Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh.

BACKGROUND: Post-hospital discharge mortality risk is high among young children in many low and middle-income countries (LMICs). The available literature suggests that child, caregiver and health care provider gender all play important roles in post-discharge adherence to medical advice, treatment-seeking and recovery for ill children in LMICs, including those with undernutrition. METHODS: A qualitative study was embedded within a larger multi-country multi-disciplinary observational cohort study involving children aged less than 2 years conducted by the Childhood Acute Illness and Nutrition (CHAIN) Network. Primary data were collected from family members of 22 purposively selected cohort children. Family members were interviewed several times in their homes over the 6 months following hospital discharge (total n = 78 visits to homes). These in-depth interviews were complemented by semi-structured individual interviews with 6 community representatives, 11 community health workers and 12 facility-based health workers, and three group discussions with a total of 24 community representatives. Data were analysed using NVivo11 software, using both narrative and thematic approaches. RESULTS: We identified gender-related influences at health service/system and household/community levels. These influences interplayed to family members' adherence to medical advice and treatment-seeking after hospital discharge, with potentially important implications for children's recovery. Health service/system level influences included: fewer female medical practitioners in healthcare facilities, which influenced mothers' interest and ability to consult them promptly for their child's illnesses; gender-related challenges for community health workers in supporting mothers with counselling and advice; and male caregivers' being largely absent from the paediatric wards where information sessions to support post-discharge care are offered. Gendered household/community level influences included: women's role as primary caretakers for children and available levels of support; male family members having a dominant role in decision-making related to food and treatment-seeking behaviour; and greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children. CONCLUSIONS: A complex web of gender related influences at health systems/services and household/community levels have important implications for young children's recovery post-discharge. Immediate interventions with potential for positive impact include awareness-raising among all stakeholders - including male family members - on how gender influences child health and recovery, and how to reduce adverse consequences of gender-based discrimination. Specific interventions could include communication interventions in facilities and homes, and changes in routine practices such as who is present in facility interactions. To maximise and sustain the impact of immediate actions and interventions, the structural drivers of women's position in society and gender inequity must also be tackled. This requires interventions to ensure equal equitable opportunities for men and women in all aspects of life, including access to education and income generation activities. Given patriarchal norms locally and globally, men will likely need special targeting and support in achieving these objectives.

Low-Sodium Dietary Perceptions and Experiences of African-American Women with Hypertension.

African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.

Fatores associados à adesão ao tratamento medicamentoso de afrodescendentes hipertensos residentes em comunidade quilombola: um estudo transversal / Factores asociados con la adherencia al tratamiento farmacológico de afrodescendientes hipertensos residentes en la comunidad de quilombola: un estudio transversal / Factors associated to adherence to hypertensive medicinal treatment for african descent people resident in quilombola community: a cross-sectional study

Introduction: Hypertension is a severe public health problem, especially in African descent people, such as those living in quilombos. Drug adherence helps reducing blood pressure levels. However, little is known about the factors related to drug adherence in hypertensive people living in the urban quilombola community. Objetive: To analyze the adherence to drug treatment and factors associated with cardiovascular health in Afro-descendants with hypertension, living in families from the urban quilombola community. Material and Methods: A cross-sectional delineate, community-based census study carried out in an urban quilombola community in a municipality of the Brazilian northeast. The study population consisted of 302 people between 35 and 79 years old, of both genders and with a diagnosis of arterial hypertension registered in medical records of the adscript basic health unit. The following instruments were used for data collect: a questionnaire on arterial hypertension in primary care and Morisky's drug adherence scale (MMAS-8). Results: There was a predominance of black hypertensive female subjects, low schooling and financial income, resident with relatives, retirees and not working. In the analysis of multiple regression the following was associated with drug adherence: Female Gender (OR 0.50 95% IC: 0.29-0.89, Adjusted OR 0.49 95% CI: 0.29-0.84), age (OR 0,96 95% IC: 0.96-0.99 Adjusted OR 0.95 95% CI: 0.93-0.97) and systolic blood pressure (SBP) (OR 1,00 95% IC: 0.99-1.02, Adjusted OR 1.11 95% CI:1.00-1.02). Of the hypertensive people who adhered to the medication, 91% lived with a companion and the majority had a sedentary behavior. Conclusions: The variables gender, age and SBP influence drug adherence of hypertensive people living in the urban quilombola community. Living with relatives can positively influence this adherence. Promoting interventions that encourage the adoption of healthy life habits can potentiate blood pressure control.

