Respondent-Driven Sampling: a Sampling Method for Hard-to-Reach Populations and Beyond

Potential impact and cost-effectiveness of oral HIV pre-exposure prophylaxis for men who have sex with men in Cotonou, Benin: a mathematical modelling study

BACKGROUND

Oral HIV pre-exposure prophylaxis (PrEP) can effectively reduce HIV incidence. A 2020-21 demonstration project assessed the feasibility and health outcomes of offering oral PrEP to men who have sex with men (MSM) in Cotonou, Benin. We evaluated the epidemiological impact and cost-effectiveness of this project and the potential scale-up of oral HIV PrEP for MSM in Cotonou.

METHODS

We calibrated an HIV transmission-dynamic model structured by age and risk within a Bayesian framework to MSM-specific HIV prevalence and treatment data, parameterised with project behavioural and cost (including PrEP drug, implementation, and HIV care costs) data. We estimated the impact and cost-effectiveness of the 2020-21 Cotonou demonstration project (PrEP coverage, 5-10% of all MSM who are not living with HIV in Grand Cotonou; and adherence, 13-21% taking at least four of seven required doses [ie, at least four doses per week for daily users and at least four of seven expected doses given reported sexual activity for on-demand users]) and of its potential scale-up over 5 years (from 2022 to 2027), reaching 30% coverage of MSM in Grand Cotonou and with demonstration project adherence levels. We additionally modelled ideal PrEP adherence (100% taking at least four of seven required doses). We estimated the percentage of cumulative new HIV infections averted among participating MSM over 1 year and among all MSM in Grand Cotonou and their female partners over 20 years, and cost-effectiveness as cost per disability-adjusted life-year (DALY) averted over 20 years. Costs and DALYs were discounted 3% annually.

FINDINGS

We found that the demonstration project averted an estimated 21·5% (95% uncertainty interval 16·6 to 26·2) of HIV infections among participants over 1 year. With ideal adherence, cases that would be averted increased to 95·2% (90·8 to 98·8). A 5-year PrEP scale-up could avert 3·2% (1·6 to 4·8) of HIV infections among all MSM and female partners over 20 years, at US$388 (36 to 2792) per DALY averted. With ideal adherence, this decreased to -$28 (-126 to 589) per DALY averted.

INTERPRETATION

Low adherence to PrEP restricted the impact of the demonstration project. At 30% coverage among MSM by 2027, PrEP scale-up would be cost-effective at a $1225 threshold with 86·6% probability, and it could be more cost-effective if high adherence could be reached without substantially increasing costs.

FUNDING

Canadian Institutes of Health Research and US National Institutes of Health.

TRANSLATION

For the French translation of the abstract see Supplementary Materials section.

Perceptions of Smoking Stigma Among African Americans: A Qualitative Study

INTRODUCTION

African Americans/Blacks (AAB) are at increased risk for morbidity and mortality from smoking-related diseases including lung cancer (LC). Smoking stigma is believed to be a primary barrier to health care-seeking for people who smoke. Previous studies illustrate that perceptions of smoking vary across populations. However, little is known about the prevalence of smoking stigmas among AAB. The purpose of this study was to increase understanding of the perception of cigarette smoking by AAB.

AIMS AND METHODS

We conducted free-listing interviews in which individuals listed all-thoughts and feelings regarding smoking and health-related questions with a convenience sample of eligible AAB adults (n = 58) in the Philadelphia region. Additionally, we collected participant self-reported demographic data. Data were cleaned and the salience of each term was computed using Anthropac. Graphical methods were then used to determine salient responses across groups stratified by gender, age, education, and smoking status.

RESULTS

The sample had a median age of 51 years and was 67.2% female. Most participants had completed college (58.6%) and had never smoked (74.1%). Regarding their perceptions of people who smoke cigarettes, results showed that "smelly," "health hazard," and "judgment" were the most salient terms among all-participants. Overall, "smelly" and "unhealthy" were salient for both males and females. However, "dental," "dirty," "addictive," and "habit" were also salient among males. Phrases such as "unhealthy" and "addictive" were primarily salient for older participants (>51 years) versus "smelly" for younger participants. The term "smelly" was salient among all-education levels. However, "unhealthy" was also salient among those with less than a 4-year college degree. Moreover, the terms "smelly" and "annoying" were most common among people who smoke as opposed to "health hazard" among people who don't smoke.

CONCLUSIONS

We observed that the most stigmatizing language was primarily associated with perceptions of negative social interactions, social judgment, and health-related concerns. Future studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and LC screening protocols.

IMPLICATIONS

Little is known about the prevalence of smoking stigmas among AAB. This study explores the AAB perspective of cigarette smoking and related stigmas. Among AAB, smoking is represented by stigmatizing language across gender, age groups, and smoking history. It is primarily associated with negative social interactions, social judgement, and health-related concerns indicating that smoking stigma is a concern for AAB individuals who smoke. Further research is warranted.

Illicit Substance Use and Treatment Access Among Adults Experiencing Homelessness

Importance

The lack of representative research on homelessness risks mischaracterizing and misrepresenting the prevalence of illicit substance use.

Objective

To estimate the population prevalence and patterns of illicit substance use, treatment, nonfatal overdose, and naloxone possession among people experiencing homelessness in 1 US state.

Design, Setting, and Participants

This representative survey study of adults experiencing homelessness from October 2021 to November 2022 in 8 California counties used multistaged probability-based sampling and respondent-driven sampling. Eligible individuals were 18 years or older and met the federal definition of homelessness.

