Changes in HIV Internalized and Experienced Stigmas and Social Support After an Urban Gardens and Peer Nutritional Counseling Intervention Among People With HIV and Food Insecurity in the Dominican Republic.

BACKGROUND: Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support. SETTING: Two HIV clinics in the Dominican Republic. METHODS: A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3-4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists. RESULTS: Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0-32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093). CONCLUSION: A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support.

Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic.

OBJECTIVE: Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic. METHODS: Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes. RESULTS: Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being. CONCLUSIONS AND IMPLICATIONS: Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.

Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic.

OBJECTIVE: Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN: Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING: An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS: The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION: An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.

The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study.

People living with HIV and a non-communicable disease (NCD) experience multi-level barriers when co-managing multiple conditions. We explored the factors affecting living with multiple chronic conditions in the Dominican Republic. We conducted 21 in-depth interviews from October 2019-February 2020 with Dominican adults who participated in a food security intervention and managed HIV and at least one chronic NCD. Using thematic analysis, we explored participant lived experiences co-managing multiple chronic conditions. All participants (mean age = 45.5 years) were linked to HIV care, but only three were linked to NCD-specific care. Individual-level barriers to managing NCDs included limited education and limited self-efficacy for self-management. Interpersonally, barriers included limited rapport building with an NCD-specific specialist. Structural barriers to managing NCDs were no health insurance, poor referral systems, and limited financial assistance. Health system adaptation requires equitably considering the needs of individuals managing multiple chronic conditions. Key factors to address include patient-provider relationships, improved referral systems, accessibility and availability of specialists, and financial assistance.

Quality changes in workplace health promotion over time: an extended validation of quality criteria from a longitudinal perspective.

Aim: The quality of workplace health promotion (WHP) is essential for the successful deployment of financial and human resources. The aim of this paper is to evaluate the measurement quality of a WHP instrument with 15 quality criteria over time. In addition, it examines whether the quality of WHP in the enterprises concerned changed over time and whether typical developments can be identified. Finally, the role of company parameters such as size and implementation phase are analysed in relation to how WHP develops over time. Subjects and methods: Evaluations of the quality of WHP collected between 2014 and 2021 were available at two and three measurement points for 570 and 279 enterprises, respectively. To assess the longitudinal measurement structure, confirmatory factor analyses were carried out followed by structural equation modelling to analyse causality. Cluster analysis was used to identify typical developments, and differences in company parameters were analysed with MANOVA. Results: The results prove that the 15 quality criteria can be used to evaluate the quality of WHP in enterprises in a valid and reliable manner, both cross-sectionally and longitudinally. The quality of WHP in the enterprises concerned remained relatively stable over approximately 12 years. The cluster solution revealed three different developments characterized by increasing, stable or decreasing quality. Conclusion: Measurements using a quality evaluation system permit a good assessment of WHP in enterprises. WHP quality also depends on company parameters; here more support should be provided to motivate enterprises in the long run, particularly in the sustainability phase.

Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic.

A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of "perfect" ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.Trial registry Clinical Trials Identifier: NCT03568682.

RESUMEN: Un estudio piloto de un ensayo controlado aleatorio por conglomerados que involucró a dos clínicas del VIH en la República Dominicana evaluó de forma preliminar la eficacia de una intervención de huertos urbanos y consejería nutricional entre pares. Un total de 115 participantes (52 de intervención, 63 de control) con inseguridad alimentaria moderada o grave y con adherencia subóptima a la terapia antirretroviral (TARV) y/o carga viral detectable fueron evaluados al inicio del estudio, y a los 6 y 12 meses. El análisis de regresión longitudinal multivariada controlando por variables sociodemográficas y tomando en cuenta la correlación serial de clúster encontró que la intervención: redujo la prevalencia de carga viral detectable en 20 puntos porcentuales a los 12 meses; redujo las citas clínicas perdidas en 34 y 16 puntos porcentuales a los 6 y 12 meses; aumentó la probabilidad de adherencia "perfecta" al TARV en 24 y 20 puntos porcentuales a los 6 y 12 meses; y disminuyó la inseguridad alimentaria a los 6 y 12 meses. Los resultados son prometedores y justifican un ensayo controlado más grande para establecer la eficacia de la intervención en mejorar los resultados clínicos del VIH.

Appreciation at work and the effect on employees' presenteeism.