Introducción: la hipertensión es un grave problema de salud pública, especialmente en personas de ascendencia africana, como las que viven en quilombos. La adherencia a los medicamentos ayuda a reducir los niveles de presión arterial. Sin embargo, se sabe poco sobre los factores relacionados con la adherencia a las drogas en personas hipertensas que viven en la comunidad urbana de quilombola. Objetivo: analizar la adherencia al tratamiento farmacológico y los factores asociados con la salud cardiovascular, en personas con hipertensión arterial, que viven en comunidades urbanas de quilombolas. Materiales y Métodos: Estudio censal, transversal y comunitario, realizado en una comunidad urbana de quilombolas en un municipio del noreste de Brasil. La población de estudio fue de 302 personas de 35 a 79 años, de ambos sexos y diagnosticadas con hipertensión arterial registrada en el registro médico de la unidad básica de salud ingresada. Para la recolección de datos, se utilizaron los siguientes instrumentos: cuestionario de hipertensión arterial en atención primaria y la escala de adherencia a la medicación de Morisky (MMAS-8). Resultados: Había un predominio de sujetos femeninos hipertensos negros, baja escolaridad e ingresos financieros, residentes con familiares, jubilados y que no trabajaban. En el análisis de regresión múltiple, lo siguiente se asoció con la adherencia al fármaco: sexo femenino (OR 0.50 IC 95%: 0.29-0.89, OR ajustado 0.49 IC 95%: 0.29-0.84), edad (OR 0,96 IC 95%: 0.96 -0.99 OR ajustado 0.95 95% IC: 0.93-0.97) y presión arterial sistólica (PAS) (OR 1,00 95% IC: 0.99-1.02, OR ajustado 1.11 95% IC: 1.00-1.02). De las personas hipertensas que se adhirieron a la medicación, el 91% vivía con un compañero y la mayoría tenía un comportamiento sedentario. Conclusiones: Las variables, sexo, edad y PAS influyen en la adherencia a la medicación de las personas hipertensas que viven en una comunidad urbana de quilombolas. Vivir con miembros de la familia puede influir positivamente en esta adhesión. Promover intervenciones que fomenten la adopción de hábitos de vida saludables puede mejorar el control de la presión arterial.

Introdução: A hipertensão é um grave problema de saúde pública, principalmente em pessoas de ascendência africana, como as que vivem em quilombos. A adesão ao medicamento ajuda a reduzir os níveis de pressão arterial. Entretanto, pouco se sabe sobre os fatores relacionados à adesão às drogas em hipertensos residentes na comunidade urbana quilombola. Objetivo: Analisar a adesão ao tratamento medicamentoso e fatores associados à saúde cardiovascular, em afrodescendentes hipertensos, residentes em famílias de comunidade quilombola urbana. Materiales e Métodos: Estudo censitário, de delineamento transversal e base comunitária, realizado em uma comunidade quilombola urbana em um município do nordeste brasileiro. A população do estudo foi de 302 pessoas com idade entre 35 à 79 anos, de ambos os sexos e com diagnóstico de hipertensão arterial registrado em prontuário da unidade básica de saúde adscrita. Para a coleta de dados utilizou-se os instrumentos: questionário de hipertensão arterial na atenção primária e escala de adesão medicamentosa de Morisky (MMAS-8). Resultados: Houve predomínio de mulheres negras hipertensas, baixa escolaridade e renda financeira, residentes com parentes, aposentados e não trabalhar. Na análise de regressão múltipla, associou-se a adesão à droga: Sexo Feminino (OR 0,50 IC 95%: 0,29-0,89, OR ajustado 0,49 IC 95%: 0,29-0,84), idade (OR 0,96 IC 95%: 0,96 -0,99 OR ajustado 0,95 IC95%: 0,93-0,97) e pressão arterial sistólica (PAS) (OR 1,00 IC95%: 0,99-1,02, OR ajustado 1,11 IC95%: 1,00-1,02). Das hipertensas que aderiram ao medicamento, 91% moravam com companheiro e a maioria apresentava comportamento sedentário. Conclusões: As variáveis, sexo, idade e PAS influenciam na adesão medicamentosa de pessoas hipertensas residentes em comunidade quilombola urbana. Conviver com familiares pode influenciar positivamente nesta adesão. Promover intervenções que incentivem a adoção de hábitos saudáveis de vida podem potencializar o controle da pressão arterial.

Supporting holistic care for patients with tuberculosis in a remote Indigenous community: a case report.