Main Outcomes and Measures

The primary outcome measures included lifetime and past-6-month illicit substance use and substance type (methamphetamine, nonprescription opioids, or cocaine). Lifetime and current substance use treatment, unmet treatment need, types of treatments received, nonfatal overdose (lifetime and current episode of homelessness), and current possession of naloxone were measured. Population prevalence estimates with 95% Wald CIs were calculated using survey replicate weights.

Results

Of 3865 individuals approached, 3042 (79%) participated and an additional 158 participants were recruited through respondent-driven sampling. Among 3200 participants, the mean age was 46.1 (95% CI, 45.3-46.9) years, 67.3% (95% CI, 65.2%-69.3%) were cisgender male, and there were similar proportions of Black and African American, Hispanic and Latine, and White participants. Overall, an estimated 65.3% (95% CI, 62.2%-68.4%) of participants used illicit drugs regularly (≥3 times per week) in their lifetime; 41.6% (95% CI, 39.4%-43.8%) began using regularly before their first episode of homelessness and 23.2% (95% CI, 20.5%-25.9%) began using regularly after. In the past 6 months, an estimated 37.1% (95% CI, 32.9%-41.3%) of participants reported regular use of any drug; 33.1% (95% CI, 29.4%-36.7%) reported use of methamphetamines, 10.4% (95% CI, 7.9%-12.9%) reported use of opioids, and 3.2% (95% CI, 1.8%-4.6%) reported use of cocaine. In their lifetime, an estimated 25.6% (95% CI, 22.8%-28.3%) injected drugs and 11.8% (95% CI, 9.8%-13.8%) injected drugs in the past 6 months. Among those with any regular lifetime use, an estimated 6.7% (95% CI, 3.8%-9.5%) of participants were currently receiving treatment. Of those with any regular use in the last 6 months, an estimated 21.2% (95% CI, 17.9%-24.5%) reported currently wanting but not receiving treatment. An estimated 19.6% (95% CI, 17.4%-21.8%) of participants had a nonfatal overdose in their lifetime and 24.9% (95% CI, 21.3%-28.5%) currently possessed naloxone.

Conclusion and Relevance

In a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment. Improving access to treatment tailored to the needs of people experiencing homelessness could improve outcomes.

Project Gender NutriScope: Methods of a Mixed Methods, Community-Engaged Study Design to Explore the Nutritional Needs of Transgender and Gender-Diverse Youth and Young Adults

OBJECTIVE

Despite growing evidence of distinct nutrition-related experiences and disparities, transgender and gender-diverse (TGD) youth and young adults are an underrepresented population in nutrition research. This paper describes the methods and study design from Project Gender NutriScope, a study that will explore the nutritional needs of TGD youth and young adults.

DESIGN

Parallel convergent cross-sectional mixed methods; community-engaged.

SETTING

A purposive sample will be recruited in a Midwest city through clinics, youth organizations, and a large state university.

PARTICIPANTS

Transgender and gender-diverse youth and young adults aged 13-24 years.

INTERVENTION

Findings from this formative study will be used to inform future intervention development.

MAIN OUTCOME MEASURES

Dietary intake, eating patterns, disordered eating patterns, food security status, perceptions of relationship with food, and nutrition-related concerns.

ANALYSIS

Quantitative data will be analyzed using descriptive summary statistics. Qualitative data will be analyzed by reflexive thematic analysis. The 2 databases will be integrated iteratively.

The association between drug injection duration and hepatitis C prevalence among people who inject drugs in Iran

People who inject drugs (PWID) are at higher risk of hepatitis C virus (HCV) due to their behaviors such as shared injection. Employing appropriate modeling approaches is crucial for accurately evaluating the impact of other variables on outcomes, in this case, HCV seropositivity. This study aimed to assess the non-linear effect of injection duration on HCV seropositivity. From July 2019 to March 2020, 2,684 PWID in Iran were recruited. The binary outcome variable was HCV serostatus (positive vs. negative), determined by detecting HCV antibodies. The non-linear effect of injection duration on HCV seropositivity was assessed using a multilevel Generalized Additive Model in R software, adjusting the effects of other variables in the analysis. We found a non-linear effect of injection duration on HCV seropositivity status (p-value < 0.001). The probability of HCV seropositivity increased with injection duration, though this relationship was non-linear. Initially, the probability rises faster; however, this effect diminishes as the injection duration extends. An initial sharp increase in HCV risk was seen during the first 20 years of injection. HCV seropositivity was notably associated with ever HIV seropositivity (OR [Odds Ratio] = 10.54, 95% CI [Confidence Interval]: 5.39, 20.61, p-value < 0.001), ever having injected methamphetamine (OR = 1.72, 95% CI: 1.33, 2.22, p-value < 0.001), being currently married (OR = 0.67, 95% CI: 0.48, 0.93, p-value = 0.018), ever shared needle/syringe with others (OR = 2.63, 95% CI: 1.32, 5.22, p-value = 0.006), and ever being incarcerated (OR = 1.97, 95% CI: 1.50, 2.58, p-value < 0.001). Our study contributes to the field by demonstrating that a non-linear approach can reveal patterns of risk that linear models might fail to capture. These findings indicate that the relationship between injection duration and HCV seropositivity can be more complex than previously understood, underscoring the importance of employing more advanced modeling techniques in future research.

Recent HIV testing and self-reported HIV prevalence among men who inject drugs in Afghanistan: a nationwide survey in 2019-2020

BACKGROUND

People who inject drugs (PWID) remain at high risk for HIV in many countries, including Afghanistan. Previous reports on HIV testing and prevalence in Afghanistan were published in 2012. This study assessed recent HIV testing and self-reported HIV prevalence among male PWID in Afghanistan from 2019 to 2020.

