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Celeste-Villalvir A, Palar K, Then-Paulino A, Wallace DD, Jimenez-Paulino G, Fulcar MA, Acevedo R, Derose KP. Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00051-4. [PMID: 38613552 DOI: 10.1016/j.jneb.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic. METHODS Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes. RESULTS Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being. CONCLUSIONS AND IMPLICATIONS Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.
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Affiliation(s)
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Ramon Acevedo
- Consejo Nacional para el VIH y Sida, Santo Domingo, Dominican Republic
| | - Kathryn P Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA; Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA.
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Dadi TL, Wiemers AMC, Tegene Y, Medhin G, Spigt M. Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis. AIDS Res Ther 2024; 21:7. [PMID: 38297363 PMCID: PMC10829476 DOI: 10.1186/s12981-024-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.
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Affiliation(s)
- Tegene Legese Dadi
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia.
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
| | - Anja M C Wiemers
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Yadessa Tegene
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mark Spigt
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsö, Norway
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Celeste-Villalvir A, Then-Paulino A, Armenta G, Jimenez-Paulino G, Palar K, Wallace DD, Derose KP. Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic. Public Health Nutr 2023; 26:3134-3146. [PMID: 37905447 PMCID: PMC10755388 DOI: 10.1017/s1368980023002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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Affiliation(s)
- Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, San Francisco, CA94143, USA
| | - Deshira D Wallace
- University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC27599, USA
| | - Kathryn P Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
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Celeste-Villalvir A, Payan DD, Armenta G, Palar K, Then-Paulino A, Acevedo R, Fulcar MA, Derose KP. Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic. PLoS One 2023; 18:e0290228. [PMID: 37616218 PMCID: PMC10449144 DOI: 10.1371/journal.pone.0290228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men's experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women's experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to "move on" and "look ahead." Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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Affiliation(s)
- Alane Celeste-Villalvir
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Denise D. Payan
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, United States of America
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, United States of America
| | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Amarilis Then-Paulino
- Facultad de Ciencia de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Kathryn P. Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, California, United States of America
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Molina R, Enriquez M. Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes. Sci Diabetes Self Manag Care 2023; 49:281-290. [PMID: 37313730 DOI: 10.1177/26350106231178838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.
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Affiliation(s)
- Rosalia Molina
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Maithe Enriquez
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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Derose KP, Then-Paulino A, Han B, Armenta G, Palar K, Jimenez-Paulino G, Sheira LA, Acevedo R, Fulcar MA, Lugo Bernard C, Veloz Camacho I, Donastorg Y, Wagner GJ. Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic. AIDS Behav 2023; 27:864-874. [PMID: 36066760 PMCID: PMC9446649 DOI: 10.1007/s10461-022-03821-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/01/2022]
Abstract
A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of "perfect" ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.Trial registry Clinical Trials Identifier: NCT03568682.
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Affiliation(s)
- Kathryn P Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA.
- Department of Health Promotion and Policy, University of Massachusetts Amherst, 715 N. Pleasant St., Amherst, MA, 01003, USA.
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA, USA
- Division of Biostatistics Research, Department of Research & Evaluations, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila A Sheira
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - María A Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz Camacho
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn J Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
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Davis VH, Nixon SA, Murphy K, Cameron C, Bond VA, Hanass-Hancock J, Kimura L, Maimbolwa MC, Menon JA, Nekolaichuk E, Solomon P. How the Term 'Self-Management' is Used in HIV Research in Low- and Middle-Income Countries: A Scoping Review. AIDS Behav 2022; 26:3386-3399. [PMID: 35429310 DOI: 10.1007/s10461-022-03668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
Abstract
This scoping review assessed how the term 'self-management' (SM) is used in peer-reviewed literature describing HIV populations in low- and middle-income countries (LMIC). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. OVID Medline, Embase, CAB Abstracts, and EBSCO CINAHL, Scopus, and Cochrane Library were searched up to September 2021 for articles with SM in titles, key words, or abstracts. Two team members independently screened the titles and abstracts, followed by the full-text. A data extraction tool assisted with collecting findings. A total of 103 articles were included. Since 2015, there has been a 74% increase in articles that use SM in relation to HIV in LMIC. Fifty-three articles used the term in the context of chronic disease management and described it as a complex process involving active participation from patients alongside providers. Many of the remaining 50 articles used SM as a strategy for handling one's care by oneself, with or without the help of community or family members. This demonstrates the varied conceptualizations and uses of the term in LMIC, with implications for the management of HIV in these settings. Future research should examine the applicability of SM frameworks developed in high-income settings for LMIC.
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Affiliation(s)
- Victoria H Davis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, M5T 3M6, Toronto, Ontario, Canada.
| | - Stephanie A Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kathleen Murphy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, Toronto, Canada
| | - Virginia A Bond
- Global and Health Development Department, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Jill Hanass-Hancock
- School of Health Science, University of KwaZulu-Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Lauren Kimura
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - J Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Derose KP, Fulcar MA, Acevedo R, Armenta G, Jiménez-Paulino G, Bernard CL, del Rosario LEP, Then-Paulino A. An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:187-201. [PMID: 34014110 PMCID: PMC8274817 DOI: 10.1521/aeap.2021.33.3.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.
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Affiliation(s)
- Kathryn P. Derose
- RAND Corporation, Santa Monica, CA, USA
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Gipsy Jiménez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
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