Search

Chronically ill persons with a condition requiring self-care activities can benefit from learning from reliable internet sources. Orem’s theory of self-care was used to answer the question: Does increasing technical knowledge about reliable internet sites for health information increase self-care agency of low-income persons living with HIV/AIDS ( N = 100)? Self-care agency, as measured by the Self-As-Carer Inventory, increased but not significantly, after two educational interventions. We hoped to gain insight into the measurement of self-care agency in our African American and Hispanic population. The only significantly different basic conditioning factor was ethnicity in that non-Hispanic/Latinos scored higher on self-care agency than Hispanic/Latinos; the only significantly different subscale was the Judgment and Decisions Affecting Production of Self-care subscale. Self-care agency remained stable over the 1-week period, pointing to two possible conclusions: Scores accurately reflect self-care agency, and a more intensive, longer intervention may be needed to change self-care agency.

Little is known about how demographic, employment and meteorological factors impact physical activity. We conducted an analysis to explore these associations from participants (N = 447) from six cities in the United States and matched their activity data with abstracted local meteorological data from National Oceanic and Atmospheric Administration (NOAA) weather reports. Participants were purposively recruited in 3-month blocks, from December 2015 to October 2017, to reflect physical activity engagement across the seasons. We calculated total physical activity (minutes/week) based on 7-day physical activity recall. Mild correlations were observed between meteorological factors and correlated with lower physical activity. Participants were least active in autumn (Median = 220 min/week) and most active in spring (Median = 375 min/week). In addition to level of education and total hours of work, maximum temperature, relative humidity, heating degree day, precipitation and sunset time together explained 17.6% of variance in total physical activity. Programs assisting in employment for PLHIV and those that promote indoor physical activity during more strenuous seasons are needed. Additional research to better understand the selection, preferences, and impact of indoor environments on physical activity is warranted.

This research explored whether participating in a brief educational intervention using the National Library of Medicine video, Evaluating Health Information: A Tutorial From the National Library of Medicine, would increase electronic health literacy. A quasi-experimental longitudinal design was used in two randomly selected settings of a treatment program for low-income persons living with HIV/acquired immune deficiency syndrome (N = 100). Individuals in both intervention groups watched the video and completed an at-home assignment brought to the second session 1 week later; one group received an additional 15 minutes with an HIV nurse clinician who reinforced video content. Generalized linear models were used in order to account for the longitudinal nature of the data; a full model was fitted first that included age, gender, race, ethnicity, education, acquired immune deficiency syndrome diagnosis, time, group, and the interaction of time by intervention group with electronic health literacy as the dependent variable. Group means were not significantly different, and the overall group pattern were the same; the only significant variable was older age, which is consistent with the findings of other literature. Electronic health literacy can be increased by viewing a free video; making this video available in a variety of settings and encouraging clients to use the Internet as a source of health information may improve self-management strategies of persons living with chronic illnesses.

Background: People with HIV (PWH), who engage in regular physical activity, have improved fitness, muscular strength, body composition, health-related quality of life and mental health symptoms, but PWH have amongst the lowest physical activity levels of those with any chronic health condition. Furthermore, there is scant evidence examining these relationships in PWH in Africa. Aim: To address these critical gaps, this cross-sectional descriptive research study examined the relationships between demographic, HIV-related, anthropometric factors, neighbourhood walkability and physical activity, amongst PWH in Durban, South Africa. Setting: Respondents ( N = 100) were receiving primary healthcare in six eThekwini nurse-run municipal clinics. Methods: Self-reported socio-demographic data were collected, and HIV-related medical data were extracted from respondent’s medical charts. Height and weight were measured to calculate the body mass index (BMI, kg/m 2 ); neighbourhood walkability was measured on the Neighbourhood Environment scale; and physical activity, specifically functional exercise capacity, was measured by the 6-min walk test (6MWT). Results: On average, respondents were black African, female, approximately 38 years old and unemployed; men were of normal weight whilst women were overweight. Only 65% of the respondents reached the age- and sex-predicted distance during the 6MWT. Correlational analyses did not reveal any significant relationships between the functional exercise capacity and socio-demographic, HIV-related factors or anthropometric measures. Conclusion: South African PWH do not reach their predicated walking distance on the 6MWT. Engaging community agencies to promote walking as both a means of transportation and leisure physical activity may decrease the risks of a sedentary lifestyle and improve progression towards recommended physical activity targets.

