Lucille; Nicholas, Patrice; Wantland, Dean; Brion, John; Beamon, E. R.; Kemppainen, Jeanne; Johnson, M.O.; Phillips, J. Craig; Sullivan, Kathleen M; Corless, Inge; Reid, Paula; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Sefcik, Elizabeth; Chen, Wei-ti; Kirksey, Kenn; Voss, Joachim; Rivero-Mendez, Marta; Tyer-Viola, Lynda; Dawson Rose, Carol; Webel, Allison; Nokes, Kathleen; Portillo, Carmen; Holzemer, William; Sanzero Eller, Lucille; Nicholas, Patrice; Wantland, Dean; Brion, John; Beamon, E. R.
Aim This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus (HIV)-related anxiety in a multinational population with HIV disease. Background Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety. Methods Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research (n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self-Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist. Findings Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males (P = 0.000) and females (P = 0.000). Levels of self-compassion and anxiety varied across countries. Conclusions Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms.
Engagement with care, substance use, and adherence to therapy in HIV/AIDS
(Hindawi, 2014-04-03) Nicholas, Patrice; Willard, Suzanne; Thompson, Clinton J.; Dawson Rose, Carol; Corless, Inge; Wantland, Dean; Sefcik, Elizabeth; Nokes, Kathleen; Kirksey, Kenn; Hamilton, Mary Jane; Holzemer, William; Portillo, Carmen; Rivero-Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Sanzero Eller, Lucille; Stanton, Mark A.; Driscoll, MaryKate; Voss, Joachim; Moezzi, Shahnaz; Nicholas, Patrice; Willard, Suzanne; Thompson, Clinton J.; Dawson Rose, Carol; Corless, Inge; Wantland, Dean; Sefcik, Elizabeth; Nokes, Kathleen; Kirksey, Kenn; Hamilton, Mary Jane; Holzemer, William; Portillo, Carmen; Rivero-Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Sanzero Eller, Lucille; Stanton, Mark A.; Driscoll, MaryKate; Voss, Joachim; Moezzi, Shahnaz
Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial () that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.
A cross-sectional relationship between social capital, self-compassion, and perceived HIV symptoms
(Elsevier, 2015-02-04) Webel, Allison; wantland, dean; Dawson Rose, Carol; Kemppainen, Jeanne; Holzemer, William; Chen, Wei-ti; Johnson, Mallory O.; Nicholas, Patrice; Sanzero Eller, Lucille; chaiphibalsarisdi, puangtip; Sefcik, Elizabeth; Nokes, Kathleen; Corless, Inge; Tyer-Viola, Lynda; Kirksey, Kenn; Voss, Joachim; Sullivan, Kathy; Rivero-Mendez, Marta; Brion, John; Iipinge, Scholastika Ndatinda; Phillips, J. Craig; Portillo, Carmen
Context Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience. Objectives The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship. Methods We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience. Results Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms. Conclusion Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.
Waterpipe tobacco smoking impact on public health: Implications for policy
(2015-08-27) Martinasek, Mary; Gibson-Young, Linda; Davis, Janiece; McDermott, Robert
Given the increasing evidence of its negative health effects, including contributions to both infectious and chronic diseases, waterpipe tobacco smoking raises public health concerns beyond even those presented by traditional smoking. Identification of Clean Indoor Air Acts (CIAAs) from each of the 50 United States and District of Columbia were retrieved and examined for inclusion of regulatory measures where waterpipe tobacco smoking is concerned. Several instances of exemption to current CIAAs policies were identified. The cumulative policy lens is presented in this study. States vary in their inclusion of explicit wording regarding CIAAs to the point where waterpipe tobacco smoking, unlike traditional smoking products, is excluded from some legislation, thereby limiting authorities’ ability to carry out enforcement. Consistent, comprehensive, and unambiguous legislative language is necessary to prevent establishments where waterpipe tobacco smoking occurs from skirting legislation and other forms of regulatory control. Stricter laws are needed due to the increasing negative health impact on both the smoker and the bystander. Actions at both the federal and state levels may be needed to control health risks, particularly among youth and young adult populations.
Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory
(Wiley, 2016-09-21) Sullivan, Kathleen M; Dawson Rose, Carol; Phillips, J Craig; Holzemer, William; Webel, Allison; Nicholas, Patrice; Corless, Inge; Kirksey, Kenn; Eller, Lucille Sanzero; Voss, Joachim; Tyer-Viola, Lynda; Portillo, Carmen; Johnson, Mallory O; Brion, John; Sefcik, Elizabeth; Nokes, Kathleen; Reid, Paula; Rivero-Mendez, Marta; Chen, Wei-Ti; Sullivan, Kathleen M; Dawson Rose, Carol; Phillips, J Craig; Holzemer, William; Webel, Allison; Nicholas, Patrice; Corless, Inge; Kirksey, Kenn; Eller, Lucille Sanzero; Voss, Joachim; Tyer-Viola, Lynda; Portillo, Carmen; Johnson, Mallory O; Brion, John; Sefcik, Elizabeth; Nokes, Kathleen; Reid, Paula; Rivero-Mendez, Marta; Chen, Wei-Ti
Aim: Sexual risk behaviour was explored and described using Social Action Theory. Background: The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. Design: Cross-sectional survey. Methods: Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. Findings: Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. Conclusion: Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.
90-90-90-plus: Maintaining adherence to antiretroviral therapies
(Mary Ann Liebert, 2017-05-01) Corless, Inge; Hoyt, Alex; Tyer-Viola, Lynda; Sefcik, Elizabeth; Kemppainen, Jeanne; Holzemer, William; Sanzero Eller, Lucille; Nokes, Kathleen; Phillips, J. Craig; Dawson Rose, Carol; Rivero-Mendez, Marta; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Portillo, Carmen J.; Chen, Wei-Ti; Webel, Allison; Brion, John; Johnson, Mallory O.; Voss, Joachim; Hamilton, Mary Jane; Sullivan, Kathleen M.; Kirksey, Kenn; Nicholas, Patrice; Corless, Inge; Hoyt, Alex; Tyer-Viola, Lynda; Sefcik, Elizabeth; Kemppainen, Jeanne; Holzemer, William; Sanzero Eller, Lucille; Nokes, Kathleen; Phillips, J. Craig; Dawson Rose, Carol; Rivero-Mendez, Marta; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Portillo, Carmen J.; Chen, Wei-Ti; Webel, Allison; Brion, John; Johnson, Mallory O.; Voss, Joachim; Hamilton, Mary Jane; Sullivan, Kathleen M.; Kirksey, Kenn; Nicholas, Patrice
Medication adherence is the “Plus” in the global challenge to have 90% of HIV-infected individuals tested, 90% of those who are HIV positive treated, and 90% of those treated achieve an undetectable viral load. The latter indicates viral suppression, the goal for clinicians treating people living with HIV (PLWH). The comparative importance of different psychosocial scales in predicting the level of antiretroviral adherence, however, has been little studied. Using data from a cross-sectional study of medication adherence with an international convenience sample of 1811 PLWH, we categorized respondent medication adherence as None (0%), Low (1–60%), Moderate (61–94%), and High (95–100%) adherence based on self-report. The survey contained 13 psychosocial scales/indices, all of which were correlated with one another (p < 0.05 or less) and had differing degrees of association with the levels of adherence. Controlling for the influence of race, gender, education, and ability to pay for care, all scales/indices were associated with adherence, with the exception of Berger's perceived stigma scale. Using forward selection stepwise regression, we found that adherence self-efficacy, depression, stressful life events, and perceived stigma were significant predictors of medication adherence. Among the demographic variables entered into the model, nonwhite race was associated with double the odds of being in the None rather than in the High adherence category, suggesting these individuals may require additional support. In addition, asking about self-efficacy, depression, stigma, and stressful life events also will be beneficial in identifying patients requiring greater adherence support. This support is essential to medication adherence, the Plus to 90-90-90.
Occupational health nurses’ self-efficacy in implementing smoking cessation interventions for workers: a manufacturing company quality improvement project
(2018-08) Thornberry, Amy Janell; Thornberry, Amy Janell; Sefcik, Elizabeth; Peck, Jessica; Garcia, Theresa J.; Peck, Jessica; Garcia, Theresa; Garcia, Theresa
The purpose of this study was to improve the delivery and quality of care to smokers at work who are poorly motivated to quit and to explore the concepts of self-efficacy for enhancing this care process within a manufacturing company. This quality improvement (QI) project aimed to educate occupational health nurses (OHN’s) by providing them with theory-based training and incentives to recruit poorly motivated smokers. Nurses practiced their skills in worker health promotion recruitment and motivational interviewing (MI) with smokers who had previously declined smoking cessation counseling. As the project evolved, theory-based applications brought OHN’s and smokers together in a new paradigm resulting in positive changes for both the OHN’s self-efficacy and smokers’ stages of change toward quitting. Paired t-tests detected statistically significant difference in OHN’s pre-and post-intervention self-efficacy scores (t(4) = -4.46, p < .001); d = 2.92) and smokers’ pre-and post-intervention stage of change toward quitting scores (t(10) = -9.07, p < .001); d = 2.09) suggesting the education intervention and motivational interviewing intervention were extremely effective in increasing OHN self-efficacy and smokers’ stage of motivation to change. Results from this pilot project indicate smokers who are poorly motivated toward quitting can be successfully recruited and counseled using motivational interviewing techniques, while simultaneously improving OHN self-efficacy toward helping these patients. Secondary findings revealed success in an innovative recruitment method of flipping the nurse-patient relationship from nurses helping patients to patients helping nurses.
