Malika Roman Isler

University of North Carolina at Chapel Hill, North Carolina, United States

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Publications (31)25.92 Total impact

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    ABSTRACT: African Americans are disproportionately affected by the HIV epidemic inclusive of men who have sex with men, heterosexual men, and women. As part of a community-based participatory research study we assessed HIV testing experience among sexually active 18-30 year old Black men and women in Durham, NC. Of 508 participants, 173 (74 %) men and 236 (86 %; p = 0.0008) women reported ever being tested. Barriers to testing (e.g., perceived risk and stigma) were the same for men and women, but men fell behind mainly because a primary facilitator of testing-routine screening in clinical settings-was more effective at reaching women. Structural and behavioral risk factors associated with HIV infection were prevalent but did not predict HIV testing experience. Reduced access to health care services for low income Black young adults may exacerbate HIV testing barriers that already exist for men and undermine previous success rates in reaching women.
    American Journal of Community Psychology 04/2015; 55(3-4). DOI:10.1007/s10464-015-9725-z · 1.74 Impact Factor
  • M Roman Isler · C Golin · J Wang · J Hughes · J Justman · D Haley · I Kuo · A Adimora · W Chege · S Hodder
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    ABSTRACT: Identifying venues where women meet sexual partners, particular partners who increase women's risk of acquiring HIV, could inform prevention efforts. We categorized venues where women enrolled in HPTN 064 reported meeting their last three sex partners as: (1) Formal, (2) Public, (3) Private, and (4) Virtual spaces. We used multinomial logistic regression to assess the association between these venues and women's individual characteristics and reports of their partners' HIV risk characteristics. The 2099 women reported meeting 3991 partners, 51 % at Public, 30 % Private, 17 % Formal and 3 % at Virtual venues. Women meeting partners at Formal venues reported more education and condom use than women meeting partners at other venues. Fewer partners met through Formal venues had "high" risk characteristics for HIV than through other venues and hence may pose less risk of HIV transmission. HIV prevention interventions can help women choose partners with fewer risk characteristics across all venue types.
    AIDS and Behavior 04/2015; DOI:10.1007/s10461-015-1057-3 · 3.49 Impact Factor
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    ABSTRACT: Innovative models to facilitate more rapid uptake of research findings into practice are urgently needed. Community members who engage in research can accelerate this process by acting as adoption agents. We implemented an Evidence Academy conference model bringing together researchers, health care professionals, advocates, and policy makers across North Carolina to discuss high-impact, life-saving study results. The overall goal is to develop dissemination and implementation strategies for translating evidence into practice and policy. Each 1-day, single-theme, regional meeting focuses on a leading community-identified health priority. The model capitalizes on the power of diverse local networks to encourage broad, common awareness of new research findings. Furthermore, it emphasizes critical reflection and active group discussion on how to incorporate new evidence within and across organizations, health care systems, and communities. During the concluding session, participants are asked to articulate action plans relevant to their individual interests, work setting, or area of expertise.
    Journal of public health management and practice: JPHMP 02/2015; Publish Ahead of Print. DOI:10.1097/PHH.0000000000000230 · 1.47 Impact Factor
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    ABSTRACT: Cancer clinical trial (CCT) accrual and retention rates remain disproportionately low among African Americans. Awarenesss and access to trials are crucial facilitators of trial participation. Strategies developed within a community-based participatory framework (CBPR) are potential solutions to increase awareness and access to CCTs. In this study, we describe the pilot phase of three innovative community-centered modules to improve basic CCT knowledge, awareness of locations to access CCT information, and opportunities to participate in CCTs. Four community organizations completed Community Bridges to CCT training-of-the-trainer and recruited adult African American volunteers to participate in one of three CCT education modules: a workshop about CCTs, a role play describing one person’s experience with CCTs, or a call and response session reviewing myths and facts about CCTs. Pre- and post-test surveys were collected and analyzed using McNemar agreement statistic to evaluate changes in knowledge and attitudes regarding trials. Trainers enrolled 125 participants in the call and response (n = 22), role play (n = 60), and workshop (n = 43) modules. Module participants were mostly African American, female, and with a mean age of 53 years. Comparison of pre- and post-test responses demonstrates favorable changes in awareness of CCTs and where to access CCTs across the sample. Analysis by module type indicates significant increases for participants in the call and response (p p CBPR framework is a promising innovation to increase knowledge about CCTs and favorable attitudes about participation that are known precursors to trial enrollment.
    Journal of Cancer Education 01/2015; 30(1). DOI:10.1007/s13187-014-0764-1 · 1.05 Impact Factor
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    ABSTRACT: Spoken word, a form of performance poetry, is a promising approach to HIV/AIDS awareness and prevention, as it has the potential to encourage dialogue among and within communities and address concerns regarding the social stigma present in rural communities. The purpose of this study is to describe the development and implementation of the Spoken Word Project (SWP), an HIV/AIDS pilot intervention in rural North Carolina designed to improve HIV-related attitudes and self-efficacy and decrease stigma through the use of performance poetry. Spoken word is a collaborative effort between residents of two rural counties in North Carolina and Project GRACE (Growing, Reaching, Advocating for Change and Empowerment), a community-based participatory research collaboration aimed at reducing health disparities in African American communities. The project included 15 adult and youth participants. Results indicated that spoken word has the ability to build upon local resources, generate community reflection, and engage a broad spectrum of performers and audiences. Our findings also showed that the effect of stigma and limited community conversations about HIV in rural communities can be abated through the use of spoken word.