Aim To explore perceptions of low income persons living with HIV/AIDS and history of substance abuse about how they decide whether an internet site is a credible source of health-related information. Background It is hard for any consumer to determine whether the information that is available on the internet is trustworthy and even more challenging for consumers with low health literacy and insufficient computer literacy skills. Methods Mixed methods with sequential explanatory design. Electronic health literacy was measured with eHEALS and a new instrument to measure confidence in choosing a credible internet site for health-related information was developed. Qualitative data were collected during three focus groups held in high prevalence neighborhoods in New York City and after participants watched a 16-minute video produced by the United States National Library of Medicine. Results Participants had low electronic health literacy and there was no relationship between electronic health literacy and confidence in identifying a credible internet site. Six themes emerged: I haven’t learned enough from the Medline video; I am not computer literate; the Internet has too many scams; the Internet piques interest in learning health-related information; prefer 1:1 interactions with trusted source for health information; and you don’t have to expose HIV status to get information. Conclusion Low income persons are interested in using the internet for health information but reluctant to do so due to multiple complex barriers. Follow-up interventions would include skills training in which persons are taught how to identify credible sites.

This study investigates socio-demographic characteristics and resilience and depressive symptoms among Korean Americans (KAs) with traumatic life experiences. Community-residing 285 KAs living in New York City and Teaneck, New Jersey completed questionnaires measuring traumatic life experiences, depressive symptoms, and resilience. Descriptive statistics, Pearson's correlations, and two-step hierarchical multiple regression analyses were conducted. 54% of KAs with traumatic life experiences reported at least mild depressive symptoms; greater resilience was associated with fewer such symptoms. English proficiency, length of time in US, marital status, and employment were significant predictors for depressive symptoms in the first step of multiple regression, but when resilience was introduced in the second step, it was the only significant predictor of depressive symptoms. The findings suggest that resilience should be supported to promote positive mental health outcomes for traumatized KAs who are depressed, and that resilience-focused interventions for this population should be designed.

Background People living with human immunodeficiency virus (PLHIV) are at an increased risk for developing cardiovascular disease (CVD). Physical activity and cardiorespiratory fitness in PLHIV are poorly understood. Objective The aims of this study were to describe physical activity and cardiorespiratory fitness by sex and age and to examine the association between physical activity and cardiorespiratory fitness in PLHIV, controlling for covariates. Methods Seven hundred two PLHIV participated in a cross-sectional study and completed validated measures of self-reported physical activity (7-day Physical Activity Recall) and cardiorespiratory fitness (6-minute walk test). Participants were recruited from 7 diverse sites in the United States and Thailand, and data were analyzed using descriptive statistics and multiple regression to examine the relationship between physical activity and cardiorespiratory fitness. Results On average, participants self-reported engaging in 115 minutes of, mostly light (75%), physical activity. Men reported twice the amount of physical activity as women (155 vs 73 minutes, P = .01). Participants' ability to achieve their predicted 6-minute walk test distances was similar between men (68%) and women (69%) (P > .01). For women, vigorous physical activity was associated with a 6.6% increase in cardiorespiratory fitness and being temporarily unemployed was associated with an 18% decline in cardiorespiratory fitness. Cardiorespiratory fitness increased with age (P Conclusions Weekly physical activity of people living with human immunodeficiency virus averaged 85 minutes of mostly light activity, well below the recommended 150 minutes of moderate activity. Vigorous physical activity was associated with improved cardiorespiratory fitness in women, but not men. Although PLHIV would benefit from interventions to increase physical activity, our data suggest a need to develop sex-specific physical activity strategies.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n=135) and providers (n=71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Introduction Blended learning refers to an educational strategy that combines face-to-face classroom instruction with on-line learning. This teaching strategy was introduced into an occupational health nursing (OHN) programme at the Durban University of Technology in 2011. Methods A mixed methods convergent design was used to merge concurrent quantitative and qualitative data to address the study aim. Quantitative data were collected from student cohorts and qualitative data were collected from all the OHN programme lecturers. The Perceptions about the use of web-based learning was used to measure current OHN student perceptions of web-based learning in the OHN programme. The demographic and work-related instrument measured person-related factors. Qualitative data were collected using three semi-structured interview questions. Quantitative data were analysed using SPSS v22. Two-tailed Pearson product moment correlations and t-tests were computed on the six factors between the scores of first and second year students. Qualitative data were analysed using the applied thematic analysis methodology. Result Computer anxiety was significantly higher for first year students compared to second-year students (t=4.08, p Discussion Blended learning, a useful teaching strategy, has the potential to advance the OHN specialisation programme at DUT through the numerous opportunities for collaborative learning that the online technology affords. However, the challenges faced by both lecturers and students need to be addressed through focused interventions to ensure the optimal use of this teaching/learning strategy.