BACKGROUND: Presenteeism, which means attending work while feeling unhealthy or ill, is a serious risk behavior that reduces the employees' productivity and performance. Employees who are treated appreciatively by their work environment show less presenteeism. Investigating the mechanisms behind the relationship between appreciation and presenteeism can help to understand how presenteeism can be reduced even more in the workplace. OBJECTIVE: This study aimed to investigate the impact of two forms of appreciation (supervisor appreciation and general appreciation from the work environment), on presenteeism and includes the moderating effects of resources and stress. This will help to answer the questions a) which form of appreciation is more beneficial for employees and b) whether appreciation counteracts presenteeism by building up resources. METHOD: 1077 Austrian workers were invited to fill-in an online survey about work-related issues. The data was analyzed with structural equation modelling (SEM). RESULTS: The results showed that both forms of appreciation increase the resources of the employees. Through this increase of resources employees experience less stress, which consequently lowers presenteeism. Additionally, general appreciation is more beneficial than supervisor appreciation. CONCLUSION: The findings indicate that appreciative behavior builds resources at the workplace which are essential for showing less presenteeism at work.

Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic.

Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.

An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic.

Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.

Risk Factors and Leadership in a Digitalized Working World and Their Effects on Employees' Stress and Resources: Web-Based Questionnaire Study.

BACKGROUND: In today's world of work, the digitalization of work and communication processes is increasing, and will increase even further. This increase in digitalization at the workplace brings many new aspects of working life to light, such as working in virtual teams, mobile working, expectations of being constantly available, and the need for support in adapting and learning new digital tools. These changes to the workplace can contain risks that might harm the well-being of employees. Leaders can support the well-being of their employees in terms of protecting and replenishing their work-related resources to cope with critical work demands. This so-called health-promoting leadership could serve as a buffer between risk at the workplace and critical outcomes, such as stress, by amplifying work-related resources. OBJECTIVE: This study's aims were twofold. First, we wanted to investigate if risk factors related to higher digitalization at the workplace can be identified and if these risk factors have an impairing effect on the well-being of employees (eg, higher stress and lower resources). Second, we wanted to investigate if the health-impairing effects of these risk factors can be reduced by health-promoting leadership. METHODS: A total of 1412 employees from Austria, Germany, and Switzerland took part in this online study and provided information on their perceived risks at the workplace, their leaders' health-promoting behaviors, and their work-related stress and resources. RESULTS: The results of a hierarchical regression analysis showed that all four risk factors of digital work (distributed team work, mobile work, constant availability, and inefficient technical support) were related to higher stress at the workplace. In addition, distributed team work and inefficient technical support were associated with lower work-related resources. A possible buffer effect of health-promoting leadership between these risks and employee well-being was visible for inefficient technical support. In particular, in the case of having fewer support opportunities in learning and using digital tools, leaders could weaken the potential critical effects on stress. As for the other risk factors, leaders might engage in a different leadership behavior to improve their employees' well-being, as the physical distance between leaders and employees in virtual team work or mobile work could make health-promoting leadership more difficult. CONCLUSIONS: In a digitalized working world, solutions are needed to create working conditions that benefit employees. The results of this study strongly support the importance of investigating risk factors associated with an increase in digitalization at the workplace in addition to traditional risk factors. As for leadership, leaders need to show leadership behavior adapted to a digitalized workplace in order to reduce employee stress and increase work-related resources.

Effects of an adjunctive, chronotype-based light therapy in hospitalized patients with severe burnout symptoms - a pilot study.

Light therapy is a well-established treatment option for seasonal affective disorders and is effective in reducing sleep problems and daytime fatigue. Symptoms of severe burnout include feelings of exhaustion and impaired sleep and mood. Thus, light therapy seems promising for burnout treatment. So far, light therapy effects in burnout were investigated in outpatient settings only, with inconclusive results. The present study targeted light therapy effects in an inpatient setting. Participants with severe burnout were recruited in two psychosomatic clinics and randomly assigned to a control group with multimodal psychiatric treatment or an add-on light treatment group. Participants in the latter group were additionally exposed to morning bright light (illuminance: 4246 lux, irradiance: 1802.81 µW.cm-2) for 3 weeks, 30 minutes a day, timed to their chronotypes. Light effects on burnout symptoms, depression, well-being, daytime sleepiness, sleep quality, and attentional performance were measured twice (pre-/postintervention design). Adjunctive chronotype-based bright light therapy was well tolerated and improved burnout symptoms and well-being without additional effect on severity of depression. Furthermore, reduced daytime sleepiness, improved nighttime sleep quality, a sleep phase advance of 25 minutes, shortened sleep latency, less sleep disturbances and increased sleep duration were observed in the light treatment group. No group differences were found in attentional performance. Chronotype-based bright light therapy seems to be effective in improving burnout symptoms and sleep problems in patients with severe burnout symptoms. Further studies with larger sample sizes and objective measures of sleep are necessary to confirm these preliminary results before practical recommendations can be made.

The Efficient Measurement of Job Satisfaction: Facet-Items versus Facet Scales.

