[Show abstract][Hide abstract] ABSTRACT: Abstract Background: The challenge of identifying and recruiting U.S. women at elevated risk for HIV acquisition impedes prevention studies and services. HIV Prevention Trials Network (HPTN) 064 was a U.S. multisite, longitudinal cohort study designed to estimate HIV incidence among women living in communities with prevalent HIV and poverty. Venue-based sampling (VBS) methodologies and participant and venue characteristics are described. Methods: Eligible women were recruited from 10 U.S. communities with prevalent HIV and poverty using VBS. Participant eligibility criteria included age 18-44 years, residing in a designated census tract/zip code, and self-report of at least one high-risk personal and/or male sexual partner characteristic associated with HIV acquisition (e.g., incarceration history). Ethnography was conducted to finalize recruitment areas and venues. Results: Eight thousand twenty-nine women were screened and 2,099 women were enrolled (88% black, median age 29 years) over 14 months. The majority of participants were recruited from outdoor venues (58%), retail spaces (18%), and social service organizations (13%). The proportion of women recruited per venue category varied by site. Most participants (73%) had both individual and partner characteristics that qualified them for the study; 14% were eligible based on partner risk only. Conclusion: VBS is a feasible and effective approach to rapidly recruit a population of women at enhanced risk for HIV in the United States. Such a recruitment approach is needed in order to engage women most at risk and requires strong community engagement.
Journal of Women s Health 04/2014; · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social construction of HIV prevention within black Baptist churches in North Carolina. Data collection included interviews with church leaders (n = 12) and focus groups with congregants (n = 7; 36 participants). Analytic tools included open coding and case-level comparisons. Social constructions of HIV/AIDS prevention were influenced by two worldviews: public health and church-based. Areas of compatibility and incompatibility exist between the two worldviews that inform acceptability and adaptability of current evidence-based strategies. These findings offer insight into ways to increase the compatibility of evidence-based HIV prevention strategies within the black Baptist church context.
Health Education Research 03/2014; · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background. Although churches are an important partner for improving health within the African American community, it is not known how congregants are best reached by health promotion activities and thus how best to target members in recruitment. This study examined how characteristics of churches and congregants' beliefs and interests in faith-based health promotion related to their willingness to attend church-based health promotion activities. Method. We surveyed adult congregants (n = 1,204) of 11 predominately African American churches in North Carolina. Surveys collected data within four domains: demographics (age, sex, education), behavioral (church attendance, respondent food choices, and physical activity), cognitive (church-based health promotion belief, Bible-based healthy living interest, healthy living resource interest), or environmental (family health, church travel distance, church health ministry activity, church members' food choices). Analyses used a dichotomous outcome, interest in attending programs offered by the health ministry. Domain-specific models were constructed. Logistic generalized estimating equations adjusted for clustering. Results. Of the 1,204 congregants, 72% were female, 57% were 50 years or older, 84% had a high school education or more, and 77% had a chronic health condition. In bivariate analyses and in models adjusting for all four domains, cognitive factors had the highest odds of willingness to attend. Conclusion. Congregants' belief in the church's role in health promotion and their desire to learn about healthy behaviors highlight the role of the African American church as a partner in addressing health disparities and the need to capitalize on this expectation through stronger partnerships between medical and faith communities.
Health Promotion Practice 03/2013; · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For decades, the dominant research paradigm has included trials conducted in clinical settings with little involvement from communities. The move toward community engaged research (CEnR) necessitates the inclusion of diverse perspectives to address complex problems. Using a relationship paradigm, CEnR reframes the context, considerations, practical steps, and outcomes of research.
The Journal of Law Medicine & Ethics 12/2012; 40(4):904-914. · 1.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Minorities are disproportionately affected by HIV/AIDS in the rural Southeast; therefore, it is important to develop targeted, culturally appropriate interventions to support rural minority participation in HIV/AIDS research. Using intervention mapping, we developed a comprehensive multilevel intervention for service providers (SPs) and people living with HIV/AIDS (PLWHA). The authors collected data from both groups through 11 focus groups and 35 individual interviews. Resultant data were used to develop matrices of behavioral outcomes, performance objectives, and learning objectives. Each performance objective was mapped with changeable, theory-based determinants to inform components of the intervention. Behavioral outcomes for the intervention included the following: (a) eligible PLWHA will enroll in clinical trials and (2) SPs will refer eligible PLWHA to clinical trials. The ensuing intervention consists of four SPs and six PLWHA educational sessions. Its contents, methods, and strategies were grounded in the theory of reasoned action, social cognitive theory, and the concept of social support. All materials were pretested and refined for content appropriateness and effectiveness.
