Protocol for the pilot quasi-experimental controlled trial of a gender-responsive implementation strategy with providers to improve HIV outcomes in Uganda.

BACKGROUND: Antiretroviral treatment (ART) is the most effective clinical intervention for reducing morbidity and mortality among persons living with HIV. However, in Uganda, there are disparities between men and women in viral load suppression and related HIV care engagement outcomes, which suggests problems with the implementation of ART. Gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement; therefore, the role of gender norms is important to consider in interventions to achieve the equitable provision of treatment and the quality of ART counseling. METHODS: The overall research objective of this study is to pilot test an implementation strategy (i.e., methods to improve the implementation of an evidence-based intervention) to increase providers' capacity to provide gender-responsive treatment and counseling to men and women on HIV treatment in Uganda. Delivered to HIV providers, this group training adapts evidence-based strategies to reduce gender biases and increase skills to deliver gender-specific and transformative HIV counseling to patients. The implementation strategy will be piloted through a quasi-experimental controlled trial. Clinics will be randomly assigned to either the intervention or control conditions. The trial will assess feasibility and acceptability and explore barriers and facilitators to implementation and future adoption while gathering preliminary evidence on the implementation strategy's effectiveness by comparing changes in patient (N = 240) and provider (N = 80-140) outcomes across intervention and control clinics through 12-month follow-up. Quantitative data will be descriptively analyzed, qualitative data will be analyzed through thematic analysis, and these data will be mixed during the presentation and interpretation of results where appropriate. DISCUSSION: This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel implementation strategy to improve men and women's HIV care engagement, with the potential to reduce gender disparities in HIV outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCT05178979 , retrospectively registered on January 5, 2022.

Factors influencing medical student self-competence to provide weight management services.

This study aimed to identify factors associated with high obesity care self-competence among US medical students. The authors performed a cross-sectional analysis of 2014 survey data on fourth year medical students collected online as part of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES). Independent variables included quality and quantity of interaction with patients and peers with obesity; hours of communication and partnership skills training; negative remarks against patients with obesity by supervising physicians, and witnessed discrimination against patients with obesity. The dependent variable was self-competence in providing obesity care. Of 5823 students invited to participate, 3689 (63%) responded and were included in our analyses. Most students were white (65%), half were women and 42% had high self-competence in caring for patients with obesity. Factors associated with high self-competence included increased interaction with peers with obesity (39% vs. 49%, P < 0.001) and increased partnership skills training (32% vs. 61%, P < 0.001). Increased partnership skills training and quantity of interactions with peers with obesity were associated with high student self-competence in providing obesity-related care to patients. Medical schools might consider increasing partnership skills training to improve students' preparedness and skill in performing obesity-related care.

Visual portrayals of obesity in health media: promoting exercise without perpetuating weight bias.

Health education campaigns for preventing and reducing obesity often contain weight-stigmatizing visual content, which may have unintended negative health consequences. The goal of the present research was to identify non-stigmatizing visual content for health education materials that can promote exercise among people of diverse weight statuses. An online sample of 483 US women viewed: (i) a woman with obesity portrayed stereotypically; (ii) a woman with obesity exercising; (iii) a woman with obesity portrayed neutrally; or (iv) a lean woman exercising. Race of the models pictured was randomized (White or Black). Participants completed measures of weight bias and exercise behavior and attitudes, and provided information about their weight status. Analysis of covariance revealed that responses to stereotypical and exercise images varied by participant weight status. Across participants, neutral obesity portrayals elicited lower expressions of weight-biased attitudes and higher reports of exercise liking/comfort. Among non-overweight participants, images portraying women with obesity stereotypically or counter-stereotypically produced greater endorsement of negative stereotypes than control, lean images. No effects of model race were found. These findings suggest that the public responds differently to visual portrayals of obesity depending on weight status, and neutral portrayals may be an effective route toward promoting exercise without perpetuating stigma.

Just say no (to stereotyping): effects of training in the negation of stereotypic associations on stereotype activation.

The primary aim of the present research was to examine the effect of training in negating stereotype associations on stereotype activation. Across 3 studies, participants received practice in negating stereotypes related to skinhead and racial categories. The subsequent automatic activation of stereotypes was measured using either a primed Stroop task (Studies I and 2) or a person categorization task (Study 3). The results demonstrate that when receiving no training or training in a nontarget category stereotype, participants exhibited spontaneous stereotype activation. After receiving an extensive amount of training related to a specific category, however, participants demonstrated reduced stereotype activation. The results from the training task provide further evidence for the impact of practice on participants' proficiency in negating stereotypes.

Aversive racism and selection decisions: 1989 and 1999.

The present study investigated differences over a 10-year period in whites' self-reported racial prejudice and their bias in selection decisions involving black and white candidates for employment. We examined the hypothesis, derived from the aversive-racism framework, that although overt expressions of prejudice may decline significantly across time, subtle manifestations of bias may persist. Consistent with this hypothesis, self-reported prejudice was lower in 1998-1999 than it was in 1988-1989, and at both time periods, white participants did not discriminate against black relative to white candidates when the candidates' qualifications were clearly strong or weak, but they did discriminate when the appropriate decision was more ambiguous. Theoretical and practical implications are considered.

