Evaluation of the AIDS prevention street nurse program: one step at a time.

The AIDS Prevention Street Nurse Program uses specially prepared community health nurses to focus on HIV and STD prevention with marginalized, hard-to-reach and high-risk clients within a broader context of harm reduction and health promotion. Street nurses (n=17), service providers (n=30), representatives of other HIV/STD programs in the province of British Columbia, Canada (n=5), and clients (n=32) were interviewed during an evaluation for the purpose of describing the nurses' work, the challenges the nurses' face, the fit of the program with other services, and the impact of the nurses' work.This article describes the impact of the nurses' work on clients. Impact/outcome changes reflected a progression from knowledge to behavioural levels and to major indicators of health/illness. Impact on clients included: knowing more about HIV/AIDS, their own situation, and options; receiving essential supplies to reduce harm and promote health; changing behaviour to reduce disease transmission, improve resistance, and promote health; connecting with help; feeling better about themselves and others; feeling supported; influencing others; receiving earlier attention for problems; being healthier with or without HIV; making major changes in drug use; and likely decreasing morbidity and mortality. The program was found to be clearly effective in making a positive impact on clients.

The influence of family on immigrant South Asian women's health.

The purpose of this study was to examine the influence of family members on immigrant South Asian women's health and health-seeking behavior. This qualitative study was part of a larger study that examined the health-seeking practices of immigrant South Asian women living in the Lower Mainland of British Columbia, Canada. Using ethnographic methods, data were collected through face-to-face interviews with women who had lived in Canada for 10 months to 31 years. Analysis of translated and transcribed data revealed that women made decisions about their health in consultation with family members. Overall, family members were perceived to be supportive and provided direct and indirect assistance to women in ways that influenced their health. Expected roles and responsibilities often had detrimental influences on women's health. Health care for immigrant South Asian women needs to take into account women's relationships with family members and the influence of family on women's health.

Psychometric assessment of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of HIV-infected women.

Since the late 1980s, several HIV-specific quality of life instruments have been developed; however, little testing has been done in terms of their validity and reliability for HIV-infected women. The purpose of this study was to test the content validity, concurrent validity, internal consistency, and test-retest reliability of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of 85 HIV-infected women. The MQOL-HIV is a 40-item scale comprised of 10 dimensions. Most of the items and all of the domains were determined content valid but revision of some of the items and domains is recommended. Concurrent validity was measured between the MQOL-HIV and the MOS-HIV and ranged from 0.51-0.81 between similar domains. Of the 10 domains and the entire instrument, 7 had a Cronbach's alpha over 0.70 (range 0.43-0.92). Eight domains and the entire instrument achieved test-retest correlation coefficients over 0.70 (range 0.60-0.96). Although some revision may make the scale more content-valid for HIV-infected women, given due care in the interpretation of results, the MQOL-HIV can be used with female populations in its current form.

Othering and being othered in the context of health care services.

Othering is a process that identifies those that are thought to be different from oneself or the mainstream, and it can reinforce and reproduce positions of domination and subordination. Although there are theoretical and conceptual treatments of othering in the literature, researchers lack sufficient examples of othering practices that influence the interactions between patients and health care providers. The purpose of this study was to explore the interactions between health care providers and South Asian immigrant women to describe othering practices and their effects. Ethnographic methods were used involving in-depth interviews and focus group discussions. The analysis entailed identifying uses of othering and exploring the dynamics through which this process took place. Women shared stories of how discriminatory treatment was experienced. The interviews with health care professionals provided examples of how views of South Asian women shaped the way health care services were provided. Three forms of othering were found in informants' descriptions of their problematic health care encounters: essentializing explanations, culturalist explanations, and racializing explanations. Women's stories illustrated ways of coping and managing othering experiences. The analysis also revealed how individual interactions are influenced by the social and institutional contexts that create conditions for othering practices. To foster safe and effective health care interactions, those in power must continue to unmask othering practices and transform health care environments to support truly equitable health care.

Shielding and being shielded: children's perspectives on coping with their mother's cancer and chemotherapy.

Little research has examined children's perceptions of what it was like when their mother was diagnosed and treated with chemotherapy for breast cancer. This research aimed to describe the children's perspectives and to suggest interventions to assist children to manage the experience with less stress. Qualitative naturalistic inquiry methods were used. Purposive sampling was used to recruit children whose mothers had chemotherapy for breast cancer in the prior two years. Eleven children were interviewed individually or with siblings. Children were between seven to 21 years of age. The major theme that emerged was Shielding and Being Shielded. Shielding refers to how children protected themselves from their thoughts and feelings and protected themselves from others. Being Shielded refers to what others did to protect the children. Shielding and Being Shielded each had components reflective of knowing/understanding, acknowledging/feeling, sharing, and shifting/helping. Recommendations directed towards assisting children, parents, and nurses and other health care professionals are suggested.