CONTEXT: Tuberculosis (TB) is a serious infectious disease with high rates of morbidity and mortality if left untreated. In Australia, TB has been virtually eradicated in non-Indigenous Australian-born populations but in remote Aboriginal and/or Torres Strait Islander communities TB presents a rare but significant public health issue. Remote health services are most likely to encounter patients with suspected and confirmed TB diagnosis but may be unprepared for supporting someone with this disease and the complexities of balancing public health risk with patient autonomy. ISSUE: This case study will outline the process for diagnosis and treatment of a TB patient in a remote Cape York community. This case involved significant delay in diagnosis and required several strategies to achieve successful disease eradication. The process of treatment, however, had a significant effect on the patient's physical health, and social and emotional wellbeing. LESSONS LEARNED: This case highlights the importance of early collaboration between medical, nursing, Indigenous health worker and allied health services and the importance of technology such as electronic information records to support opportunistic access to diagnostic services and treatment. The enactment of the TB protocol should include discussions about the consequences of any restrictions of movement, employment or social/community roles. Identifying alternative opportunities to engage in meaningful roles may reduce the impact the disease has on a patient's quality of life.

Identity and treatment adherence in predominantly ethnic minority teens and young adults with type 1 diabetes.

BACKGROUND: The demands of diabetes care can place substantial burden on youth with type 1 diabetes (T1D), who must manage their treatment in conjunction with the developmentally typical tasks of adolescence. How diabetes affects the normative task of identity development deserves further exploration. METHODS: A sample of 83 participants (ages 13-21) completed a qualitative interview about life with diabetes and a battery of validated psychosocial measures. Individual interviews were analyzed using content analysis to create criteria for whether a teen had incorporated their T1D in relation to their identity. Convergent validity was assessed by comparing identity groups on various validated measures of psychosocial characteristics and health-related outcomes. Analysis of covariances (ANCOVAs) were used to determine whether identity status had a significant relationship to health outcomes. RESULTS: Results indicated that youth who were categorized as incorporating their T1D into their identities demonstrated significantly greater perceived social competency (P = .014), greater diabetes-specific self-esteem (P < .001), better self-care (P = .002), and more life satisfaction (P = .001) than those who had not incorporated T1D. Incorporation was also associated with better glycemic control (P = .003). Identity remained significantly associated with the above psychosocial and health-related outcomes even when controlling for covariates of gender and method of insulin delivery (Ps < .01). CONCLUSIONS: Successful incorporation of diabetes is associated with better biomedical and psychosocial outcomes in teens with T1D. Further research is warranted to assess influences on identity as well as how to encourage and support incorporation in this at-risk population.

Group Prenatal Care Attendance and Women's Characteristics Associated with Low Attendance: Results from Centering and Racial Disparities (CRADLE Study).

OBJECTIVES: Group prenatal care (GPC), an alternative to individual prenatal care (IPC), is becoming more prevalent. This study aimed to describe the attendance and reasons of low attendance among pregnant women who were randomly assigned to receive GPC or IPC and explore the maternal characteristics associated with low-attendance. METHODS: This study was a descriptive study among Medically low risk pregnant women (N = 992) who were enrolled in an ongoing prospective study. Women were randomly assigned to receive CenteringPregnany GPC (N = 498) or IPC (N = 994) in a single clinical site The attendance frequency and reason for low-attendance (i.e. ≤ 5/10 sessions in GPC or ≤ 5 visits in IPC) were described separately in GPC and IPC. Multivariable logistic regressions were performed to explore the associations between maternal characteristics and low-attendance. RESULTS: On average, women in GPC attended 5.32 (3.50) sessions, with only 6.67% attending all 10 sessions. Low-attendance rate was 34.25% in GPC and 10.09% in IPC. The primary reasons for low-attendance were scheduling barriers (23.19%) and not liking GPC (16.43%) in GPC but leaving the practice (34.04%) in IPC. In multivariable analysis, lower perceived family support (P = 0.01) was positively associated with low-attendance in GPC, while smoking in early pregnancy was negatively associated low-attendance (P = 0.02) in IPC. CONCLUSIONS FOR PRACTICE: Scheduling challenges and preference for non-group settings were the top reasons for low-attendance in GPC. Changes may need to be made to the current GPC model in order to add flexibility to accommodate women's schedules and ensure adequate participation. TRIAL REGISTRATION: NCT02640638 Date Registered: 12/20/2015.

Asian American and Pacific Islander substance use treatment completion.

