Intersectionality of Socioecological Factors Associated With Cognitive Function Among Older Women With HIV in the United States: A Structural Equation Model Analysis Using Data From the Women's Interagency HIV Study.

ABSTRACT: Increased life expectancy of people with HIV has health implications including the intersection of the long-term use of antiretroviral treatment, inflammatory events, and age-related immunosenescence. In a cross-sectional study utilizing using the Socio-Eecological Model, we identified pathways of cognitive function (CF) among 448 women with HIV, 50 years and older. A structural equation model showed the direct effects of mood (ß = -0.25, p < .01), comorbidities (ß = --0.13, p < .05), race (ß = --0.13, p < .05), and abuse (ß = 0.27, p < .001) on the latent variable CF. Substance and alcohol use, depressive symptoms, cigarette smoking, and the number of comorbidities are important considerations when designing interventions utilizing using a multi-level and intersectional lens to maximize positive CF outcomes.

Intimate Partner Violence Training and Readiness to Respond among Students, Staff, and Faculty in Three Institutions in the United States.

Intimate partner violence (IPV) is a significant public health concern; however, limited studies have explored perceptions and experiences towards IPV among students, staff, administrators, and faculty across diverse disciplines at institutions of higher education. The purposes of this study were to (1) assess experiences of IPV among a sample of students, staff/administrators, and faculty and (2) examine the relationship among attitudes, actual and perceived knowledge, awareness, training, readiness, and personal experiences with IPV in this sample. Participants were recruited from an urban university and two university-affiliated medical institutions to participate in an online survey. Bivariate and multivariate associations were assessed. Structural Equation Modeling (SEM) was used to examine direct and indirect effects of perceived and actual knowledge and personal experiences with IPV. Of the 216 respondents, 42.6% reported personally experiencing IPV and 34.3% reported having witnessed IPV. Over 34% of participants never received training on IPV. The sub-sample with training received between one and more than 15 hours of training. Standardized total effect of training on attitudes and awareness was ß = 0.42 (95% confidence interval [CI] = 0.30-0.51), the combined indirect effects was ß = 0.18 (95% CI = 0.10-0.27) and the direct effects of ß=0.23 (95% CI = 0.12-0.34), indicating that hours of training was highly associated with the participants' perceived knowledge and actual knowledge, which improved their attitudes and awareness towards IPV survivors. Our findings suggest the need for campus-wide formal training on IPV to better prepare members in higher education to accurately identify, assess, and intervene to protect victims of abuse. Interprofessional approaches are needed that focus on the multiple and intersecting needs of victims of violence and should also enhance professional self-efficacy and increase readiness to respond to IPV survivors.

Impact of Sources of Strengths on Coping and Safety of Immigrant Survivors of Intimate Partner Violence.

Intimate partner violence (IPV) is a national and international public health and human rights concern. Immigrant women are disproportionately affected by IPV that includes homicides. This study explored the perspectives of survivors of IPV, who are immigrants to the United States, regarding their sources of strength that enhance their safety and promote coping in abusive relationships. Data for this qualitative study were collected from ethnically diverse immigrant women residing in Massachusetts, Arizona, Virginia, Washington, D.C., New York, Minnesota, and California, using purposive and snowball sampling techniques. Eighty-three in-depth interviews were conducted with adult immigrant survivors of IPV who self-identified as Asian (n = 30), Latina (n = 30), and African (n = 23). Data were analyzed using thematic analysis. Women identified both external (e.g., community support, support from social service agencies) and internal (e.g., optimism, faith, beliefs) sources of strength. The study highlights how these sources can adequately address needs of survivors and offers areas for improvement in services for survivors. The findings are informative for practitioners serving immigrant survivors of IPV in legal, social service, and physical and mental health settings.

Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women.

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors' unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors' co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Understanding Intimate Partner Violence among Immigrant and Refugee Women: A Grounded Theory Analysis.

Immigrant and refugee women may experience considerable multifaceted and interrelated barriers that place them at heightened risk for intimate partner violence (IPV). The objective of this analysis was to increase our understanding of immigrant and refugee women's responses to abuse. We conducted in-depth interviews with 84 women who immigrated from Africa, Asia, and Latin America. Engendering Resilience to Survive emerged as the core category explaining women's strength to stay safe and survive IPV experiences. In the face of the violence they experienced, women in this sample demonstrated remarkable resilience and the ability to harness their strength to survive. Resilience as a process and outcome could facilitate empowerment, and self-directedness to access health services and resources to stay safe. The developed Engendering Resilience to Survive Model can be utilized as a framework to inform research, policy, and practice to support abused women.

