Application of ADAPT-ITT: adapting an evidence-based HIV/STI mother-daughter prevention intervention for Black male caregivers and girls.

BACKGROUND: Black girls are disproportionately impacted by HIV and sexually transmitted infections (STIs), underscoring the urgent need for innovative strategies to enhance the adoption and maintenance of HIV/STI prevention efforts. Historically, Black male caregivers have been left out of girls' programming, and little guidance exists to inform intervention development for Black girls and their male caregivers. Engaging Black male caregivers in Black girls' sexual and reproductive health may reduce sexual risk-taking and improve the sustainability of preventative behaviors. OBJECTIVE: This paper describes the formative phases, processes, and methods used to adapt an evidence-based mother-daughter sexual and reproductive health intervention for Black girls 9-18 years old and their male caregivers. METHODS: We used the ADAPT-ITT model to tailor IMARA for Black girls and their male caregivers. Diverse qualitative methods (interviews, focus groups, and theater testing) were used throughout the adaption process. RESULTS: Findings support using the ADAPT-ITT model to tailor an evidence-based HIV/STI intervention for Black girls and their Black male caregivers. Findings highlight the importance of community engagement and the use of qualitative methods to demonstrate the acceptability and feasibility of the adapted intervention. Key lessons learned are reviewed. CONCLUSIONS: Adapting evidence-based interventions to incorporate Black girls and their Black male caregivers should be driven by a relevant theoretical framework that aligns with the target population(s). Adapting the intervention in partnership with the community has been shown to improve acceptability and feasibility as it is responsive to community needs. Using a systematic process like the ADAPT-ITT model will ensure that the new program is ready for efficacy trials.

Building community-engaged health research and discovery infrastructure on the South Side of Chicago: science in service to community priorities.

OBJECTIVE: To describe the roles community members can and should play in, and an asset-based strategy used by Chicago's South Side Health and Vitality Studies for, building sustainable, large-scale community health research infrastructure. The Studies are a family of research efforts aiming to produce actionable knowledge to inform health policy, programming, and investments for the region. METHODS: Community and university collaborators, using a consensus-based approach, developed shared theoretical perspectives, guiding principles, and a model for collaboration in 2008, which were used to inform an asset-based operational strategy. Ongoing community engagement and relationship-building support the infrastructure and research activities of the studies. RESULTS: Key steps in the asset-based strategy include: 1) continuous community engagement and relationship building, 2) identifying community priorities, 3) identifying community assets, 4) leveraging assets, 5) conducting research, 6) sharing knowledge and 7) informing action. Examples of community member roles, and how these are informed by the Studies' guiding principles, are provided. CONCLUSIONS: Community and university collaborators, with shared vision and principles, can effectively work together to plan innovative, large-scale community-based research that serves community needs and priorities. Sustainable, effective models are needed to realize NIH's mandate for meaningful translation of biomedical discovery into improved population health.

Faith as a Mechanism for Health Promotion among Rural African American Prostate Cancer Survivors: A Qualitative Examination.

Conceptualized using critical race theory as a theoretical underpinning, this study analyzed the lived experiences of older, rural, African American male prostate cancer (hereafter referenced as PrCA) survivors' faith and health promotion practices within Northeast Louisiana. Qualitative data from journaling, observations, and semi-structured interviews were obtained from ten older, African American male PrCA survivors residing in four rural parishes of Louisiana. The data analysis employed a two-stage approach known as Polkinghorne's analysis of narratives and narrative analysis using an art-based methodological approach. Framed as composite character counterstories, survivors' narratives revealed how survivors made sense of and gave meaning to their PrCA diagnosis, treatment, recovery, and survivorship. Specifically, their counterstories indicate that centering and honoring the unique and often taken-for-granted perspectives of older, rural, African American male PrCA survivors offered a deeper understanding of the multiple factors influencing their quality of life, as well as the sociostructural mechanisms impacting their survivorship care. Faith was examined as both a secular and sacred source of support that these men viewed as central to the acceptance of their diagnosis, treatment, recovery, and survivorship.

African American adolescent males' views on doctors and the health care system.