Mental health professionals and administrators work to improve substance use treatment for racially and ethnically diverse populations. However, a national comparison study of Asian Americans and Pacific Islanders (AAPIs) and non-AAPIs substance use outpatient treatment completion has received little attention. The present study examined treatment completion by comparing AAPI clients to White and Latinx clients, and identified demographic and treatment-related moderating factors associated with treatment completion using discharge data from the Treatment Episode Data Sets-Discharge (TEDS-D). A retrospective analysis of AAPI treatment completion was conducted using logistic regression for the years 2006-2011 (N = 2,356,883). AAPIs were significantly more likely to complete treatment than non-AAPIs when controlling for all study variables in the multivariate model, Wald χ[1]2 = 158.60, p < .001, AOR = 1.19, 95% CI = 1.15-1.21. Additionally, we found a moderating effect (Wald χ[2]2 = 69.65, p < .001) with large effect sizes in treatment completion differences between the three comparison groups (AAPI, White, and Latinx). Results demonstrated AAPI clients are more likely to complete treatment than White and Latinx clients with small effect sizes. Additionally, being female, an adolescent, in school, living with parents or adult guardians, having more frequent substance use, and being admitted to treatment at younger age in the AAPI samples were associated with higher treatment completion percentages with clinically meaningful effect sizes. These findings may help to enhance and expand culturally competent psychological services to AAPIs at risk for substance use problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A qualitative study on alcohol consumption and HIV treatment adherence among men living with HIV in Ugandan fishing communities.

Ugandan fishing communities are dually burdened with high rates of HIV and alcohol use. This qualitative study explores context and motivation of alcohol consumption, and alcohol's effect on antiretroviral treatment (ART) adherence, among male fisherfolk living with HIV in Wakiso District, Uganda. We conducted in-depth semi-structured interviews with 30 men in HIV care and on ART, and used a thematic analysis approach for analysis. Alcohol use was identified as a major barrier to ART adherence through cognitive impairment and the intentional skipping of doses when drinking. Men reportedly reduced their drinking since HIV diagnosis - motivated by counseling received from providers and a newfound desire to live a healthy lifestyle. However, social, occupational, and stress-related influences that make alcohol reduction difficult were identified. Our findings suggest alcohol use may pose a challenge to ART adherence for fishermen living with HIV - and has implications for the tailoring of screening and brief intervention for alcohol reduction in HIV care for this population.

Enhancing Adherence to Care in the HIV Care Continuum: The Barrier Elimination and Care Navigation (BEACON) Project Evaluation.

Interventions are needed to address each phase of the HIV care continuum in order to improve health outcomes and reduce likelihood of HIV transmission. The purpose of this study was to assess the impact of a community- and clinic-based intervention designed and implemented to reengage individuals who were lost to HIV care. Eligible participants had either never engaged in HIV care or had not had a medical visit for at least 12 months. Participants enrolled in a community- and clinic-based intervention that included intensive case management, access to a community nurse and peer navigator, as well as emergency stabilization funds. Data were collected at baseline and 6-month time points by the case managers; which included sociodemographics, general health, abstracted HIV viral loads and CD4 cell counts from their medical records. Descriptive and GEE analyses were conducted to assess changes from baseline to 6 months. A total of 322 participants enrolled over a 5-year period, of whom the majority were male (n = 250) and African American with a mean age of 42.0 years. After 6 months of the intervention, there was a significant increase of individuals who had undetectable HIV viral loads and their median CD4 cell counts increased (p < 0.01 for both). General health improved as well (p < 0.01). It is clear that this method of engagement, while staff intensive, is successful at engaging and retaining individuals in HIV care at least through 6 months.

Body dissatisfaction predicts poor behavioral weight loss treatment adherence in overweight Mexican American women.

Poor adherence poses a major barrier to the success of behavioral weight loss (BWL) programs, particularly for overweight Mexican American women. Given the high prevalence and costs of overweight/obesity, factors that contribute to attendance and adherence problems should be identified, especially in ethnic minority populations. The current study examined the role of pre-treatment body dissatisfaction and depression in predicting attendance and adherence in a BWL intervention. Ninety-nine overweight/obese Mexican American women enrolled in the intervention and completed baseline measures. Eighty-one of the women attended at least one treatment session and provided measures of dietary and physical activity adherence. Simultaneous linear regression analyses suggested that although higher levels of body dissatisfaction and depression each played unique roles in predicting poorer attendance, only body dissatisfaction predicted adherence. Specifically, higher body dissatisfaction predicted poorer treatment adherence. Findings highlight the importance of addressing body dissatisfaction early in BWL treatment to increase attendance and adherence.

Trajectory of systolic blood pressure in a low-income, racial-ethnic minority cohort with diabetes and baseline uncontrolled hypertension.