Evaluation of smoking cessation interventions for veterans in HIV clinics in the United States: a theory-informed concurrent mixed-method study.

OBJECTIVE: Although veterans living with HIV infection are burdened with smoking-related morbidities, few studies have explored theory-informed, evidence-based smoking cessation interventions in the Veterans Affairs (VA) Health System. METHOD: In this concurrent mixed-method study, we sought to better understand factors influencing the adoption of existing evidence-based smoking cessation interventions (reminders, telephone quit lines, pharmacological) for veterans in VA HIV clinics. We explored the alignment of the revised Promoting Action on Research Implementation in Health Services Framework (i-PARIHS) with study results. RESULTS: Nineteen clinicians working at eight HIV clinics in the VA System participated in the study. Seven themes were identified with relative quantitative and qualitative data convergence of clinicians' perceptions of the importance of integrating evidence-based smoking cessation interventions for veterans with HIV infection. CONCLUSION: Identified themes underscore the need for clinicians to provide smoking cessation training, supportive care, and motivate veterans living with HIV infection to quit smoking. Integrating smoking cessation programs into HIV treatment plans in the veteran patient population is critical. Dedicated time to fully implement these efforts will maximize smoking cessation intervention efforts and will yield successful utilization and subsequent patient compliance. Importantly, combination strategies will ensure cessation program impact and sustainability.Trial registration:Netherlands National Trial Register identifier: ntr050..

Methodological and Ethical Considerations in Research With Immigrant and Refugee Survivors of Intimate Partner Violence.

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.

Evaluation of a technology-enhanced intervention for older women with HIV infection: a proof of concept study.

The syndemic effects of HIV infection, side effects of highly active antiretroviral medications, and age-related changes lead to increased risk for comorbidities and functional decline for older people with HIV. This proof of concept (PoC) study evaluated perceived usefulness, satisfaction, acceptability, intervention processes, resource management, and outcome effect variances of ThE CARE Intervention guided by the Self-Determination Theory. To test the utility of ThE CARE, we conducted a one-group pre/posttest intervention design with a convenience sample of 20 women, 50 years and older. The mean age was 56 years (SD = 11) and years since HIV diagnosis was 23.7 (SD = 8.6). ThE CARE intervention was found useful and participants "felt empowered" utilizing the app. Fourteen participants (70%) reported high-intensity distress and negative impact on life from neuropathic pain, anxiety (55%), fatigue (50%), and depressive symptoms (35%). Self-awareness and self-regulation also improved. Modest results of acceptability, usability, and positive trends in the outcome measures suggest possible effects. The interactivity and cultural relevance of ThE CARE would enhance women's autonomous motivation and perceived competence to actively engage in self-care. The PoC study provides important foundational information to advance science in mHealth interventions for older women with HIV.

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant, refugee and indigenous women with intimate partner violence experiences.

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services [WHY?] and research is needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.

Evaluating Relevance of Nursing Theories in Cross-Cultural and International Contexts.

Nursing has evolved over the past five decades in propagating the development of theoretical and empirical evidence through the application of nursing theories. The objective of this commentary is to stimulate scholarly debate focused on the development, application, and adaptation of nursing theory by nurse scientists, its relevance in the cross-cultural contexts, and to discuss future directions with a call to action using Leininger's seminal work on Culture Care Theory. The implicit nature of nursing theories preclude the optimal use and application in cross- cultural contexts because of the limitations in achieving conceptual, semantic, and operational equivalence. Work conducted by nurse scientists to date demonstrates that cultural values and beliefs are integral in cross-cultural contexts to enhance meaningful theory application for health interventions. More work is needed to advance nursing science through cross-cultural application of theories in research, practice, and education to optimize nursing theory adaptation in cross-cultural and international contexts.

Leveraging Community Engagement to Develop a Mobile Health Application for Older Women With HIV Infection.