Health Education & Behavior 09/2012; · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few rural minorities participate in HIV clinical trials. Mobile health units (MHUs) may be one strategy to increase participation. We explored community perceptions of MHU acceptability to increase clinical trial participation for rural minorities living with HIV/AIDS. We conducted 11 focus groups (service providers and community leaders) and 35 interviews (people living with HIV/AIDS). Responses were analyzed using constant comparative and content analysis techniques. Acceptable MHU use included maintaining accessibility and confidentiality while establishing credibility, community ownership and control. Under these conditions, MHUs can service rural locations and overcome geographic barriers to reaching major medical centers for clinical trials.
AIDS and Behavior 02/2012; 16(7):1895-901. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although racial and ethnic minorities have disproportionately high rates of HIV infection, these groups are underrepresented in HIV-related clinical trials. This illustrates the need for more innovation in attempts to engage underrepresented populations in calls for interdisciplinary and translational research.
Eleven focus groups and 35 interviews were conducted with people living with HIV/AIDS (PLWHA) to explore the perspectives of rural community leaders, service providers, and PLWHA about bringing HIV-related research, including clinical trials, into rural communities.
Over a period of 3 months in spring 2007, we collected qualitative data from three sources: Community leaders, service providers, and PLWHA. Text data were analyzed using the constant comparative method and content analysis techniques of theme identification.
Respondents want an integrated approach to HIV research that builds trust, meets community needs, and respects their values. They conceptualize HIV research as part of a broader spectrum of HIV testing, prevention, and care, and suggest integrating HIV trials with existing community services, organizations, and structures, engaging various segments of the community, and conducting research using a personal approach.
These findings support calls for more relevant, translational, and engaged research. An integrated approach may be an important innovation to transform the research enterprise to meet these goals and more directly improve the health of individuals.
Progress in community health partnerships: research, education, and action 01/2012; 6(2):121-9.
[Show abstract][Hide abstract] ABSTRACT: A disconnect exists between research resources and the health and health care needs of people those resources are designed to serve. While a great deal of research is being produced at academic institutions across the country, the topics investigated are often driven by researchers' interests or by funding announcements focused on specific research areas of interest to the funder. PURPOSE OF THE ARTICLE: The purpose of this article is to describe a process that connects community identified health priorities with research funds as well as capacity building efforts.
The North Carolina Translational and Clinical Sciences Institute (NC TraCS) developed a process to identify the health priorities of North Carolina communities through a partnership with the network of county Healthy Carolinians partnerships. The priorities identified were obesity, youth issues, healthcare delivery/access, mental health/ substance abuse, specific chronic diseases, cancer/tobacco, and injury/ violence. NC TraCS then used these research priorities to guide pilot funding and facilitate research capacity building.
Tapping into an established community-based network and linking researchers to community-identified priorities ensures that NC TraCS addresses the most pressing health needs of North Carolina's residents.
Progress in community health partnerships: research, education, and action 01/2012; 6(3):339-48.
[Show abstract][Hide abstract] ABSTRACT: • To explore the perspectives of rural community leaders, service providers, and people living with HIV/AIDS about bringing HIV-related research, including clinical trials, into rural communities.
• Although racial and ethnic minorities have disproportionately high rates of HIV infection, these groups are underrepresented in HIV-related clinical trials.
• Participants in HIV/AIDS trials still tend to be overwhelmingly White, of higher socioeconomic status, and from larger urban centers.
• The literature to guide engaging rural populations in HIV/AIDS clinical trials is sparse, especially studies involving minority populations.
• All respondents described the need for HIV research and clinical trials to be thought of as one point on a continuum of HIV care and services.
• In our analysis, effectively engaging rural minority communities in HIV clinical trials went beyond the logistics of recruitment; research teams were expected to use a comprehensive approach that addresses, in some way, all points along the continuum of HIV care. An integrated approach to research would result in building trust, sharing power, and more effectively addressing the needs and values of the community.
• People living with HIV/AIDS
• Service providers
• Community leaders
• Rural minorities
• Health organizations and agencies
• HIV researchers
• HIV researchers should partner with other local organizations and agencies to offer comprehensive health-related services, including HIV clinical trials, as a way to conduct both HIV and non-HIV research and health outreach.
• HIV researchers need to partner with existing services, organizations, and structures in the community to build trust and more effectively address the needs of a given community.
• Comprehensive and deliberate attention to integrating HIV clinical trials with other HIV and non-HIV-related health efforts is thought to be important to leverage financial and nonfinancial research resources for supporting the HIV care and services continuum.
• Integrating HIV clinical trials with existing services is a way to gain a more comprehensive understanding of the structure and values of a community.
• Community members should be considered partners in research to engage the community in the importance and need for research.
Progress in community health partnerships: research, education, and action 01/2012; 6(2):111-2.
[Show abstract][Hide abstract] ABSTRACT: We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering--the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole.
Qualitative Health Research 11/2010; 21(4):489-501. · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The black church is a promising site to engage in health disparities research; however, little is understood about the pastors' perspectives. We used role theory to explore their expectations, potential conflicts, and synergy with research.