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Health literacy, including people's abilities to access, process, and comprehend health-related information, has become an important component in the management of complex and chronic diseases such as HIV infection. Clinical measures of health literacy that focus on patients' abilities to follow plans of care ignore the multidimensionality of health literacy. Our thematic analysis of 28 focus groups from a qualitative, multisite, multinational study exploring information practices of people living with HIV (PLWH) demonstrated the importance of location as a dimension of health literacy. Clinical care and conceptual/virtual locations (media/Internet and research studies) were used by PLWH to learn about HIV and how to live successfully with HIV. Nonclinical spaces where PLWH could safely discuss issues such as disclosure and life problems were noted. Expanding clinical perspectives of health literacy to include location, assessing the what and where of learning, and trusted purveyors of knowledge could help providers improve patient engagement in care.

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

Globally, people living with HIV (PLWH) are at remarkably high risk for developing chronic comorbidities. While exercise and healthy eating reduce and mitigate chronic comorbidites, PLWH like many others, often fail to engage in recommended levels. We qualitatively examined the perspectives and contextual drivers of diet and exercise reported by PLWH and their health care providers. Two hundred and six participants across eight sites in the United States, Puerto Rico and Botswana described one overarching theme, Arranging Priorities, and four subthemes Defining Health, Perceived Importance of Diet and Exercise, Competing Needs, and Provider Influence. People living with HIV and their health care providers recognize the importance of eating a healthy diet and engaging in regular exercise. Yet there are HIV-specific factors limiting these behaviors that should be addressed. Health care providers have an important, and often underutilized opportunity to support PLWH to make improvements to their exercise and diet behavior.

Aim To examine the validity of the Spanish version of an instrument used to measure electronic health literacy (eHEALS) with an older Hispanic population from a number of Spanish-language countries living in New York City in the United States (US). Background Although the Internet is available globally, complex skills are needed to use this source of valuable health-related information effectively. Electronic health literacy is a multifactorial concept that includes health literacy but also requires technology skills. Design Cross-sectional. Method Recruitment occurred at a Senior Organization located in a largely Hispanic neighbourhood in New York City (N = 100). Participants completed eHEALS and selected items from the Health Information National Trends Survey (HINTS) which assesses how adults use different communication channels, including the Internet, to obtain vital health information. Data from the US HINTS sample (N = 162) were matched to the Senior Organization sample on age range and Hispanic ethnicity. The average Senior Organization participant was 68 years old, female, born in one of six different Spanish-language countries, and completed high school while the average HINTS participant was 67 years old, female and had high school or less education. Results Although there was no relationship with the two HINTS subscales and electronic health literacy, there were significant relationships between electronic health literacy and health status and confidence in self-care. Conclusions Inadequate electronic health literacy is a barrier to positive health outcomes. The Spanish version of eHEALS could be used as a screening instrument to identify gaps and tailored interventions could be developed to increase consumer confidence in using the Internet for reliable health-related information. Relevance to clinical practice Knowledge in self-management is related to positive health outcomes; all persons irrespective of their electronic health literacy should be able to use all sources of health information to enhance their self-care.

© 2016 John Wiley & Sons Ltd 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.

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.

