Internet Use for Health-Related Information: Self-Care Agency of Lower Income Persons Living With HIV/AIDS.

Chronically ill persons with a condition requiring self-care activities can benefit from learning from reliable internet sources. Orem's theory of self-care was used to answer the question: Does increasing technical knowledge about reliable internet sites for health information increase self-care agency of low-income persons living with HIV/AIDS (N = 100)? Self-care agency, as measured by the Self-As-Carer Inventory, increased but not significantly, after two educational interventions. We hoped to gain insight into the measurement of self-care agency in our African American and Hispanic population. The only significantly different basic conditioning factor was ethnicity in that non-Hispanic/Latinos scored higher on self-care agency than Hispanic/Latinos; the only significantly different subscale was the Judgment and Decisions Affecting Production of Self-care subscale. Self-care agency remained stable over the 1-week period, pointing to two possible conclusions: Scores accurately reflect self-care agency, and a more intensive, longer intervention may be needed to change self-care agency.

Do Brief Educational Sessions Increase Electronic Health Literacy of Low-Income Persons Living With HIV/AIDS?

This research explored whether participating in a brief educational intervention using the National Library of Medicine video, Evaluating Health Information: A Tutorial From the National Library of Medicine, would increase electronic health literacy. A quasi-experimental longitudinal design was used in two randomly selected settings of a treatment program for low-income persons living with HIV/acquired immune deficiency syndrome (N = 100). Individuals in both intervention groups watched the video and completed an at-home assignment brought to the second session 1 week later; one group received an additional 15 minutes with an HIV nurse clinician who reinforced video content. Generalized linear models were used in order to account for the longitudinal nature of the data; a full model was fitted first that included age, gender, race, ethnicity, education, acquired immune deficiency syndrome diagnosis, time, group, and the interaction of time by intervention group with electronic health literacy as the dependent variable. Group means were not significantly different, and the overall group pattern were the same; the only significant variable was older age, which is consistent with the findings of other literature. Electronic health literacy can be increased by viewing a free video; making this video available in a variety of settings and encouraging clients to use the Internet as a source of health information may improve self-management strategies of persons living with chronic illnesses.

HIV and aging: A primer for NPs.

Estimates indicate 70% of all individuals with HIV will be age 50 or older by 2030. Chronic conditions, including cardiovascular disease, diabetes mellitus, kidney disease, malignancies, neurocognitive disorders, and osteopenia or osteoporosis, occur more frequently in patients with HIV and have become the leading cause of morbidity in this population. NPs play an integral role in helping this population age healthfully.

A qualitative description of service providers' experiences of ethical issues in HIV care.

BACKGROUND: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. RESEARCH DESIGN: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. PARTICIPANTS AND CONTEXT: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. ETHICAL CONSIDERATIONS: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. FINDINGS: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. DISCUSSION: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. CONCLUSION: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Perceptions of low income HIV+ persons about finding accurate web-based health information.

AIM: To explore perceptions of low income persons living with HIV/AIDS and history of substance abuse about how they decide whether an internet site is a credible source of health-related information. BACKGROUND: It is hard for any consumer to determine whether the information that is available on the internet is trustworthy and even more challenging for consumers with low health literacy and insufficient computer literacy skills. METHODS: Mixed methods with sequential explanatory design. Electronic health literacy was measured with eHEALS and a new instrument to measure confidence in choosing a credible internet site for health-related information was developed. Qualitative data were collected during three focus groups held in high prevalence neighborhoods in New York City and after participants watched a 16-minute video produced by the United States National Library of Medicine. RESULTS: Participants had low electronic health literacy and there was no relationship between electronic health literacy and confidence in identifying a credible internet site. Six themes emerged: I haven't learned enough from the Medline video; I am not computer literate; the Internet has too many scams; the Internet piques interest in learning health-related information; prefer 1:1 interactions with trusted source for health information; and you don't have to expose HIV status to get information. CONCLUSION: Low income persons are interested in using the internet for health information but reluctant to do so due to multiple complex barriers. Follow-up interventions would include skills training in which persons are taught how to identify credible sites.

Understanding Health Literacy for People Living With HIV: Locations of Learning.

Health literacy, including people's abilities to access, process, and comprehend health-related information, has become an important component in the management of complex and chronic diseases such as HIV infection. Clinical measures of health literacy that focus on patients' abilities to follow plans of care ignore the multidimensionality of health literacy. Our thematic analysis of 28 focus groups from a qualitative, multisite, multinational study exploring information practices of people living with HIV (PLWH) demonstrated the importance of location as a dimension of health literacy. Clinical care and conceptual/virtual locations (media/Internet and research studies) were used by PLWH to learn about HIV and how to live successfully with HIV. Nonclinical spaces where PLWH could safely discuss issues such as disclosure and life problems were noted. Expanding clinical perspectives of health literacy to include location, assessing the what and where of learning, and trusted purveyors of knowledge could help providers improve patient engagement in care.

A Systematic Review of Health Literacy Interventions for People Living with HIV.