OBJECTIVE: African American adolescent males have disproportionately high rates of morbidity and mortality and low levels of primary care use. To optimize health care for this group, there is a need to understand their views on doctors and health care, reasons for foregone care, and preferences regarding provision of health care. METHODS: This was a pilot survey of African American adolescent males attending community groups in Chicago. RESULTS: A majority of respondents agreed with declarative statements about doctors being considerate, truthful, and respectful (63%, 80%, and 80%, respectively). A majority also indicated that the health care system informs them of ways to stay healthy (65%), but fewer agreed that it meets the needs of adolescents and minorities (44% and 33%, respectively). Race/gender concordance with physicians did not seem to be a high priority. Significant reasons for foregone care included conflict with school hours, parents not having time, and lack of transportation. Despite access issues, only a minority of participants wanted health care services co-located with other aspects of their daily lives (school, community centers, church, and barbershops). CONCLUSION: African American adolescent males may view doctors and the health care system positively. Eliminating barriers to care and ensuring positive interactions may create opportunities to improve health issues afflicting these at-risk adolescents.

Game Changers: A Critical Race Theory Analysis of the Economic, Social, and Political Factors Impacting Black Fatherhood and Family Formation.

Family has always been one of the strongest institutions in the African American community. However, over the past 30 years, massive changes have occurred within the structure of African American families, resulting in many fathers living apart from their children. Applying the basic tenets of Critical Race Theory (CRT) and Michelle Alexander's notion of Racialized "Game Changing," this article examines the social, political, and economic factors that have worked to undermine normative Black fatherhood involvement and family formation patterns over time. Two of the major arguments-the slavery argument and the cultural argument-offered in the empirical research literature in an attempt to explain the shifts that have occurred within Black families historically are also examined, followed by an in-depth discussion and analysis of factors that underlie the changes in Black family structure and formation over time. The article concludes with a set of policy recommendations for strengthening Black fatherhood and family formation in the 21st century.

According to him: barriers to healthcare among African-American men.

OBJECTIVES: We sought to elicit barriers to health and primary healthcare use among African-American men residing in a low-income, urban area. METHODS: We conducted a qualitative study of African-American men using focused group interviews. A purposive sampling technique was used to recruit 8 select subgroups: adolescents (age 16-18), trauma survivors, HIV-positive men, homeless men, men who have sex with men (MSM), substance abusers, church affiliated men and a mixed sample (N=71). Focus groups were moderated by trained, African-American male focus group leaders. RESULTS: Qualitative analysis of focused group transcripts yielded 2 major categories-intrinsic barriers and extrinsic barriers. Within the intrinsic barriers category, 5 subcategories emerged: lack of health awareness, fear, healthcare as needed, medical mistrust and fatalism. Extrinsic barriers included cost/benefit, clinic experience, and cultural and linguistic differences. Participants also offered solutions to address key barriers. CONCLUSIONS: African-American men identified key intrinsic and extrinsic barriers to health and primary healthcare, including lack of health awareness and providers' cultural and linguistic differences. These barriers constitute important areas of future research and intervention to address African-American men's health and willingness to seek healthcare.

African-American men's perceptions of health: a focus group study.

African-American men are disproportionately affected by preventable medical conditions, yet they underutilize primary care health services. Because healthcare utilization is strongly dependent on health beliefs, the purpose of this qualitative study was to identify and explore African-American men's perceptions of health and health influences. We conducted eight focus group interviews with select subgroups of African-American men, including adolescents, trauma survivors, HIV-positive men, homeless men, men who have sex with men, substance abusers, church-affiliated men and a mixed sample (N=71). Definitions of health, beliefs about health maintenance and influences on health were elicited. Participants' definitions of health went beyond the traditional "absence of disease" definition and included physical, mental, emotional, economic and spiritual well-being. Being healthy also included fulfilling social roles, such as having a job and providing for one's family. Health maintenance strategies included spirituality and self-empowerment. Stress was cited as a dominant negative influence on health, attributed to lack of income, racism, "unhealthy" neighborhoods and conflict in relationships. Positive influences included a supportive social network and feeling valued by loved ones. This study provides insight into African-American men's general health perceptions and may have implications for future efforts to improve healthcare utilization in this population.

Fathers in child welfare: caseworkers' perspectives.

Five focus groups substantially agreed about the lack of paternal participation in child welfare services and the reasons for low paternal involvement. The groups had considerable disagreement about whether child welfare professionals should address this issue. Some caseworkers believed that all fathers and mothers should be treated identically with respect to services to be offered and time frames for services; other caseworkers thought that the special circumstances of some fathers, such as lack of child care experience, called for service approaches that differ from those for mothers. Another disagreement was whether more fathers would be more involved if services were gender sensitive, that is, if agencies provided male caseworkers for fathers and had father-only services. Much of the debate focused on pragmatic considerations (would gender-sensitive services improve paternal participation and outcomes?), although some participants were concerned about equity (would such services give fathers an advantage in disputed custody cases?).