The purpose of this preliminary work was to develop a new short tool to assess personal health records (PHRs) self-efficacy. Prior work had found 4 distinct skills related to creating, updating, tracking symptoms, and sharing information with health care providers using PHR. Although PHRs have great promise, their uptake has been rather limited, especially in economically limited populations. A convenience sample of community-living persons with HIV/AIDS (N = 100) was asked to complete the new tool along with other self-efficacy measures. Preliminary work indicated more confidence about paper-based PHRs compared with computer-based PHRs. The paper-based subscale was significantly correlated to chronic illness and HIV treatment self-efficacy scales as expected, but there were no relationships for the computer-based subscale. This simple screening tool could identify interested clients and their preference either for a paper-based or computer-based PHR. Further research is needed with larger sample sizes and different chronically ill populations to further explore the psychometrics of the instrument.

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

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.

Since HIV infection can be spread through sexual contact, it is important to understand how sexual behavior is expressed in different age groups. The purpose of this article was to conduct a secondary analysis of a multi-site study to explore sexual function in a sample of younger /older HIV+persons living in the United States (N = 558) and Puerto Rico (N = 98). Data were collected using a demographic survey and the Sexual Function subscale of the HIV Assessment Tool (HAT)-Quality of Life instrument. Independent sample t-tests found significant differences (p = .002) in sexual function for younger/adult HIV+person in the US but not in PR (p = .770). Regional variations in sexual function need to be explored in order to tailor the most effective primary and secondary HIV prevention messages.

Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.

Depressive symptoms are highly prevalent yet undertreated in people living with HIV/AIDS (PLHAs). As part of a larger study of symptom self-management (N=1217), this study examined the prevalence, correlates, and characteristics (intensity, distress, and impact) of depressive symptoms, and the self-care strategies used to manage those symptoms in PLHAs in five countries. The proportion of respondents from each country in the total sample reporting depressive symptoms in the past week varied and included Colombia (44%), Norway (66%), Puerto Rico (57%), Taiwan (35%), and the USA (56%). Fifty-four percent (n=655) of the total sample reported experiencing depressive symptoms in the past week, with a mean of 4.1 (SD 2.1) days of depression. Mean depression intensity 5.4 (SD 2.7), distressfulness 5.5 (SD 2.86), and impact 5.5 (SD 3.0) were rated on a 1-10 scale. The mean Center for Epidemiologic Studies Depression Scale score for those reporting depressive symptoms was 27 (SD 11; range 3-58), and varied significantly by country. Respondents identified 19 self-care behaviors for depressive symptoms, which fell into six categories: complementary therapies, talking to others, distraction techniques, physical activity, medications, and denial/avoidant coping. The most frequently used strategies varied by country. In the US sample, 33% of the variance in depressive symptoms was predicted by the combination of education, HIV symptoms, psychological and social support, and perceived consequences of HIV disease.

As part of a larger randomized controlled trial examining the efficacy of an HIV/AIDS symptom management manual (n = 775), this study examined the prevalence of peripheral neuropathy in HIV-infected individuals at 12 sites in the USA, Puerto Rico, and Africa. Neuropathy was reported by 44% of the sample; however, only 29.4% reported initiating self-care behaviors to address the neuropathy symptoms. Antiretroviral therapy was found to increase the frequency of neuropathy symptoms, with an increased mean intensity of 28%. A principal axis factor analysis with Promax rotation was used to assess the relationships in the frequency of use of the 18 self-care activities for neuropathy, revealing three distinct factors: (i) an interactive self-care factor; (ii) a complementary medicine factor; and (iii) a third factor consisting of the negative health items of smoking, alcohol, and street drugs. The study’s results suggest that peripheral neuropathy is a common symptom and the presence of neuropathy is associated with self-care behaviors to ameliorate HIV symptoms. The implications for nursing practice include the assessment and evaluation of nursing interventions related to management strategies for neuropathy.

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as "asymptomatic" by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003-2005 and 2005-2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.

The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.

Although the internet increases the availability of diabetes-related health information, health care consumers need to have different skills in order to obtain, interpret and evaluate such information. The eHealth literacy scale (eHEALS) was originally developed to assess consumers' perceived skills at using information technology for health. The objective of this study was to explore the experiences of older Hispanics' with type 2 diabetes in using the internet for diabetes management. This study was conducted in the USA among a convenience sample of older Hispanics with type 2 diabetes (n = 20) who attended a senior center in East Harlem, New York City. All participants first completed eHEALS and a demographic, diabetes-related, and smart phone use form either in English or Spanish and then participated in a focus group. Descriptive statistics and a univariate exploratory analysis were conducted to determine differences in electronic health literacy based on age or gender. In addition, qualitative data from the focus groups were analyzed. No significant differences were found based on age (F = 0.76, p = 0.66), but a t-test found significant differences based on gender (t = -2.67, df = 18, p = 0.015). During the qualitative data analysis, five themes were identified from the focus group responses. Although the participants had access to the internet, they were not using the technology to access diabetes-related health information. Given the small sample size in this study, the Spanish version of the instrument needs to be used in a larger sample and further psychometric testing.