A quality improvement initiative to improve diabetes self-care education for Hispanic older adults using culturally-sensitive, age specific-approach
(2018-08) Babalola, Olubanke; Babalola, Olubanke; Sefcik, Elizabeth; Garcia, Theresa J.; Day, Cristi; Garcia, Theresa; Day, CristiGarcia, Theresa J.; Day, Cristi
Introduction: The underuse of culturally-sensitive, age-specific diabetes education for older-aged Hispanic people likely contributes to deficits in diabetes knowledge, self-management and glycemic control. This quality improvement initiative applied evidence-based, culturally-competent, age-specific education methods to improve processes and health outcomes in a primary care setting. Methodology: A one-group, pre-test/post-test design was used to conduct this project at a large community clinic in Texas. Hispanic adults > 60 years, with T2DM (n=12) received biweekly classes over 3 months, including healthy Hispanic foods, family involvement, a Spanish interpreter using earphone technology, and interactive, bilingual, large-print materials and tools. Paired samples t-tests were used to compare diabetes knowledge, self-management, and A1C levels, pre- and post-education. Results: There was a significant difference in pre- and post-education outcomes: knowledge (t(11)=-7.969, p=.000; d=2.32), self-management (t(11)= -7.930, p=.000; d= 2.43), and A1C levels (t(11)=6.434, p=.000; d=0.78). Conclusion: Culturally-competent, age-specific education can positively impact knowledge, self-management behaviors, and glycemic values in older-aged Hispanic people.
A vivar! A plant-based diabetes prevention pilot program for older Hispanics in South Texas
(2018-08) Niles, Patricia Soliz; Niles, Patricia Soliz; Bell, Eva; Day, Cristi; Garcia, Theresa J.; Day, Cristi; Garcia, Theresa; Garcia, Theresa
Purpose: A community-oriented culturally sensitive plant-based nutritional pilot program for older South Texas Hispanics was designed to determine if participation in a three-month plant-based diabetes prevention program would result in healthy dietary changes. Method: A pre-test post-test diabetes prevention initiative was designed to promote healthy nutrition and discover changes in dietary knowledge and behavior. Results: Statistically significant increased knowledge (t(21) = -3.43, p = .003) and self-reported consumption of plant-based foods (t(21) = -5.42, p = .000) was discovered existing surveys and project director designed questionnaires in a convenience sample of 22 older Hispanics who attended two adult recreational centers in Laredo, Texas. Conclusions and Implications for Practice: Collaborative health projects can be provided within community infrastructures that may positively impact the health of individuals by increasing knowledge and adopting lifestyle dietary changes. Further research is needed to explore gender variations and longitudinal outcomes.
Reducing nurse practitioner turnover in home-based primary care:a Department of Veterans Affairs quality improvement project
(2018-08) Hughes, Ashley Kate; Hughes, Ashley Kate; Keys, Yolanda; Peck, Jessica L; Garcia, Theresa J.; Peck, Jessica L; Garcia, Theresa; Garcia, Theresa
Objective: To identify factors in the Department of Veteran Affairs (VA) Home Based Primary Care (HBPC) program that may contribute to nurse practitioner (NP) retention and decrease provider gaps and access to primary care disparities for veterans. Background: For a Texas VA Medical Center, high and rapid HBPC NP turnover was identified and a program evaluation was conducted to explore factors associated with turnover. Methods: To determine factors with potential to decrease NP turnover, a program evaluation was conducted using the Anticipated Turnover Scale (ATS) and the Misener NP Job Satisfaction Scale (MNPJSS), administered to currently employed, non-supervisory NPs, who had been in HBPC for more than six months. Results: ATS responses reflected 57.1% of the participants intended to stay; however, mean responses to individual questions represented the group was equally divided on intent to leave. Of the 43 MNPJSS questions, 24 were answered as dissatisfied and 19 were answered as satisfied by the group. Conclusions: Recommendations resulting from this program evaluation may help retain NPs in HBPC, reduce organizational costs, and support optimal veteran outcomes.