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    ABSTRACT: Background: Minority engagement in HIV prevention research can improve the process and products of research. Using community-based participatory research (CBPR) to develop capacity-building tools can promote community awareness of HIV prevention, clinical research, and community roles in research. Objectives: We sought to describe a CBPR approach to curriculum development to increase HIV prevention research literacy among Blacks ages 18 to 30. Methods: Community members and researchers documented the iterative and participatory nature of curriculum development and lessons learned. Results/Lessons Learned: We used specific strategies to support and verify multi-stakeholder engagement, team building, capacity building, and shared decision making. Objective or formal assessments of baseline capacity, ongoing stakeholder engagement, and reinforcing the value of multiple perspectives can promote further equity in curriculum development between researchers and community members. Conclusions: The iterative process of shared discussion, development, and consensus building strengthened collaboration between stakeholder groups and produced a stronger, more culturally appropriate curriculum to promote HIV prevention research engagement among young Blacks.
    Progress in community health partnerships: research, education, and action 01/2015; 8(4). DOI:10.1353/cpr.2014.0059
  • Progress in Community Health Partnerships Research Education and Action 01/2015; 9(1):41-48. DOI:10.1353/cpr.2015.0014
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    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; 23(6). DOI:10.1089/jwh.2013.4654 · 1.90 Impact Factor
  • Malika Roman Isler · Eugenia Eng · Susanne Maman · Adaora Adimora · Bryan Weiner
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    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; DOI:10.1093/her/cyu006 · 1.66 Impact Factor
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    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 01/2014; 15(1):125-133. DOI:10.1177/1524839913480799 · 0.55 Impact Factor
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    ABSTRACT: Background: The Southeast remains the U.S. region hit hardest by HIV/AIDS. As elsewhere, African-Americans are disproportionately affected. Discussions of HIV risk in African-American communities often overlook the diversity of knowledge, attitudes, and behaviors within those communities. As part of a community-based participatory research (CBPR) project, we surveyed Black young adults in Durham, NC to understand the range of factors that place them at risk for, or protect them from HIV. Methods: We employed respondent-driven sampling to recruit sexually active, Black residents of Durham age 18-30 (n=508). Using an Audio Computer-Assisted Self Interview (ACASI), participants answered questions regarding sexual behaviors across 4 types of partners: steady, casual, one-night stands, and child's mother/father. This presentation describes sexual behaviors among women reporting sex with men (WSM), women reporting sex with men and women (WSMW), and men reporting sex with women (MSW). Results: Mean number of partners in the previous 6 months was 3.0 (WSM), 3.6 (WSMW), and 6.1 (MSW). The proportion engaging in concurrent relationships in the previous 6 months was 24% (WSM), 32% (WSMW), and 38.3% (MSW). Sexual risk behaviors (inconsistent condom use and alcohol use before/during sex) were common across partner types, although less common with casual partners and one-night stands than with steady partners and child's father/mother. Participants who had concurrent relationships reported risk behaviors at rates similar to those who did not. Conclusions: Concurrent relationships and risk behaviors across partner types place a substantial proportion of this sample of southern Black young adults at risk for HIV.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • Malika Roman Isler · Giselle Corbie-Smith
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    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 &amp Ethics 12/2012; 40(4):904-914. DOI:10.1111/j.1748-720X.2012.00719.x · 0.94 Impact Factor
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    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 &amp Behavior 09/2012; 40(3). DOI:10.1177/1090198112452124 · 1.54 Impact Factor
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    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. DOI:10.1007/s10461-012-0151-z · 3.49 Impact Factor
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    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. DOI:10.1353/cpr.2012.0026
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    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. DOI:10.1353/cpr.2012.0045
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    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. DOI:10.1353/cpr.2012.0023
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    ABSTRACT: Background: Minorities are disproportionately affected by HIV/AIDS in the rural Southeast, yet they are underrepresented in HIV clinical trials. Therefore, it is important that targeted culturally appropriate interventions support rural minorities' participation in HIV/AIDS research. Intervention mapping (IM) provides a structured, theory-based approach for developing such interventions. The following presentation highlights the development of a community-wide effort to increase rural minority participation in HIV clinical trials. Methods: Qualitative data was collected from three data sources: people living with HIV/AIDS (n=35) community leaders (n= 40), and service providers (n= 36). This data informed the development matrices with: behavioral outcomes, environmental outcomes, and performance objectives. Each performance objective was mapped with changeable, theoretically-based determinants in a matrix. Methods and strategies were developed to reflect the influencing factors and desired outcomes in each matrix. Results: The outcomes and objectives varied by target group to produce a total of five matrices (three behavioral and two environmental). The three behavioral outcomes included: 1) Eligible PLWHA will enroll in clinical trials, 2) Service providers will refer eligible PLWHA to clinical trials, and 3) Community leaders will support HIV/AIDS research. The environmental outcomes included: 1) Decreasing HIV stigma, and 2) Increasing HIV testing and care. Resultant methods and strategies used constructs from the Theory of Reasoned Action, Social Cognitive Theory, and Social Support Theory. Conclusion: This intervention was developed using IM and resulted in a comprehensive community-based program. It is potentially replicable, and can assist rural service providers and PLWHA in making informed decisions regarding trial participation.
    138st APHA Annual Meeting and Exposition 2010; 11/2010
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    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. DOI:10.1177/1049732310387935 · 2.19 Impact Factor
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    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