METHOD

We visited 374 public venues and hotpots where PWID used to gather and meet their peers across 8 cities in Afghanistan to enroll eligible participants in our study. Using interviews and a survey, our trained interviewers collected data on the demographics, types of drugs, HIV testing history, and self-reported HIV status of the participants. We analyzed the data using the venues and hotpots as clusters to report the percentages of recent HIV tests and self-reported HIV prevalence overall and in subgroups defined by demographic characteristics and locations.

RESULTS

Among the 1385 participants, most were from Kabul city (28.9%), spoke Dari (67.4%), were aged 25-34 years (42.1%), and were married (52.4%). Overall, 70.7% (95% CI 67.6-73.6) (ranging from 20.0% in Kandahar to 99.3% in Mazar-i-Sharif) were tested for HIV within the past 12 months. Among those who had ever been tested for HIV, 20.7% (95% CI 17.8-24.0) (ranging from 0% in Zarang to 63.2% in Kabul) reported being positive for HIV.

CONCLUSION

Compared with the results of a similar study in 2012, we found a significant improvement in HIV testing coverage among PWID in Afghanistan. The high self-reported HIV prevalence among this group also highlights the need for targeted screening and treatment programs for PWID in Afghanistan, particularly in the cities of Kabul and Jalalabad.

From Vulnerability to Stability: Migrant Nurses' Experiences of Autonomy, Competence and Relatedness-A Qualitative Descriptive Study

Aim: To understand how migrant nurses perceive their needs for autonomy, competence and relatedness are satisfied and relate how these contribute to regional workplace retention. Design: A qualitative descriptive study. Methods: Data were collected through semistructured interviews among 17 migrant nurses employed at a hospital in regional Australia. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. The self-determination theory provided a framework for the study. Results: One overarching theme, facing challenges with determination to make oneself at home, was identified, with themes: migration and relocation to a regional area, commencing and adjusting to the workplace and integrating with the community. These are further explained with subthemes: experiencing personal vulnerabilities, experiencing familial challenges and adjustment, building connections, finding one's feet, finding meaningful work through nurse empowerment, valuing relationships at work, and embracing the regional lifestyle. Conclusion: An unfamiliar work environment and culture may challenge migrant nurses' needs for autonomy, competence and relatedness, potentially impacting their integration. Supportive work environments, valued workplace relationships, community support and networking with peers from similar backgrounds can assist migrant nurses successfully transition, which may impact long-term retention.

The Relationship Between Past Condom Use and Condom Use Intention Among Male Construction Worker Clients of Sex Workers in the Western Cape, South Africa: A Parallel Multiple Mediator Model

Male clients of sex workers in South Africa are at high risk for HIV, yet limited research has examined the psychological factors influencing their condom use intentions. This study addressed this gap by assessing the mediating roles of positive attitudes towards condom use, condom use self-efficacy, and perceived norms in the relationship between past condom use and intentions to use condoms. A cross-sectional survey was used to obtain data from male construction workers who reported sexual intercourse with a sex worker in the past three months. Using a parallel multiple mediator model, the analysis revealed that condom use self-efficacy (β = 0.060, 95% CI [0.021, 0.107]) and positive attitudes towards condom use (β = 0.027, 95% CI [0.004, 0.058]) significantly mediated the relationship between past condom use and condom use intention, while perceived norms did not (β = - 0.001, 95% CI [- 0.007, 0.007]). These findings underscore the importance of targeting instrumental and affective attitudes and enhancing self-efficacy to promote consistent condom use in this population. Although perceived norms were not determined to be statistically significant in this study, their potential role as a mediator merits further exploration, particularly in light of the study limitations. This research highlights the need for tailored interventions to reduce HIV risk among male clients of sex workers in South Africa.

The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness

Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing.

Ethical considerations for nurse practitioners conducting research in populations with opioid use disorder

ABSTRACT

People with opioid use disorder (OUD) are a vulnerable population who face unique risks of harm when participating in research. Despite a long-standing dialogue, written research codes of ethics, and institutional review board oversight for the conduct of ethical research in vulnerable populations, protections for study populations with OUD is rarely mentioned. Nurse practitioners who conduct research using participants with OUD, especially when recruiting their own patients (i.e., dual role), must be aware of the unique ethical considerations necessary to protect their patients and participants from increased risks. This article explores vulnerabilities and influences that can affect participant recruitment and consent, imbalances in the distribution of risk and benefits to participants participating in research, and the concerns of coercions, undue influence, and unjustifiable pressure contributing to vulnerabilities. Strategies to reduce the risks of influences that are of concern in the vulnerable population of research participants with opioid disorder are suggested. The goal of this article was to raise awareness of the unique potential risks of harm when using people with OUD as research participants and to explore strategies to minimize potential risks of various levels of influence in this vulnerable population.

Doing transdisciplinary research in Guyana's prisons

This article reflects on the research process that underpinned the ESRC GCRF project ‘Mental Health, Neurological and Substance Abuse Disorders in Guyana's Jails: 1825 to the present day’. Introducing readers to a transdisciplinary team comprised of academics and practitioners, in what follows we think through how the methods of the research underpinned the production of the data used in this special issue. The article highlights the emotional labour and ethics of care among the team, and the benefits of transdisciplinary research and the mutual recipriocity and learning that took place between academics and prison staff. The goal of the project was to create equitable and ethical partnerships, and this contributed to the success of this research in terms of findings, data, and real‐world impact.

Uptake and experience of professional interpreting services in primary care in a South Asian population: a national cross-sectional study

BACKGROUND

Interpreting services bridge language barriers that may prevent patients and clinicians from understanding each other, impacting quality of care and health outcomes. Despite this, there is limited up-to-date evidence regarding the barriers to and facilitators of uptake in primary care. The aim of this study was to ascertain current national uptake and experience of interpreting services in primary care (general practice) by South Asian communities in England.