Asian American women are more prone to suffer from depression compared to their non-Asian American counterparts and have lower rates of seeking mental healthcare services due to lack of available culturally appropriate therapies. Two prior studies of a culturally tailored therapeutic intervention called LogoAutobiography were helpful in treating depressed Korean American women. The LogoAutobiography program was revised to enhance its efficacy not only for depressive symptoms and purpose in life but also to increase coping strategies.To test the efficacy of the Enhanced LogoAutobiography program on depressive symptoms, purpose in life, and coping strategies of depressed community-dwelling Korean American women.Two-group, non-randomized quasi-experimental design.Local Korean community areas located in New York City and eastern New Jersey of the United States.A total of 54 depressed women with Korean heritage completed either experimental group (n1=25) or control group (n2=29). Sample inclusion criteria were adult women with Korean heritage, depressive symptoms as measured by a CES-D score 16 or higher, fluent Korean language, and able to participate independently. Sample exclusion criteria were those who presented active suicidal ideation and history of episodes of mania or psychosis screened by the psychosocial survey questionnaire.The experimental group received Enhanced Logo-Autobiography program which was guided by a facilitator who used a manualized intervention for 90minute sessions over 8weeks; the control group attended routine weekly community activities. Data were collected during the first session (pretest), the end of 8weeks (posttest), and the 3months follow-up session. Time and group changes in depressive symptoms, purpose in life, and coping strategies were computed using Repeated Measures General Linear Model (RMGLM).Findings suggested that the experimental group showed greater improvement in depressive symptoms (F=6.94 (2, 88), p0.01), active cognitive coping (F=5.07 (2, 86), p0.01), and avoidance coping strategies (F=3.48 (2, 86), p0.05) compared to the control group during the three time intervals. Purpose in life showed statistically significant Time and Group effects (F=5.18 (2, 88), p0.01; F=9.44 (2, 88), p0.01, respectively), but no significant interaction effect of Time and Group was detected.These findings suggest that enhanced LogoAutobiography is effective for depressive symptoms and coping strategies and somewhat effective for improving purpose in life for depressed Korean American women.

Health policies increasingly address the need to eliminate disparities in healthcare and it is imperative that nurses identify how they contribute to achievement of that goal. The purpose of this descriptive, cross-sectional research was to identify if there is relationship between a core personality trait, core self-evaluations, and confidence in the ability of beginning graduate nursing students (N = 71) in a Clinical Nurse Leader (CNL) track to deliver culturally competent nursing care. A partial correlation, controlling for age, pre-licensure nursing education program, race, and satisfaction with current nursing position, found that core self-evaluations were significantly related to the three subscales on the transcultural self-efficacy scale, specifically: cognitive ( r = .417, p = .001); affective ( r = .479, p = .000); and practical ( r = .521, p = .000) self-efficacy. The relatively low core self-evaluations for this group of nurses in the early phases of graduate education for the CNL role compared to other samples is less than desirable for persons who are embracing a new nursing role that requires leadership skills to inspire followers. Although core self-evaluations are a relatively stable personality characteristic, educational programs could incorporate strategies to improve core self-evaluations in order to assist professionals to appraise their workplace challenges in a more positive framework.

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 ± 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue—men 46% ( n = 62), women 54% ( n = 74); nausea—men 52% ( n = 33), women 48% ( n = 30); depression—men 55% ( n = 90), women 45% ( n = 73); and anxiety—men 77% ( n = 83), women 87% ( n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (χ 2 = 14.81, 1 df, p = .000), nausea (χ 2 = 4.10, 1 df, p =.043), and depression (χ 2 = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

Data were analyzed from an ethnically diverse convenience sample comprising 1071 adults participating in a multisite study. Older African Americans, Hispanics, and females were more likely to use prayer as a complementary health strategy for HIV-related anxiety, depression, fatigue, and nausea. Implications for future studies are discussed.