In two primary care clinics in Texas serving low-income patients, systolic blood pressure (SBP) trajectory was examined during 2 years in patients with diabetes mellitus (mean SBP ≥140 mm Hg: 152 mm Hg±11.2 in the baseline year). Among 860 eligible patients, 62.0% were women, 78.8% were Hispanic, and 41.2% were uninsured. Overall, SBP dropped 0.56 mm Hg per month or 13.4 mm Hg by 24 months. For patients with mean glycated hemoglobin ≥9% in year 1, SBP declined 4.8 mm Hg less by 24 months vs those with glycated hemoglobin <7% (P=.03). Compared with white women, SPB declined 7.2 mm Hg less by 24 months in Hispanic women (P=.03) and 9.6 mm Hg less by 24 months in black men (P=.04). SBP also declined 9.1 mm Hg less by 24 months for patients taking four or more blood pressure drug classes at baseline vs one drug class. In this low-income cohort, clinically complex patients and racial-ethnic minorities had clinically significantly smaller declines in SBP.

Reliability and validity of the Chinese version of the HIV Treatment Adherence Self-Efficacy Scale in mainland China.

The aim of this study was to translate the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and evaluate its reliability and validity in people living with HIV (PLWHIV) in mainland China. The original HIV-ASES was translated from English into Chinese and adapted for cultural context according to cross-cultural adaptation guidelines. A cross-sectional survey investigating 1742 PLWHIV receiving antiretroviral treatment was conducted. Exploratory factor analysis with varimax rotation confirmed the presence of two factors with an accumulated contribution rate of 58.357%. Furthermore, confirmatory factor analysis revealed the model's goodness-of-fit index. The comparative fit index was greater than 0.9 and the overall efficacy of the model was satisfactory. The Cronbach α coefficient of the questionnaire was 0.876 (95% CI: 0.868-0.885), and the correlation coefficient of each item and the total was 0.536-0.660 ( P < 0.01). The Chinese version of the HIV-ASES has high reliability and validity; however, the individual item requires some adjustment.

Medical mistrust among social network members may contribute to antiretroviral treatment nonadherence in African Americans living with HIV.

RATIONALE: African Americans living with HIV are less likely to adhere to antiretroviral treatment (ART) compared to other racial/ethnic groups. Medical mistrust is thought to be a factor in this disparity. OBJECTIVE: We examined (1) whether exposure to HIV conspiracy beliefs, a specific type of HIV-related mistrust (about the origins and treatment of HIV) in social networks is associated with ART nonadherence among African Americans living with HIV; and (2) the characteristics of individuals who discuss HIV-related mistrust in the social networks of African Americans living with HIV. METHODS: At baseline and 6- and 12-months post-baseline, 175 African Americans living with HIV on ART completed egocentric social network assessments, from which we assessed the structure and composition of their personal networks (the social context immediately surrounding them). HIV-related mistrust was operationalized with an indicator of whether any social network member had expressed HIV conspiracy beliefs to the participant. Daily medication adherence was monitored electronically. RESULTS: At baseline, 63% of participants agreed with at least one conspiracy belief, and 55% reported hearing at least one social network member ("alter") express conspiracy beliefs. In a multivariate linear repeated measures regression, expression of conspiracy beliefs by similar others in the network (in terms of age, gender, HIV status, sexual orientation, and race/ethnicity) was associated with ART nonadherence (i.e., percentage of prescribed doses taken). In a multivariate logistic regression, expression of conspiracy beliefs was more likely among social network members who were HIV-positive, who knew the participants' serostatus, and with whom participants interacted frequently, and less likely among more well-connected social network members. CONCLUSION: HIV-related mistrust in the network may be most influential when expressed by similar others who may be HIV-positive themselves.

Motivación para el cambio: una construcción conjunta que posibilita y orienta la intervención psicopedagógica / Motivation for change: a joint construction that enables and guides psychopedagogical intervention

Ateneo realizado por el Equipo de Psicopedagogía del Área Programática del Hospital General de Agudos J. M. Ramos Mejía, de la Ciudad de Buenos Aires, que atiende pacientes derivados en su gran mayoría por los Equipos de Orientación de los Distritos Escolares III y VI, así como también, por otros profesionales del hospital, como fonoaudiólogos, psicólogos, pediatras, psiquiatras, neurólogos, entre otros. Otra fuente de derivación es el mismo equipo de psicopedagogía, quien dentro del Programa de Salud Escolar lleva a cabo una prueba de screening, con el objetivo de realizar una detección precoz de niños en riesgo de presentar dificultades de aprendizaje. Se analiza el grado de motivación que se advierte en los padres que asisten con sus hijos a la consulta, cuando son derivados al servicio de Psicopedagogía, y si esa motivación se relaciona con la adherencia al tratamiento.