METHODS

We conducted a national cross-sectional survey in 2023 with people with limited or no English language proficiency (n = 609). Multilingual researchers interviewed people from Bangladeshi (n = 213), Indian (n = 200), and Pakistani (n = 196) backgrounds from four regions in England (Greater London, Midlands, Yorkshire and the Humber, North West).

RESULTS

Sixty-three percent of participants reported using professional interpreting services in primary care. The most common modality was face-to-face interpreting (55%), followed by telephone (17%) and video (8%). Multivariable analysis identified several correlates of lower uptake: participants from Indian backgrounds, those living in the Midlands, and those whose family member/friend interpreted for them within the past year were less likely to have used a professional interpreter provided by their general/family practice. Participants who had visited primary care within the last 12 months, had requested an interpreter but were told they could not have one, were informed about professional interpreting services, and were given choice in their language support were more likely to have used a professional interpreter.

CONCLUSIONS

Our approach provides novel data on professional interpreting service use and evidence about the factors that may play a role in patient uptake and experience.

Paid Domestic Work and Depressive Symptoms in Mexico: Results of a National Health Survey

Paid domestic work (PDW) is an important source of employment for the global female workforce. It is frequently performed under precarious working conditions and occupational risks that are often associated with depressive symptoms (DSs). Although 10% (2.2 million) of Mexican working women are paid domestic workers (PDWs), their mental health has remained understudied. This article analyzes the occurrence and factors associated with DSs in a sample of Mexican workers segmented into six workforce groups, including PDWs. A three-stage statistical analysis was performed on national health survey data from Mexico (ENSANUT 2012): 1. Tabulation of inferential statistics; 2. Multiple logistic regression modeling of DSs; 3. Postestimation of DSs prevalence. Our findings suggest a context of social disadvantages based on gender, education, and labor market segregation that manifests in PDWs having the highest adjusted prevalence of DSs (14.1%, 95%CI = 9.7-18.4). Significant differences in prevalence were observed when compared with other workforce groups, such as formal employees. Among working women, after adjusting for relevant covariates, the odds of DSs were higher among PDWs as compared with formal employees (OR = 1.65, 95%CI = 1.04-2.61). Ongoing efforts for PDW formalization should be maintained in Mexico as an employment policy and mechanism to achieve PDWs' social well-being and mental health.

How sociodemographic factors relate to trust in artificial intelligence among students in Poland and the United Kingdom

The article aims to determine the sociodemographic factors associated with the level of trust in artificial intelligence (AI) based on cross-sectional research conducted in late 2023 and early 2024 on a sample of 2098 students in Poland (1088) and the United Kingdom (1010). In the times of AI progressively penetrating people's everyday life, it is important to identify the sociodemographic predictors of trust in this increasingly dynamically developing technology. The theoretical framework for the article is the extended Unified Theory of Acceptance and Use of Technology (UTAUT), which highlights the significance of sociodemographic variables as predictors of trust in AI. We performed a multivariate ANOVA and regression analysis, comparing trust in AI between students from Poland and the UK to identify the significant predictors of trust in this technology. The significant predictors of trust were nationality, gender, length of study, place of study, religious practices, and religious development. There is a need for research into the sociodemographic factors of trust in AI and for expanding the UTAUT to include new variables.

Adherence to and predictors of iron-folate acid supplementation among pregnant women in a pastoral population in Ghana: a community-based cross-sectional study

BACKGROUND

Iron-Folate Acid Supplementation (IFAS) interventions have been recognized globally as key in reducing the burden of anemia among pregnant women. However, adherence to and determinants of IFAS remain indistinct, as it is the main constraint with supplementation therapy, particularly among minority populations. Hence, this study sought to determine the adherence to and predictors of IFAS among nomadic Fulani pregnant women in the West Gonja Municipality of Ghana.

METHODS

A community-based cross-sectional design was employed to involve 130 respondents between February to July, 2022 in the West Gonja Municipality of Ghana. Fulani pregnant women aged 15-49 years, possessing maternal and child health record book and were given iron-folate supplements within 16 weeks and resided within the study area ≥ 6 months before/during the data collection period were included in the study. Multivariable logistic regression was used to determine independent predictors of IFAS using SPSS version 25.0 (p ≤ 0.05 deemed statistically significant across all models). ResultsUptake of and adherence to IFAS was 47.7% and 35.5% respectively. Major barriers to IFAS uptake were forgetfulness (25.7%) and unavailability (20.0%). About 65.4% of the respondents revealed poor knowledge of IFAS. Spousal occupation (AOR = 0.17, p = 0.010), spousal income (AOR = 4.125, p = 0.050) and knowledge on IFAS (AOR = 0.259, p = 0.039) were predictors of IFAS.

CONCLUSIONS

Poor adherence to and knowledge on IFAS were noted in the study and highlighted as a grave public health concern. Thus, nutrition and antenatal educational programs should give necessary attention to adherence to IFAS during pregnancy, particularly among nomadic and other vulnerable and minority populations to limit the burden of illnesses.

Evaluation of a multi-component prevention concept for hazardous substance use among refugees in shared accommodations: study protocol for a cluster randomized controlled trial

BACKGROUND

Refugees are exposed to various risk factors in shared accommodations in Germany where they are housed after their arrival. Due to their often traumatic experiences before, during, and after their flight and socio-structural post-migration stressors, refugees are potentially vulnerable to hazardous substance use. They form a structurally disadvantaged group for substance use prevention and intervention. Various barriers make it difficult for them to access the healthcare system and to get health information. Therefore, a participatory multi-component prevention concept for refugees in shared accommodations was developed. The aim of the trial is to evaluate the efficacy of this concept regarding the increase in knowledge about substance use among refugees living in shared accommodations.