A prospective quality improvement project using a mammography risk assessment tool to increase screening mammogram use with low-income Hispanic women
(2018-08) Walker-Smith, Tammy L.; Walker-Smith, Tammy L.; Baldwin, Sara; Murphy, Christina; Dyess, Susan; Murphey, Christina; Dyess, SusanMurphy, Christina; Dyess, Susan
Breast cancer is the second leading cause of cancer mortality among U.S. women. Hispanic women experience a lower 5-year survival rate of 79% compared to 91% among non-Hispanic White women. The purpose of this DNP project was to design an evidence-based quality improvement (QI) project to improve the screening mammogram completion rates by implementing concurrent educational and clinic referral tool systemic strategies in a primary care clinic. Medline, CINAHL, and the Cochrane Collection, databases were used to identify key studies between 2013-2018 that addressed the disparity of low-income Hispanic women, and evidence-based practice breast cancer risk assessments based on risk factors and current screening guidelines. The evidence-based tools used were the Breast Cancer Risk Assessment Tool and the National Health Interview Survey, available in English and Spanish. Once the tools triggered a nurse referral, health providers determined if a screening mammogram order was needed. This provided a systematic change process for early detection and improved screening mammogram rates for women between the ages of 50-74. The QI project findings addressed evidence-based interventions that improved screening mammogram rates 7.21% in a three-month period. The outcomes discussed in this report provide guidance for new policy considerations and clinical protocols.
Nurse practitioner-led telehealth to improve outpatient pediatric tracheostomy management in South Texas
(2018-08) Moreno, Laura; Moreno, Laura; Peck, Jessica L.; Garcia, Theresa J.; Keys, Yolanda; Garcia, Theresa; Keys, YolandaGarcia, Theresa J.; Keys, Yolanda
Pediatric tracheostomy patients are a medically complex population with increased incidence of emergency room (ER) use, hospital readmissions, tracheostomy-associated complications, and caregiver anxiety, especially the 30 days following discharge. The objective of this quality improvement (QI) initiative was to improve access to and quality of care for vulnerable, underserved populations by providing a Nurse Practitioner-led telehealth intervention. Method: This pilot feasibility study utilized a one-group, pre-test, post-test, quasi-experimental, retrospective cohort design in a free-standing pediatric hospital serving underserved populations using the Caregiver Knowledge Checklist, Care Transitions Measures Survey, Telehealth Satisfaction Survey, and Trach Care Behavior Scale. Results: Participants experienced no post-surgical tracheostomy complications or hospital readmissions with improved scores on all survey instruments, resulting in changed department clinical practice guidelines using telehealth. Discussion: Telehealth is effective in managing outpatient tracheostomy patients, supporting caregivers, and refining proficiency caring for tracheostomy-dependent children. Telehealth is accessible, affordable, and effective in improving outcomes.
Identifying migration flexibility and the environmental factors that influence variation in recruitment success in partially migratory Hawaiian fishes
(2019-05) Heim-Ballew, Heidi; Hogan, J. Derek; Portnoy, David; Pollack, Jennifer
Behavior flexibility during the larval stage influences differential mortality, recruitment, and population dynamics; recruitment is poorly understood, yet important for understanding population persistence. The purpose of this dissertation was to examine fishes for migration flexibility and to identify factors at different spatiotemporal scales that are influential to differential survival within and across populations. I found that four underexplored native freshwater fishes of Hawai‘i exhibited a larval migratory strategy, but many were flexible. One species (Sicyopterus stimpsoni) showed all individuals made a migration, and the others showed 25 – 40 % did not migrate. Next, I examined if migrant (S. stimpsoni) and flexible species (Awaous stamineus) showed lunar rhythmicity at hatching and settlement. Migrants of the flexible species showed more hatching around the full moon and settlement around the new moon, and residents showed the opposite pattern. The divergence in life-history timing appears to be a balance between ecological costs and benefits. Next, I examined the influence of variation in localized conditions on the ratio of migrant to resident contingents (A. stamineus) in adult populations. Residents were least represented when stream flow and nutrients were low; however, the abundance of a common invasive predator showed a negative relationship with resident abundance. Highly urbanized systems may impose such stressful conditions that resident recruitment is diminished, which underscores the importance of stream management to conserve vulnerable native species. Lastly, I examined the frequency of contingents (A. stamineus), larval duration, and growth rates across ENSO. The proportion of migrants was highest during La Niña, and resident proportions were highest during weak La Niña and strong El Niño; once El Niño became very strong, resident proportions decreased. Migrants had faster growth than residents across all growing stages. Migrant growth rates in the early larval stage were highest during El Niño, and pre-settlement growth was highest during La Niña. Resident growth was fastest during neutral conditions. The duration of the early fast-growing period was shortest during El Niño, and the larval duration was longer. These dissertation findings show the importance of evaluating multiple influential scales to understand life-history strategies of individuals, especially those that inhabit multiple ecotypes.

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