Factors Associated with Engaging Socially Marginalized HIV-Positive Persons in Primary Care
Boston University, Boston, Massachusetts, United States AIDS PATIENT CARE and STDs
(Impact Factor: 3.5).
02/2007; 21 Suppl 1(s1):S30-9. DOI: 10.1089/apc.2007.9989
This paper examines factors associated with engaging socially marginalized HIV-positive persons in primary care using interview and chart review data from 984 clients presenting for services at 10 agencies participating in a multisite demonstration project. The sample was predominantly minority, and many reported drug and mental health problems as well as housing instability. At baseline, roughly half of the participants were engaged in HIV primary care; the other participants were either not at all engaged in HIV primary care or somewhat engaged in care. Those who were somewhat engaged in care were very similar to those who were not at all engaged in care, and significantly different than those who were fully engaged in care across a number of demographic, health status/utilization, and barriers to care items and fared equally poorly with regard to engagement in care at 12-month follow-up. In 12-month longitudinal analyses, 58% of those not engaged at baseline ( n = 517) became more fully engaged in care. In the final multivariate model that controlled for disease stage, decreases in drug use, structural barriers, and unmet needs were associated with engagement in care. Interventions that focus on decreasing structural barriers and unmet support services needs, addressing negative health beliefs and attending to drug use are promising public health strategies to engage marginalized HIV-positive persons in HIV primary care.
Available from: Michael Steger
- "These behaviors are inherently proactive, and directed toward fostering positive health and wellbeing . Research in the general population suggests that health behaviors are linked to the importance people place on health maintenance, the extent to which they believe that performing certain activities benefits health (Dutta-Bergman 2004; Rumptz et al. 2007) and their attitudes toward available health information (Dutta-Bergman 2004). Because we are interested in general health behaviors we sought to examine general health attitudes. "
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ABSTRACT: Mounting research has demonstrated relationships between meaning in life (MIL) and a wide range of health-relevant outcomes, including health symptoms, health-promoting behaviors, health-risking behaviors, cognitive decline, and mortality. Despite these provocative results, there have been few efforts to explain why meaning and health should be linked. It is proposed that meaning supports a more positive health orientation among people, which in turn is related to more positive health behaviors and health. This model was tested using structural path analysis in a healthy, but health-risk-prone, sample of 571 undergraduate students, focusing on health criterion variables of health symptoms, attitudes toward condom use, and substance abuse. Two aspects of health orientation, proactive health orientation and health information discounting, were assessed. Direct relationships were observed between MIL and health criterion variables, as well as indirect relationships carried by combinations of both health orientations. In a generally healthy, health-risk-prone sample, MIL was beneficially related to health symptoms, risky condom attitudes, and substance use. Proactive health orientation and health information discounting statistically explained some of these relationships, suggesting new avenues for intervening to promote healthy lifestyle factors and prevent adverse health outcomes.
Available from: Matt Mutchler
- "" and " How many of these did you miss? " Participants were defined as not engaged in care if they did not have any healthcare visits, or if they reported at least 2 missed visits, in the past three months. Participants who reported attending at least one medical visit and who did not report any missed visits in the past three months were considered to be engaged in care (Rumptz et al. 2007). "
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ABSTRACT: Treatment advocacy (TA) programs, based in AIDS service organizations and clinics, aim to engage clients into care and support antiretroviral treatment (ART) adherence through client-centered counseling; advocate for patients with providers; and provide social service referrals. Systematic evaluations of TA are lacking. We conducted a non-randomized evaluation examining relationships of TA participation to adherence, care engagement, social services utilization, unmet needs, patient self-advocacy, and adherence self-efficacy among 121 HIV-positive clients (36 in TA, 85 not in TA; 87% male, 34% African American, 31% White, 19% Latino). In multivariate models, TA participants (vs. non-TA participants) showed higher electronically monitored [85.3% vs. 70.7% of doses taken; b(SE) = 13.16(5.55), p < .05] and self-reported [91.1% vs. 75.0%; b(SE) = 11.60(5.65), p < .05] adherence; utilized more social service programs [Ms = 5.2 vs. 3.4; b(SE) = 1.97(0.48), p < .0001]; and had fewer unmet social-service needs [Ms = 1.8 vs. 2.7; b(SE) = -1.06(0.48), p < .05]. Findings suggest the need for a randomized controlled trial of TA.
Available from: Deborah J Konkle-Parker
- "Barriers and facilitators that have been identified in the literature to date include structural aspects of care, availability of support services, and personal factors (Rumptz et al., 2007). "
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