METHODS

Based on a randomized controlled stepped-wedge design, the study will be conducted in a multicenter setting in nine shared accommodations and will aim to include refugees living in shared accommodations as well as social workers and psychologists working there.

DISCUSSION

This trial will be one of the first to generate evidence about effective participatory prevention concepts for refugees in shared accommodations. Evidence-based concepts for refugees can improve access to health care and might be helpful for the multidisciplinary workforce in shared accommodations.

TRIAL REGISTRATION

OSF Registry: osf.io/ebnj3. Registered on May 24, 2024. Registration DOI: https://doi.org/10.17605/OSF.IO/EBNJ3.

Role of servicescape in patients' clinic care waiting experience: Evidence from developing countries

The aim of this research is to investigate the role of servicescape on re-patronage and recommended intention through pleasure feeling and satisfaction in healthcare settings that put substantial contribution in the process of healthcare service delivery. Data were collected through cross-sectional convenience sampling via a self-administered survey questionnaire from 431 clinical outpatients who revisit the same hospital of metropolitan areas of Punjab, Pakistan. Structural Equation Modeling (SEM) was carried out for path analysis through AMOS (24.0 V), while statistical measures were analyzed using SPSS (25.0 V). The present study results revealed that patients' intention optimistically triggered through partial mediation and affirm the direct and indirect association with servicescape. It also revealed that patient-recommended and re-patronage intentions to visit the clinic were statistically substantial and positively influenced by intervening constructs of pleasure feeling and satisfaction. Additionally, it is found that servicescape and pleasure feeling contributed to 30% change in satisfaction. Moreover, pleasure feeling, and satisfaction contributed to 50% change in re-patronage and 31% change in recommendation intention of the patients. The current study findings contribute significantly to servicescape literature from a theatrical perspective and reevaluate the patterns and operations in healthcare. It also helps managers and administrators of private hospitals to make strategies to increase patient satisfaction.

High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal

Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.

Wiidookaage'win: Beta-test of a Facebook group intervention for Native women to support opioid use recovery

INTRODUCTION

The ongoing opioid misuse epidemic has had a marked impact on American Indian/Alaska Native (AI/AN) communities. Culture- and gender-specific barriers to medically assisted recovery from opioid use disorder (OUD) have been identified, exacerbating its impact for AI/AN women. Wiidookaage'win is a community-based participatory research study that aims to develop a culturally tailored, moderated, private Facebook group intervention to support Minnesotan AI/AN women in medically assisted recovery from OUD. The current study assessed the preliminary feasibility and acceptability of the intervention in a beta-test to inform refinements before conducting a pilot randomized controlled trial (RCT).

METHODS

The intervention was beta-tested for 30 days. Moderators were trained prior to delivering the intervention. Study assessments were conducted at baseline and post-intervention. The post-intervention assessments included substance use (self-report and urine drug screen), treatment acceptability, mental health, and spirituality outcomes. We examined intervention engagement patterns using Facebook metrics and qualitatively explored common topics that emerged in participant posts and comments.

RESULTS

Ten AI/AN women taking medication for OUD (MOUD) were accrued (age range 25-62 years). Participants had been in opioid recovery a mean of 15.2 months (SD = 16.1; range = 3-60). The study participation rate (accrued/eligible) was 91 %. Nine participants completed the post-intervention survey assessment and eight completed a UDS. Acceptability was high based on the mean treatment satisfaction score (M = 4.8, SD = 0.2 out of a possible 5.0), Facebook group engagement, and positive qualitative feedback. All participants retained at post-intervention continued their MOUD treatment, and none had returned to opioid use.

CONCLUSIONS

The beta-test indicated that the Facebook platform and study procedures generally worked as intended and that the intervention was largely acceptable to study participants. The results of this study phase provided valuable insights to inform refinements prior to conducting a pilot RCT to further assess the feasibility, acceptability, and potential efficacy of the intervention.

Practices and preferences for HIV testing and treatment services amongst partners of transgender women in Lima, Peru: An exploratory, mixed methods study

BACKGROUND

In Peru, one-third of transgender women (TW) are estimated to be living with HIV. While TW are recognized as a priority population, their sexual partners are an at-risk hidden population with unmet needs for HIV services. We conducted a study examining the practices and preferences for HIV services among partners of transgender women (PTW), as compared to TW, to better understand the needs of PTW and inform HIV service delivery for them in Peru.

METHODS

Between July-October 2022 we conducted a cross-sectional mixed methods study among PTW and TW in Lima, Peru. Using an explanatory sequential design, we administered online surveys to PTW (n = 165) and TW (n = 69), then interviewed a subset of participants (n = 20: 16 PTW, 4 TW). We quantitatively and qualitatively described PTW practices/perspectives on HIV testing and treatment and compared them to TW practices/preferences; we also compared practices/preferences among PTW based on their relationship with TW.

RESULTS

Overall, PTW and TW shared similar experiences and preferences for HIV testing/treatment, but fewer PTW reported accessing non-traditional HIV testing options and PTW expressed less strong preferences for HIV services. PTW practices/preferences varied by type of relationship with TWs. Surveys and interviews highlighted a need to prioritize efficiency for HIV testing, eliminate gender/sexuality-based discrimination in healthcare settings, increase privacy when delivering HIV services, and increase awareness of pre-exposure prophylaxis.

CONCLUSION

PTW identified many aspects related to the location, convenience, and privacy of HIV services as important. Next steps could include a discrete choice experiment to further clarify priorities for HIV services for PTW in Peru.

Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal

Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy that remarkably reduces HIV transmission risk. Although PrEP has been available in Nepal since 2019, very little is known about PrEP use among MSM in Nepal. This study aimed to examine PrEP awareness and its use among Nepali MSM and the factors influencing its adoption. A cross-sectional survey was conducted among MSM in Nepal between October and December 2022 (N = 250). Bivariate analysis and logistic regression were performed to determine factors associated with awareness and use of PrEP. In the study population, 59.6% of participants were aware of PrEP, however, only 30.4% of them had utilized it. The odds of PrEP awareness were higher among participants who had completed high school or above (aOR = 4.1; 95% CI = 1.8-9.6), those with health insurance coverage (aOR = 6.9; 95% CI = 2.1-22.3) and had tested for HIV (aOR = 21.2; 95% CI = 8.3-53.9). Similarly, participants who identified as gay (aOR = 3.4; 95% CI = 1.4-8.4), had visited a doctor within the past 6 months (aOR = 2.9; 95% CI = 1.2-6.5), had previously tested for HIV (aOR = 12.3; 95% CI = 3.4-44.7), and had been diagnosed with sexually transmitted infections (aOR = 7.0; 95% CI = 2.5-19.5) were more likely to have used PrEP. Our results highlight the critical importance of healthcare providers engaging in providing care for MSM, including facilitating as well as discussions about PrEP. In addition, there is a pressing need for innovative strategies (e.g., peer educators, social media, online facilitating technologies) to disseminate PrEP knowledge and reduce stigma surrounding PrEP.

A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics

BACKGROUND

Thailand's HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys.

OBJECTIVE

We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM.

METHODS

We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants' phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation.

RESULTS

Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using "borrowed" phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw.

CONCLUSIONS

We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection.

ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: Guidance and examples to support reporting consensus methods

BACKGROUND

When research evidence is limited, inconsistent, or absent, healthcare decisions and policies need to be based on consensus amongst interested stakeholders. In these processes, the knowledge, experience, and expertise of health professionals, researchers, policymakers, and the public are systematically collected and synthesised to reach agreed clinical recommendations and/or priorities. However, despite the influence of consensus exercises, the methods used to achieve agreement are often poorly reported. The ACCORD (ACcurate COnsensus Reporting Document) guideline was developed to help report any consensus methods used in biomedical research, regardless of the health field, techniques used, or application. This explanatory document facilitates the use of the ACCORD checklist.

METHODS AND FINDINGS

This paper was built collaboratively based on classic and contemporary literature on consensus methods and publications reporting their use. For each ACCORD checklist item, this explanation and elaboration document unpacks the pieces of information that should be reported and provides a rationale on why it is essential to describe them in detail. Furthermore, this document offers a glossary of terms used in consensus exercises to clarify the meaning of common terms used across consensus methods, to promote uniformity, and to support understanding for consumers who read consensus statements, position statements, or clinical practice guidelines. The items are followed by examples of reporting items from the ACCORD guideline, in text, tables and figures.

CONCLUSIONS

The ACCORD materials - including the reporting guideline and this explanation and elaboration document - can be used by anyone reporting a consensus exercise used in the context of health research. As a reporting guideline, ACCORD helps researchers to be transparent about the materials, resources (both human and financial), and procedures used in their investigations so readers can judge the trustworthiness and applicability of their results/recommendations.

Reaching the unheard: overcoming challenges in health research with hard-to-reach populations

PURPOSE

Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research.

METHODS

This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned.

RESULTS

Creative strategies to engage hard-to-reach populations in research included considering the participants' socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants' preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live.

CONCLUSIONS

Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties-A multicenter cross-sectional study

OBJECTIVE

To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties.

RESULTS

The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927.

DISCUSSION

CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries.

CONCLUSION

The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

The evolution of professional identity in intensive care nurses during COVID-19 - An interpretive phenomenological study

OBJECTIVES

This study explored the meaning behind professional identity in intensive care nurses who cared for patients with COVID-19.

RESEARCH METHODOLOGY/DESIGN

The exploration was conducted using a qualitative interpretive phenomenological approach with guidance from hermeneutics.

SETTING

Semi-structured audiovisual interviews were conducted with intensive care unit nurses (n = 20) throughout the United States of America, spanning nurse experiences of caring for patients with COVID-19 between 2019 and 2022.

OUTCOME MEASURE

Outcome measures were codes and themes which emerged from data using Benner's interpretive phenomenology method for nursing and Heidegger's hermeneutic circle.

FINDINGS

Four critical findings of this study were the themes a) Keep Them Alive, b) We Are Survivors, c) I Am An Intensive Care Unit Nurse, and d) I Was Meant For This.

CONCLUSION

Findings suggest that professional identity is evolving for nurses as they care for patients in the intensive care and that evolution affects nursing professionals' quality of life.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings of this study have important implications for nursing practice. These themes highlight intensive care nurses' deep commitment and strong professional identity, which can positively impact nurse retention and foster a sense of purpose and fulfillment. Understanding the meaning attached to nurses' experiences can allow nurse leaders and mentors to enhance their roles and aid in the preparation of future intensive care nurses, helping future nurses find focus and satisfaction in their professional identities. Recognizing and nurturing nurses' strong professional identity may positively impact nurse retention and fulfillment. To achieve this, nurse leaders must comprehend and support nurses' experiences, cultivating an environment that empowers these caregivers to thrive and make a lasting impact on patient care.

