ABSTRACT
Syndemic risk is an ecological construct, defined by co-occurring interdependent socio-environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self-worth among women with and at-risk for HIV in an impoverished urban community. In order to better understand these interrelationships, we developed and validated a system dynamics (SD) model based upon peer-reviewed literature; secondary data analyses of a cohort dataset including women living with and at-risk of HIV in Bronx, NY (N = 620); and input from a Bronx-based community advisory board. Simulated model output revealed divergent levels and patterns of syndemic risk over time across different sample profiles. Outputs generated new insights about how to effectively explore multicomponent multi-level programs in order to strategically develop more effective services for this population. Specifically, the model indicated that effective multi-level interventions might bolster women's resilience by increasing self-worth, which may result in decreased perceived financial hardship and risk of violence. Overall, our stakeholder-informed model depicts how self-worth may be a major driver of vulnerability and a meaningful addition to syndemic theory affecting this population.
Subject(s)
HIV Infections/psychology , Poverty/psychology , Self Concept , Social Environment , Adult , Aged , Cohort Studies , Community-Institutional Relations , Female , Humans , Middle Aged , Models, Psychological , New York City , Risk Factors , Risk-Taking , Sexual Behavior , Stress, Psychological , Substance Abuse, Intravenous , Urban Population , ViolenceABSTRACT
This article presents the results of a qualitative analysis of 80 articles, chapters, and practitoners' guides focused on collaboration and coalition functioning. The purpose of this review was to develop an integrative framework that captures the core competencies and processes needed within collaborative bodies to facilitate their success. The resulting framework for building collaborative capacity is presented. Four critical levels of collaborative capacity--member capacity, relational capacity, organizational capacity, and programmatic capacity--are described and strategies for building each type are provided. The implications of this model for practitioners and scholars are discussed.