Health literacy significantly impacts health-related outcomes among people living with HIV. Our aim was to systematically review current literature on health literacy interventions for people living with HIV. The authors conducted a thorough literature search following the PRISMA statement and the AMSTAR checklist as a guide, and found six studies that met inclusion/exclusion criteria. The majority of these interventions were designed to improve HIV treatment adherence as well as HIV knowledge and treatment-related skills, with one study focusing on e-Health literacy. Several of the studies demonstrated trends toward improvement in medication adherence, but most did not achieve statistical significance primarily due to methodological limitations. Significant improvements in knowledge, behavioral skills, and e-Health literacy were found following interventions (p = 0.001-0.05). Health literacy interventions have the potential to promote HIV-related knowledge, behavioral skills, and self-management practices. More research is needed to assess the efficacy of interventions to promote a variety of self-management practices.

Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members.

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Advancing HIV Nursing Practice: The Doctor of Nursing Practice HIV Specialty at Rutgers, the State University of New Jersey.

The move to integrate HIV treatment and care into primary care is a major obstacle for the current U.S. health care workforce. Many HIV specialty providers will soon retire, while few primary care clinicians have been adequately trained in the diagnosis, care, and treatment of people living with HIV. The Health Resources and Services Administration (HRSA) has supported the development of a Doctor of Nursing Practice (DNP) program with an HIV specialty at Rutgers, the State University of New Jersey, to assure successful transition to an HIV primary care workforce. The Rutgers School of Nursing has been at the forefront of the DNP education movement and is among the first to develop an HIV-focused DNP program. Thirty-seven students have enrolled in the 3-year program, and two have graduated from the first cohort. Here we discuss the planning, implementation, successes, and recommendations of the new program.

Anxiety symptoms in HIV-infected individuals.

Anxiety is one of the most frequent symptoms recognized by providers who care for persons living with HIV disease (PLWH). This evidence-based review of anxiety and HIV disease includes an overview of anxiety symptoms, their prevalence in PLWH, and co-existing mood and behavioral disorders. Harmful physiologic effects are also highlighted. Valid and reliable clinical measurement tools used for assessing anxiety include the Clinical Diagnostic Questionnaire, the Hamilton Anxiety Scale, the State-Trait Anxiety Scale, the Profile of Mood States, and the Hospital Anxiety and Depression Scale. Evidence supports the use of cognitive behavioral therapy as a recommended intervention for the treatment of anxiety symptoms and/or anxiety disorders in PLWH. Medications for use with more severe and disabling anxiety are discussed, as well as evidence based on expert opinion for anxiety self-management.

A composite case study of a woman with human immunodeficiency virus: integration of nursing research and theory with practice.

PURPOSE: The purpose of this case study is to demonstrate integration of the research-based standardized languages of NANDA-I, the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) with Barrett's middle range theory of power to support a woman's experience of ending sexual exploitation and stopping drug use. DATA SOURCE: Clinical practice, the collective experiences of patients, research evidence, and books that explain NANDA-I, NOC, and NIC. DATA SYNTHESIS: The success of this woman in managing her health supports the use of Barrett's theory of power. CONCLUSION: Theory and research provide the foundations for quality-based clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Identification of readiness to change enabled significant life changes.

Self-compassion: a concept analysis.

This concept analysis uses a modification of the evolutionary method (Rodgers, 1989) to identify the antecedent, attributes, and consequences of self-compassion. The antecedent to self-compassion is suffering, experienced in six possible realms: an event, a situation, an emotional response, a psychological state, spiritual alienation, or a physical response to illness or pain. Suffering has three dimensions: intrapersonal, interpersonal, and contextual. Suffering manifests as a pattern of decreased self-care, decreased ability to relate to others, and diminished autonomy. The attributes of self-compassion are self-kindness, mindfulness, commonality, and wisdom. The consequences of self-compassion are the opposite of the antecedent: self-compassion manifests as a pattern of increased self-care capacity, compassion for others, and increased relatedness, autonomy, and sense of self. Ideal, borderline and contrary cases of self-compassion provide examples of the concept. The article concludes with a discussion of implications of the concept of self-compassion for nursing practice and research.

My first patient as a nurse practitioner: a man with low literacy.

PURPOSE: The purpose of this case study is to demonstrate the use of the nursing process and the standardized nursing languages of NANDA-I, the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a man with low literacy to self-manage his medication regimen. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence related to helping people with low literacy, and the books that explain NANDA-I, NOC, and NIC. DATA SYNTHESIS: This case study demonstrates nurses' clinical decision making in providing care for a person with low health literacy. CONCLUSIONS: Low health literacy should be considered when nurses identify the nursing diagnosis of Ineffective Self-Health Management. After trust is established, a screening tool should be used to evaluate the person's literacy level. Active partnership of the nurse and the person supports interventions to assist the person implement the medication regimen. IMPLICATIONS FOR NURSING: Inadequate evaluation of health literacy may result in mislabeling a person as "nonadherent" or "noncompliant" to a medication or treatment regimen. Low literacy is often an unrecognized barrier to effective self-health management.