OBJECTIVE: To develop a mobile health app for older women with HIV infection that will be used in a larger study. DESIGN: A qualitative study design. SETTING: Baltimore-Washington metropolitan area clinics and communities. PARTICIPANTS: Ten women 50 years and older (mean age = 62.8 years, standard deviation = 3.62, range = 58-69 years) who self-identified as Black or African American and were infected with HIV. METHODS: At the start of the study, we used relevant empirical and the self-determination theory to inform the draft Web-based app content that was shared with two focus groups. Data were analyzed with input from a community advisory board (CAB) to inform the development of the mobile health app. RESULTS: We inductively identified eight subthemes within the coding structure of two overall themes: Navigating Content, Functions, and Features and Enhancing Provider Interaction With Patients that represented the perspectives of participants regarding the app. From the eight subthemes, we integrated the contributions from the CAB, which we then used to further optimize the app. CONCLUSION: The app was designed to provide support, tools, and resources for older women with HIV. Engagement of community collaborators could be challenging because of multiple personal and structural barriers. Nonetheless, the potential community member benefits are invaluable. If successful, the Web-based app could be a model to address the needs of older persons with HIV infection.

Multilevel Risk and Protective Factors for Intimate Partner Violence Among African, Asian, and Latina Immigrant and Refugee Women: Perceptions of Effective Safety Planning Interventions.

Immigrant and refugee women are at high risk for intimate partner violence (IPV) and intimate partner homicide (IPH). Given the growing number of immigrants and refugees in the US and the concerns about IPV and IPH among immigrant and refugee groups, this paper aims to identify survivors and practitioners' perceptions of a) common and culturally specific risk and protective factors for IPV and IPH for immigrant and refugee women and b) areas of safety planning interventions for survivors who are at risk for severe or lethal violence by an intimate partner. Qualitative data for this multi-site study were collected from women and practitioners residing in seven geographically diverse US locations. Eighty-three in-depth interviews were conducted with adult immigrant and refugee survivors of IPV, who identified as Asian (n=30), Latina (n=30), and African (n=23). Additionally, nine focus groups and five key informant interviews were conducted with practitioners (n=62) who serve immigrant and refugee survivors of IPV. Results revealed multilevel risk and protective factors for IPV/IPH found at the societal-level (e.g., patriarchal cultural norms), relationship-level (e.g., partner abusive behaviors), and individual-level (e.g., acculturation in the US). These findings can inform the development of culturally responsive risk assessment and safety planning interventions across legal, social service, and healthcare settings.

An Integrative Review of Flipped Classroom Teaching Models in Nursing Education.

Nursing care is changing dramatically given the need for students to address complex and multiple patient comorbidities. Students experience difficulties applying knowledge gained from didactic instruction to make important clinical decisions for optimal patient care. To optimize nursing education pedagogy, innovative teaching strategies are required to prepare future nurses for practice. This integrative review synthesized the state of the science on flipped classroom models from 13 empirical studies published through May 2016. The purpose of the review was to evaluate studies conducted on flipped classroom models among nursing students using a validated framework by Whittemore and Knafl. Multiple academic databases were searched, ranging in scope including PubMed, Embase (Elsevier), CINAHL (Ebsco), Scopus, Web of Science, and Google Scholar, resulting in 95 unique records. After screening and full-text reviews, 82 papers were removed. Thirteen empirical studies were included in the final analysis and results provided (a) design and process information on flipped classroom models in nursing education, (b) a summary of the state of the evidence to inform the implementation of flipped classrooms, and (c) a foundation to build future research in this area of nursing education. To develop sound evidence-based teaching strategies, rigorous scientific methods are needed to inform the implementation of flipped classroom approaches.

Knowledge, attitudes, cultural, social and spiritual beliefs on healthseeking behaviors of Gambian adults with HIV/AIDS.

HIV/AIDS continues to grow exponentially in sub-Saharan Africa. Early HIV/AIDS care is essential for early interventions to increase quality of life and reduce mortality. The objectives of the study were: (1) to determine the relationship among attitudes, spiritual beliefs, cultural beliefs, social beliefs and knowledge on health-seeking behaviors (HSB) of Gambian adults living with HIV/AIDS; and (2) to provide preliminary data on psychometric characteristics of the newly developed HIV/AIDS Knowledge, Attitudes and Beliefs Patient Questionnaire. The descriptive design included 93 adults aged 21 to 65 years. Correlation and hierarchical regression analyses were used. Bivariate analyses demonstrated significant relationships between all five variables and HSB at p