Recruiting Nurse Participants in Ambulatory Care Nursing Research

Patient care needs in ambulatory care (AC) settings continue to grow and evolve in the United States, with commensurate growth of nursing responsibilities in AC. Conducting research on the nursing workforce and nursing practice is essential to understanding and meeting the needs of nurses and patients in this setting. However, the structures and characteristics of AC settings pose challenges for conducting research on AC nursing practice. This article explains unique barriers to participation in research for nurses in AC, describes recruitment challenges for nurse researchers in AC, and provides strategies to increase recruitment of nurses for AC research. Researchers in AC must find ways to recruit representative participant samples, be clear and precise in defining terms, and report robust demographic information about participants and their practice settings.

Suicidal ideation, plan, and attempt among men who have sex with men in Nepal: Findings from a cross-sectional study

Men who have sex with men (MSM) are at increased risk for suicide, with a much higher prevalence of suicidality than the general population. While there is a growing interest in the identification of risk factors for suicidal behaviors globally, the understanding of the prevalence and risk factors for suicidal behaviors among MSM in the context of low- and middle-income countries is almost non-existent. Therefore, this study aimed to investigate suicidal ideation, plan, and attempts, and related factors among MSM in Nepal. A cross-sectional respondent driven survey was conducted on 250 MSM between October and December 2022. Bivariate and multivariable logistic regression was used to evaluate independent correlates of suicidal behaviors of MSM. Overall, the lifetime prevalence of suicidal ideation, plans, and attempts among MSM in this study were 42.4%, 31.2%, and 21.6%, respectively. MSM with depressive symptoms (aOR = 5.7, 95% CI = 2.4-14.1), advanced education (higher secondary and above; aOR = 2.9, 95% CI = 1.4-6.1), and smoking habit (aOR = 2.5, 95% CI = 1.2-5.3) were at increased risk for suicidal ideation. Similarly, those with depressive symptoms (aOR = 2.2, 95% CI = 1.1-4.8) and advanced education (aOR = 2.7, 95% CI = 1.2-5.7) were more likely to plan suicide, whereas young MSM were significantly more prone to attempting suicide (aOR = 2.7, 95% CI = 1.3-5.8). Interestingly, MSM with moderate to severe food insecurity were 2-3 times more likely to think about, plan, or attempt suicide (ideation: aOR = 3.5, 95% CI = 1.6-7.7; plan: aOR = 3.7, 95% CI = 1.6-8.3; attempt: aOR = 2.2, 95% CI = 1.1-4.6). The results suggest the importance of early assessment of suicidal behaviors among MSM and the need for tailored interventions to simultaneously address mental health problems and food insecurity to reduce suicide-related problems among Nepalese MSM.

Gay App Use, Sexuality Traits, and High-Risk Sexual Behaviors Among Men Who Have Sex With Men in China: Mediation Analysis

BACKGROUND

Gay geosocial networking apps, also known as "gay apps," have gained increasing popularity in the men who have sex with men (MSM) community. Certain sexuality traits and gay app use are both associated with high-risk sexual behaviors among MSM. However, little is known about the underlying mechanism of such relationships.

OBJECTIVE

Based on the uses and gratifications theory, this study aimed to test the mediation effect of gay app use on the relationship between sexuality traits (sexual compulsivity and sexual sensation seeking) and high-risk sexual behaviors (multiple sexual partners and unprotected anal intercourse) among MSM.

METHODS

A cross-sectional, multicenter study was conducted in Wuhan and Changsha, China, from August to October 2020. A representative sample of 402 MSM was recruited through respondent-driven sampling. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, gay app use, sexual compulsivity, and sexual sensation seeking. Path analysis was conducted to assess the mediation effect.

RESULTS

Our study revealed that 67.42% (n=271) of MSM used gay apps for seeking potential sexual partners, with 37.06% (n=149) of them engaging in unprotected anal intercourse, and 45.42% (n=218) of them having multiple sexual partners. Of the participants, 17.16% (n=69) reported significant sexual compulsivity, while 29.10% (n=117) reported significant sexual sensation seeking. Notably, gay app usage partially mediated the relationship between sexual compulsivity and multiple sexual partners but fully mediated the relationship between sexual compulsivity and unprotected anal intercourse. Furthermore, gay app usage partially mediated the relationship between sexual sensation seeking and multiple sexual partners but fully mediated the relationship between sexual sensation seeking and unprotected anal intercourse.

CONCLUSIONS

High-risk sexual behaviors are common among MSM. Most MSM rely on gay apps to find sexual partners, which, when combined with higher levels of sexual compulsivity and sexual sensation seeking, can increase the likelihood of engaging in high-risk sexual behaviors. Therefore, interventions aimed at reducing these behaviors among MSM should focus on addressing the use of gay apps, while also considering the influence of their sexuality traits on gay app use.

A mixed method study exploring gender differences in dementia caregiving

Few studies have investigated the experience of male carers of people with dementia and fewer specifically examined whether male and female carers of people with dementia differ in their approach to the caring role. As such, this research set-out to investigate whether male carers of people with dementia approach the caring role differently to female carers. Data from 167 survey participants (24 males and 143 females) were analysed using a mixed research methodology. Participants' demographics and scores on standardised burden and coping scales were analysed using linear regression. Participants' written responses to open-ended questions were analysed using thematic analysis anchored in theories of hegemonic masculinity. No significant gender differences were identified in carers' coping strategies or self-reported carer burden. However, qualitative analysis revealed strong thematic gender differences like: gendered barriers to help-seeking; gendered service preference; gendered considerations about residential care; gendered expression of burden; and themes of the absent son and exhausted daughter. This research identified that male carers of people with dementia approach help-seeking differently to female carers, typically focusing on addressing functional tasks and refraining from showing emotions, this despite reporting similar carer burden. Rapport building with male carers should start with conversations around functional issues rather than assessing the emotional impact of the caring role. The findings reinforce the need for more qualitative research into the unmet needs of male carers of people with dementia, to inform the design of male-friendly interventions which could facilitate timely access to services by male carers.