Four focus groups (n = 30) were conducted with pastors and analyzed using principles of grounded theory and content analysis.
Pastors identified a variety of potential roles in research. They noted potential conflicts due to perceptions of research, the process, and pace of research. Areas of synergy included perceptions of health disparities research as consistent with the healthy mind, body, and spirit ideology, and clear benefits to congregations and communities. Pastors' research expectations included long-term commitments, honest and clear communication, investigator visibility, respect for church traditions/practices, and support in forming collaborations.
Understanding pastors' roles, potential areas of synergy and conflict, and collaboration expectations offers insight in support of successful church-academic partnerships.
Journal of the National Medical Association 09/2010; 102(9):823-31. · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Human immunodeficiency virus (HIV) prevention programs and agencies are fighting growing rates of infection with decreasing resources. Identification of gaps in HIV prevention services can help inform prevention funding and program policies. To describe HIV prevention needs in a southern U.S. state, we conducted face-to-face interviews with prevention agencies and persons considered by others in their community to be "influential informants" of the community's HIV prevention services in a sample of counties in North Carolina. Using county as the unit of analysis (n = 10), we investigated differences in gaps by community characteristics, such as disparities in sexually transmitted disease rates. Lack of programs and problems with service program coordination/cooperation were reported frequently by rural counties. The most commonly reported barrier to meeting the needs of persons at risk for HIV was funding, followed by stigma. Findings from this study can inform local and regional planners on how to efficiently target prevention programs, including programs aimed at reducing racial and geographic disparities in sexually transmitted diseases, such as HIV.
Social Work in Public Health 05/2010; 25(3):327-40. · 0.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The social dynamics of some communities are affected by the loss of significant numbers of people to prison and by the release of others who encounter the challenge of coping with the negative effects of the incarceration experience. The effects on communities are evident, in part, in the high rates of sexually transmitted infections (STIs) in North Carolina (NC) counties that have a high rate of incarceration. In the present study, we examined whether the same associations can be observed at the census tract level in one urban city of NC. To identify the mechanisms by which incarceration can affect the transmission of STIs, we conducted ethnographic interviews with ex-offenders and people who lost a sexual partner to prison. We found that census tract rates of incarceration were consistently associated with gonorrhea rates in the subsequent year. An increase of the percentage of census tract person-time spent in prison from 2.0% to 2.5% corresponded to a gonorrhea rate increase of 7.1 cases per 100,000 person-years. The people interviewed spoke of sexual partnership changes including those left behind finding new partners, in part for help in making financial ends meet; men having sex with men for the first time in prison; and having multiple new partners upon reentry to the community. The statistical associations and stories of the effects of incarceration on sexual relationships provide additional evidence of unintended community health consequences of high rates of incarceration.
Journal of Urban Health 02/2008; 85(1):90-9. · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to describe the network structures of agencies and individuals engaged in HIV prevention in a North Carolina county.
The authors conducted a cross-sectional study of interconnected agencies and individuals identified through snowball sampling. Participants were interviewed face to face with a structured questionnaire about interactions with others in the network. Network characteristics such as density and centralization were computed with UCINET software.
The network of 11 agencies had an information exchange density of 14%. Exchanges of clients and funds were even more rare. The network of 17 individuals influential in HIV prevention was better connected with a density of 42%.
The HIV prevention agencies in the county were not functioning as a network and thus were not benefiting the community to their full potential. Any connectedness between the agencies may be attributable to the better connections between influential individuals, several of whom worked for the agencies in the agency network.
Sex Transm Dis 03/2007; 34(2):71-5. · 2.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increasing the engagement of racial and ethnic minorities in genomic research may help alleviate health disparities. This paper examines community perceptions of the relationships between race, genes, environment, and health disparities, and it discusses how such perceptions may influence participation in genomic research.
We conducted semi-structured interviews with 91 African American, Latino, and white lay community members and community leaders in North Carolina. Using constant comparison methods, we identified, compared, and developed linkages between conceptual categories and respondent groups.
Participants described gene-environment interactions as contributing to group differences in health outcomes, expressed the belief that genetic predisposition to disease differs across groups, and said that social conditions trigger group-level genetic differences and create poorer health outcomes among African Americans.
Given the regional presence of major research institutions and the relatively high education level of many participants, this sample may not reflect the perspectives of those most disparately affected by health disparities.
Members from multiple community sectors share perceptions and may respond to similar approaches when attempts are made to increase participation in genomic research. Researchers may inadvertently fuel the perception that health disparities experienced by minorities are rooted in the shared genomes of a particular group as distinct from those of other groups. The way researchers use race and ethnicity in recruitment, analysis, and communication of research findings inaccurately implies that there are genetic differences between races, when categories of social experience or ancestry may more accurately characterize health differences. Understanding these issues is crucial to designing effective community engagement strategies, recruitment plans, and messages about genomic research, which could ultimately help to lessen health disparities.