Search

Community-Based Participatory Research partnerships typically do not include adolescents as full community partners. However, partnering with adolescents can enhance the success and sustainability of adolescent health interventions. We partnered with adolescents to address health disparities in a low-income urban community. In partnering with youth, it is important to consider their developmental stage and needs to better engage and sustain their involvement. We also learned the value of a Youth Development framework and intentionally structuring a youth-friendly Community-Based Participatory Research environment. Finally, we will raise some ethical responsibilities to consider when working with youth partners.

One in five people living with HIV are unaware of their status; they account for an estimated 51% of new infections. HIV transmission can be reduced through a “Test and Treat” strategy, which can decrease both viral load and risk behaviors. However, linkage of newly diagnosed HIV positive persons to care has proved challenging. We report quantitative and qualitative data on linkage to care from HIV testing sites that partnered with the New York City Department of Health and Mental Hygiene (DOHMH) to implement “The Bronx Knows”, (TBK) an initiative that tested 607,570 residents over 3 years. During TBK, partner agencies reported the aggregate number of HIV tests conducted, the number of confirmed positives (overall and new), and the number of confirmed positives linked to medical care. We conducted qualitative interviews with directors of 24/30 TBK HIV testing agencies to identify linkage barriers and selected 9 for case studies. Barriers to linkage fell into 3 domains: (1) health care system factors (long wait for provider appointments; requirement of a positive confirmatory test before scheduling an appointment; system navigation; disrespectful to patients); (2) social factors (HIV stigma); and (3) characteristics of risk populations (e.g., mental illness, homelessness, substance use, immigrant). Best practices for linkage included networking among community organizations, individualized care plans, team approach, comprehensive and coordinated care services, and patient peer navigation. Research and public health implications are discussed.

Many of the individuals most at risk for HIV infection (i.e., minority populations, women, adolescents) are also the most marginalized by our health care system. Lacking primary care providers, they rely on the Emergency Department (ED) for their health care needs and education. In this prospective randomized controlled trial, we compared the educational effectiveness of a 15-minute posttest counseling video with the normal practice of a session with an HIV counselor. The study population was composed of ambulatory patients recruited for rapid HIV testing in the ED.The RAs (research assistants) recruited a convenience sample of stable patients presenting to the walk-in section of an inner-city adult ED for rapid HIV testing. Eligible patients for this study included patients who consented for the rapid HIV test and completed measures on condom intention and condom use self-efficacy. Before receiving their results, participants who consented to be in this study were randomized to either a 15-minute HIV posttest educational video available in English/Spanish or to a posttest educational session with an HIV counselor. Afterwards, both groups completed an assessment tool concerning HIV prevention and transmission.Of the 128 participants, 61 and 67 patients were randomized to the video and counselor groups, respectively. The groups were similar with respect to gender, ethnicity and experience with prior HIV testing. Mean knowledge scores were higher in the video group (76.20% vs. 69.3%; 90% CI for the difference, 2.8, 11.2). As the lower bound of the CI for the difference was higher than the lower equivalence boundary (-5%), we infer that the video was at least as effective as the counselor educational session.The use of an educational counseling video is a valid alternative for providing posttest education and prevention information during the waiting period associated with the 20-minute HIV rapid test. Without disruption in clinical flow, both testing and education can be accomplished in a meaningful way in a busy ED.

Objectives.Poor children's reliance on emergency facilities is one factor implicated in the rise of morbidity attributed to asthma. Although studies have examined doctor-patient communication during routine pediatric visits, little data are available about communication during emergency care.This st

Numerous educational interventions have been developed and tested to improve management of childhood asthma. Most programs assume that knowledge about asthma is related to initiating and/or maintaining recommended management behaviors. Although this assumption is widely accepted, some available evidence casts doubt upon its validity. We investigated the relationship between asthma management behaviors and (1) knowledge about asthma, (2) behavioral adjustment, (3) anxiety, and (4) health locus of control. Data were collected on 91 children 7 to 12 years of age with moderately severe asthma. After adjusting for covariates, reported asthma management behavior was significantly related only to knowledge about asthma (p less than .05). The relationship between knowledge and behavior is nonlinear: accurate knowledge is related to engaging in more of the recommended behaviors, but only up to a moderate level of knowledge. Also, the relationship between knowledge and asthma management behavior was especially strong for children who scored lower on behavioral adjustment. These results suggest that children's knowledge about asthma can influence behavior, but only under certain conditions. Educational interventions for children whose knowledge is already adequate may not increase adherence to recommended practices.