Reducing intergroup bias: elements of intergroup cooperation.

The authors examined the potentially separable contributions of 2 elements of intergroup cooperation, interaction and common fate, and the processes through which they can operate. The manipulation of interaction reduced bias in evaluative ratings, which supports the idea that these components are separable, whereas the manipulation of common fate when the groups were interacting was associated with lower bias in nonverbal facial reactions in response to contributions by in-group and out-group members. Whereas interaction activated several processes that can lead to reduced bias, including decategorization, consistent with the common in-group identity model (S. L. Gaertner, J. F. Dovidio, P. A. Anastasio, B. A. Bachman, & M. C. Rust, 1993) as well as M. Hewstone and R. J. Brown's (1986) group differentiation model, the primary set of mediators involved participants' representations of the memberships as 2 subgroups within a superordinate entity.

Intergroup bias: status, differentiation, and a common in-group identity.

The present research examined factors that moderate and mediate the reduction of intergroup bias. Two 3-person laboratory groups, which had first worked separately on a task, were informed prior to intergroup contact that (a) the groups were equal or unequal in status based on their task performance, and (b) they had been working on the same or on different task dimensions. Consistent with M. Hewstone and R. J. Brown's (1986) mutual intergroup differentiation model, bias was eliminated when the groups' areas of expertise were differentiated and equally valued (i.e., in the equal status-different dimensions conditions). Moreover, as expected on the basis of the common in-group identity model, more inclusive group representations mediated this effect. The findings of the present research thus offer a theoretical integration that can suggest interventions to facilitate positive intergroup contact.

Relationship of solo status, academic rank, and perceived distinctiveness to job satisfaction of racial/ethnic minorities.

The relationships among solo status of racial/ethnic minorities in psychology departments, job satisfaction, and subjective feelings of distinctiveness were examined. Distinctiveness was defined as stigmatizing feelings associated with token status of racial/ethnic minorities in academia. It was hypothesized that minorities in positions of solo (relative to nonsolo) status within their departments, members of more stigmatized groups, and minorities occupying lower academic ranks would feel more distinctive and less satisfied with their jobs and that perceptions of distinctiveness would mediate job satisfaction. The data partially supported these hypotheses, most notably for African Americans. The implications of situational salience and the importance of recognizing differences among and between minority groups are considered.

The relationship of social power to visual displays of dominance between men and women.

Two studies, with undergraduate subjects, investigated how sex and situation-specific power factors relate to visual behavior in mixed-sex interactions. The power variable in Study 1 was expert power, based on differential knowledge. Mixed-sex dyads were formed such that members had complementary areas of expertise. In Study 2, reward power was manipulated. Consistent with expectation states theory, both men and women high in expertise or reward power displayed high visual dominance, defined as the ratio of looking while speaking to looking while listening. Specifically, men and women high in expertise or reward power exhibited equivalent levels of looking while speaking and looking while listening. High visual dominance ratios have been associated with high social power in previous research. Both men and women low in expertise or reward power looked more while listening than while speaking, producing a relatively low visual dominance ratio. In conditions in which men and women did not possess differential expertise or reward power, visual behavior was related to sex. Men displayed visual behavior similar to their patterns in the high expertise and high reward power conditions, whereas women exhibited visual behavior similar to their patterns in the low expertise and low reward power conditions. The results demonstrate how social expectations are reflected in nonverbal power displays.

The relationship between stressful life events and school-related performances of type A and type B adolescents.

Previous research indicates that an individual's style of coping with stress and the nature of stressful events combine to mediate responses to stress. The present study investigated the responses of Type A and Type B high school students to controllable and uncontrollable stressful life events. Specifically, the associations between life stress and gradepoint average, extracurricular activity, sports involvement, days absent, and delinquent behavior were examined. The results revealed a negative relationship between life stress and school-related performance that was more pronounced for Type B than for Type A adolescents. These findings are discussed in terms of different coping mechanisms used by Type A's and B's when encountering environmental stress.

Effects of stress and commonality of fate on helping behavior.

An experiment was performed in order to examine the joint effects of stress and commonality of fate on helping behavior. In a 2 times 2 factorial design, subjects were randomly assigned to one of four conditions in which (a) the subject and a confederate are both awaiting an experiment involving electric shock (high stress-common fate); (b) the subject is awaiting an experiment involving electric shock while the confederate is awaiting an innocuous word association experiment (high stress-dissimilar fate); (c) the subject is awaiting the word association experiment while the confederate awaits shock (low stress-dissimilar fate); and (d) the subject and the confederate are both awaiting an innocuous word association experiment (low stress-common fate). As predicted, a significant interaction, p less than .01, was obtained, indicating that high stress, as compared to low stress, facilitates helping if the potential recipient is in the same stressful situation but inhibits helping if the potential recipient is in a dissimilar and less stressful situation.