In order to maximize their health status, persons living with HIV/AIDS must use a variety of self-management strategies. They learn these strategies from many sources often based on a specific need or problem. Information needs can be addressed during health care appointments but time is often limited and spent on more acute issues such as symptom control or medication adherence. In order to assess information needs, a 76-item HIV+ Information for Self-Care Quiz was developed and piloted with two samples. Both samples (n = 50, 43) were predominantly people of color and male with a mean age of either 44 or 56 years, respectively. This paper describes the phases of development and offers suggestions for its use in clinical settings, research, and provider education. By using this quiz to determine preexisting knowledge level, interactions with the health care provider can be more focused to address knowledge gaps and less time could be spent teaching information that the client already knows.

Aim. This paper reports a study with people living with HIV to examine the experience of depressive symptoms, self-care symptom management strategies, symptom outcomes in response to those strategies, and sources from which the strategies were learned. Background. Depressive symptoms are common, under-diagnosed and under-treated in people living with HIV. These symptoms have been associated with lower medication adherence, risky behaviours and poorer health outcomes. Methods. The study was based on the model of symptom management developed by the University of California San Francisco School of Nursing Symptom Management Faculty. Thirty-four HIV+ men and women from a larger study of symptom self-care strategies (n = 422) reported experiencing depressive symptoms. Data were collected from this subset on the Web, by mail and in-person using the critical incident technique. Results. Depressive symptoms were described using 80 words and phrases clustered into eight categories: futility, sadness, loneliness/isolation, fatigue, fear/worry, lack of motivation, suicidal thoughts and other. A total of 111 self-care strategies were coded into six categories: practising complementary/alternative therapies, talking to others, using distraction techniques, using antidepressants, engaging in physical activity, and using denial/avoidant coping. Sources of information for strategies used were trial and error (31%), healthcare providers (28%), family and friends (20%), classes/reading (8%), clergy (8%), support groups (4%) and other (3%). Overall, 92% of the self-care strategies used were reported as helpful, 4% were sometimes helpful and 4% were not helpful. Conclusions. People living with HIV use numerous effective self-care strategies to manage depressive symptoms. Further study is needed to validate the use of these strategies across populations, to standardize dose, duration and frequency, and to measure their effectiveness.

To prepare for community engagement and partnerships with diverse communities, nursing students must understand the principles of service-learning, as well as the essential skills needed to work within a democracy. The purposes of these two pilot tests were to develop a 15-hour service-learning intervention; refine the 15-hour service-learning intervention; and explore whether participation in the intervention made a difference in the critical thinking, cultural competence, and civic engagement of nursing student participants. Although the sample was small ( n = 14), results of paired t tests found that, after the intervention, critical thinking scores measured by the California Critical Thinking Disposition Inventory were significantly lower ( t = −2.23, p = .04), particularly on the self-confidence sub-scale ( t = 2.29, p = .039); cultural competence scores measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals were significantly lower ( t = 4.83, p = .000); and civic engagement scores significantly increased ( t = −3.54, p = .004).

The purpose of this study was to describe the frequency and correlates of complementary and alternative medicine (CAM) therapies used by people with HIV/AIDS to manage illness and treatment-related symptoms. Data were collected from a convenience sample (N = 422) of people living with HIV disease. Demographic variables (e.g., education, age, and gender) were compared for those who reported using at least one CAM therapy. There were significant differences for gender (χ2 = 4.003, df =1,p = .045) and for ethnicity (χ2 = 6.042, df =2, p = .049). Females and African Americans used CAM more frequently. More than one third of the participants used CAM, and there were a total of 246 critical incidents of nontraditional treatment use. It is possible that these nonallopathic interventions may positively affect health-related quality of life in persons with HIV by ameliorating or reducing the side effects associated with the disease and its treatments.