The Feasibility of Make My Day-A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare

Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.

Defining research priorities and needs in cancer symptoms for adults diagnosed with cancer: an Australian/New Zealand modified Delphi study

PURPOSE

This study asked consumers (patients, carers) and healthcare professionals (HCPs) to identify the most important symptoms for adults with cancer and potential treatment interventions.

METHODS

A modified Delphi study was conducted involving two rounds of electronic surveys based on prevalent cancer symptoms identified from the literature. Round 1 gathered information on participant demographics, opinions and/or experience on cancer symptom frequency and impact, and suggestions for interventions and/or service delivery models for further research to improve management of cancer symptoms. In Round 2, respondents ranked the importance of the top ten interventions identified in Round 1. In Round 3, separate expert panels of consumers and healthcare professionals (HCPs) attempted to reach consensus on the symptoms and interventions previously identified.

RESULTS

Consensus was reached for six symptoms across both groups: fatigue, constipation, diarrhoea, incontinence, and difficulty with urination. Notably, fatigue was the only symptom to reach consensus across both groups in Round 1. Similarly, consensus was reached for six interventions across both groups. These were the following: medicinal cannabis, physical activity, psychological therapies, non-opioid interventions for pain, opioids for breathlessness and cough, and other pharmacological interventions.

CONCLUSIONS

Consumers and HCPs prioritise differently; however, the symptoms and interventions that reached consensus provide a basis for future research. Fatigue should be considered a high priority given its prevalence and its influence on other symptoms. The lack of consumer consensus indicates the uniqueness of their experience and the need for a patient-centred approach. Understanding individual consumer experience is important when planning research into better symptom management.

A multi-country study of the associations between HIV vulnerability status, perception of COVID-19 related stigma and post-traumatic stress symptoms during the first wave of the pandemic

BACKGROUND

This study investigated the associations between COVID-19 related stigma and post-traumatic stress symptoms (PTSS); and the associations between PTSS and COVID-19 related stigma, HIV status, COVID-19 status and key HIV population status.

METHODS

This was a secondary analysis of data of 12,355 study participants generated through an online survey that recruited adults from 152 countries between July and December 2020. The dependent variables were COVID-19-related stigma and PTSS. The independent variables were HIV status (positive/negative), transaction sex (yes/no), use of psychoactive drugs (yes/no), and vulnerability status (transaction sex workers, people who use psychoactive drugs, living with HIV, and COVID-19 status). The confounding variables were age, sex at birth (male/female), level of education, sexual minority individuals (yes/no) and country income level. Multivariable logistic regression analyses were conducted to determine associations between the dependent and independent variables after adjusting for confounders.

RESULTS

There were 835 (6.8%) participants who experienced COVID-19 related stigma during the pandemic and 3,824 (31.0%) participants reported PTSS. Respondents who were living with HIV (AOR: 1.979; 95%CI: 1.522-2.573), tested positive for COVID-19 (AOR: 3.369; 95%CI: 2.692-4.217), engaged in transactional sex (AOR: 1.428; 95%CI: 1.060-1.922) and used psychoactive drugs (AOR: 1.364; 95%CI: 1.053-1.767) had significantly higher odds of experiencing COVID-19 related stigma. Individuals with vulnerability status (AOR:4.610; 95%CI: 1.590-13.368) and who experienced COVID-19 related stigma (AOR: 2.218; 95%CI: 1.920-2.561) had significantly higher odds of PTSS.

CONCLUSION

Individuals with vulnerability status may be at increased risk for COVID-19 related stigma. Key and vulnerable populations who were living with HIV and who experienced stigma may be at a higher risk of experiencing PTSS. Populations at risk for PTSS should be routinely screened and provided adequate support when they contract COVID-19 to reduce the risk for poor mental health during COVID-19 outbreaks and during future health crisis with similar magnitude as the COVID-19 pandemic.

Cancer Risk Behaviors, Cancer Beliefs, and Health Information Seeking Among Under-Represented Populations in San Francisco: Differences by Sexual Orientation and Gender Identity

Purpose

Sexual and gender minority (SGM) individuals in the United States are at increased risk of cancer compared to the non-SGM population. Understanding how SGM persons perceive cancer risk and their practices and preferences for accessing health information is key for improving the preventive and health care services they receive.

Methods

In this cross-sectional study, we analyzed data from the San Francisco Health Information National Trends Survey. SGM individuals were identified by self-report. Differences in cancer risk factors, cancer beliefs, and health information seeking were evaluated by SGM status using multivariable logistic regression models.

Results

Out of 1027 participants, 130 (13%) reported being SGM individuals. Current smoking (odds ratio [OR]=1.93, 95% confidence interval [CI]=1.24-3.01) and alcohol use (OR=1.69, 95% CI=1.10-2.59) were more common among SGM persons than among non-SGM persons. No differences by SGM status were observed in health information seeking behaviors, preferences, and cancer beliefs, but SGM participants reported significantly higher odds of feeling frustrated (OR=1.78, 95% CI=1.20-2.64) and having concerns about the quality of the information (OR=1.54, 95% CI=1.03-2.31) during their most recent health information search.

Conclusions

Intervention efforts aimed at SGM individuals with current use of tobacco and/or alcohol should be expanded. SGM communities also need improved access to consistent, reliable, and accurate sources of health information. Their increased frustration when seeking health information and concerns about the quality of the information they find have important implications for SGM health and care, and the drivers of these differences merit further evaluation.