The measurement of job satisfaction as a central dimension for workplace health and well-being is crucial to set suitable health- and performance-enhancing management decisions. Measuring different facets of job satisfaction leads to a more precise understanding about job satisfaction in research as well as to more specific interventions in companies. This study examines the measurement of job satisfaction with facet scales (multiple-items for one facet) and facet-items (one item for one facet). Facet-items are a cost-effective and fast way to measure job satisfaction in facets, whereas facet scales are more detailed and provide further information. Results from 788 bank employees showed that facet-items of job satisfaction were significantly correlated with the corresponding facet scales and had high factor loadings within the appropriate factor. Furthermore, the same correlational pattern between facet scales and external criteria was found for facet-items and external criteria (identification with the company, work engagement, stress, resources). The findings support the usage of facet-items in companies and in research where cost- and time-effectiveness is imperative and the usage of facet scales where an even deeper understanding of job satisfaction is needed. In practice, the usage of efficient measurements is evident, especially in the upcoming field of eHealth tools.

Integration of eHealth Tools in the Process of Workplace Health Promotion: Proposal for Design and Implementation.

BACKGROUND: Electronic health (eHealth) and mobile health (mHealth) tools can support and improve the whole process of workplace health promotion (WHP) projects. However, several challenges and opportunities have to be considered while integrating these tools in WHP projects. Currently, a large number of eHealth tools are developed for changing health behavior, but these tools can support the whole WHP process, including group administration, information flow, assessment, intervention development process, or evaluation. OBJECTIVE: To support a successful implementation of eHealth tools in the whole WHP processes, we introduce a concept of WHP (life cycle model of WHP) with 7 steps and present critical and success factors for the implementation of eHealth tools in each step. METHODS: We developed a life cycle model of WHP based on the World Health Organization (WHO) model of healthy workplace continual improvement process. We suggest adaptations to the WHO model to demonstrate the large number of possibilities to implement eHealth tools in WHP as well as possible critical points in the implementation process. RESULTS: eHealth tools can enhance the efficiency of WHP in each of the 7 steps of the presented life cycle model of WHP. Specifically, eHealth tools can support by offering easier administration, providing an information and communication platform, supporting assessments, presenting and discussing assessment results in a dashboard, and offering interventions to change individual health behavior. Important success factors include the possibility to give automatic feedback about health parameters, create incentive systems, or bring together a large number of health experts in one place. Critical factors such as data security, anonymity, or lack of management involvement have to be addressed carefully to prevent nonparticipation and dropouts. CONCLUSIONS: Using eHealth tools can support WHP, but clear regulations for the usage and implementation of these tools at the workplace are needed to secure quality and reach sustainable results.

Subtypes in clinical burnout patients enrolled in an employee rehabilitation program: differences in burnout profiles, depression, and recovery/resources-stress balance.

BACKGROUND: Burnout is generally perceived a unified disorder with homogeneous symptomatology across people (exhaustion, cynicism, and reduced professional efficacy). However, increasing evidence points to intra-individual patterns of burnout symptoms in non-clinical samples such as students, athletes, healthy, and burned-out employees. Different burnout subtypes might therefore exist. Yet, burnout subtypes based on burnout profiles have hardly been explored in clinical patients, and the samples investigated in previous studies were rather heterogeneous including patients with various physical, psychological, and social limitations, symptoms, and disabilities. Therefore, the aim of this study is to explore burnout subtypes based on burnout profiles in clinically diagnosed burnout patients enrolled in an employee rehabilitation program, and to investigate whether the subtypes differ in depression, recovery/resources-stress balance, and sociodemographic characteristics. METHODS: One hundred three patients (66 women, 37 men) with a clinical burnout diagnosis, who were enrolled in a 5 week employee rehabilitation program in two specialized psychosomatic clinics in Austria, completed a series of questionnaires including the Maslach Burnout Inventory - General Survey (MBI-GS), the Beck Depression Inventory, and the Recovery-Stress-Questionnaire for Work. Cluster analyses with the three MBI-GS subscales as clustering variables were used to identify the burnout subtypes. Subsequent multivariate/univariate analysis of variance and Pearson chi-square tests were performed to investigate differences in depression, recovery/resources-stress balance, and sociodemographic characteristics. RESULTS: Three different burnout subtypes were discovered: the exhausted subtype, the exhausted/cynical subtype, and the burned-out subtype. The burned-out subtype and the exhausted/cynical subtype showed both more severe depression symptoms and a worse recovery/resources-stress balance than the exhausted subtype. Furthermore, the burned-out subtype was more depressed than the exhausted/cynical subtype, but no difference was observed between these two subtypes with regard to perceived stress, recovery, and resources. Sociodemographic characteristics were not associated with the subtypes. CONCLUSIONS: The present study indicates that there are different subtypes in clinical burnout patients (exhausted, exhausted/cynical, and burned-out), which might represent patients at different developmental stages in the burnout cycle. Future studies need to replicate the current findings, investigate the stability of the symptom patterns, and examine the efficacy of rehabilitation interventions in different subtypes.