PURPOSE/OBJECTIVES To identify when fatigue is reported as a problem by people who are HIV positive, what the perception of fatigue is, and which self-care behaviors are used and with what efficacy. DESIGN Multisite descriptive study. SETTING University-based AIDS clinics, community-based organizations, and homecare agencies located in cities across the United States, in Norway, and through a university Web site. SAMPLE Convenience sample of 422 self-identified people who are HIV positive. MAIN RESEARCH VARIABLES Symptom description, symptom relief, symptom help, and self-care strategies. FINDINGS The sixth most reported symptom in this study, fatigue, was treated with a variety of self-designed strategies. In only three instances was consultation with a healthcare provider (i.e., physician) or an injection (medication not defined) mentioned. The most frequently used interventions were supplements, vitamins, and nutrition followed by sleep and rest; exercise; adjusting activities, approaches, and thoughts; distraction; and complementary and alternative therapies. In addition to self-designed strategies, the media and friends and family were sources of information. CONCLUSIONS Fatigue was reported less frequently in this study than in other HIV-, AIDS-, or cancer-related studies. This may be an artifact of the study design. The use of informal networks for assistance, let alone the prevalence of unrelieved fatigue, indicates the need for more attention to this problem among people with AIDS. IMPLICATIONS FOR NURSING Careful assessment of the pattern of fatigue and its onset, duration, intervention, and resolution is required if the varied types of fatigue are to be identified and treated successfully.

ContextIndividual resources of social capital and self-compassion are associated with health behaviors and perceivedsymptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience.ObjectivesThe 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.MethodsWe 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.ResultsControlling 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&nbsp

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 (n=775) 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.

Purpose: To examine cross-cultural measurement of quality of life (QOL) and issues to consider in adapting quality-of-life instruments. Organizing Construct: Health-related quality of life. Methods: Review of the literature on cross-cultural QOL using the Cumulative Index to Nursing & Allied Health Literature (CINAHL), 1982 to February 2000, and Medline, 1966 to May 2000, databases. Findings: Use of research instruments beyond the samples with which they were initially tested, particularly if the new samples are cross-cultural, presents considerable challenges. The findings indicate consideration of these problems: phenomenon of interest, cross-cultural versus cross-national, salience, conceptual equivalence, cultural hegemony versus cultural validity, cultural equivalence versus verbal equivalence, fidelity versus appropriateness, privacy versus disclosure, appropriateness of format, and resource utilization for translation. Although the literature indicates increased discussion of theoretical, conceptual, and operational approaches to measuring cross-cultural QOL, problems continue in adapting instruments from one culture to another. Conclusions: Many issues about cross-cultural QOL were identified. By addressing these issues, researchers can develop appropriately translated and validated quality-of-life instruments to advance knowledge about cross-cultural QOL.

This study used the Symptom Experience dimension of the revised UCSF Symptom Management Conceptual model to examine correlates of sleep quality in HIV-infected persons. According to this model, person, health/illness, and environment categories influence perception of a symptom. The average person in the sample (N = 58) reported being HIV-infected for 8.5 years and was 46 years old, not working, and a person of color. Depending on the level of data, either chi square or Pearson corrrelations were computed between the person, health/illness, and environment categories and the dependent variable, sleep quality, as measured by the Pittsburgh Sleep Quality Index. Person variables significantly related to sleep quality were employment status, trait anxiety, and general well-being. Health/illness variables significantly related to sleep quality were length of time living with HIV disease and five health status measures (depressive symptoms, state anxiety, symptom severity, daytime sleepiness, and functional status). The environmental variables associated with sleep quality were sleeping alone, having a separate bedroom, and sleeping in a noisy room. Correlates of better sleep quality are positive general well-being, less anxious personality trait and emotional state, less daytime sleepiness, less depressive symptoms, and less symptom severity. Correlates of worse sleep quality are impaired functional status and longer duration of living with HIV disease.

Urologists and health care professionals treating erectile dysfunction face a significant challenge in caring for the HIV-positive patient who seeks restoration of normal sexual function. The encounter between the health care provider and the patient in this setting requires knowledge of HIV disease and potential drug interactions specific to this population, as well as thorough counseling on strategies aimed at reducing the infectiousness of HIV-1. The interaction extends beyond the immediate boundaries of the doctor-patient relationship and their respective rights, to include careful consideration of the rights of the partner/s and the society as a whole. This paper is a summary and analysis of presentations and discussions by medical, legal, nursing and bioethics specialists in an interactive seminar on this topic.