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Underhill A, Persad Y, Lacombe-Duncan A, Armstrong I, Kia H, Logie CH, Tharao W, Halpenny R, Loutfy M. Community partnership to optimize engagement in research: Reflections on the trans women HIV research initiative. Br J Clin Pharmacol 2024. [PMID: 38469905 DOI: 10.1111/bcp.16038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
| | | | - Ashley Lacombe-Duncan
- Women's College Hospital, Toronto, Canada
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Hannah Kia
- Faculty of Social Work, University of British Columbia, Vancouver, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | | | - Mona Loutfy
- Women's College Hospital, Toronto, Canada
- Maple Leaf Medical Clinic, Toronto, Canada
- Maple Leaf Research, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
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Harris GE, Watson JR, Li ATW, Ibáñez-Carrasco F, Muchenje M, Demetrakopoulos AS, McGee A, Chambers L, Gahagan J, Ceranto A, Cumby C, Liddell M. Meaningful inclusion of people living with HIV as a model for workplace policies: Key findings from the project PEER study. Work 2024; 78:489-503. [PMID: 38427522 DOI: 10.3233/wor-230289] [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] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND As a large number of people live with HIV, it is worthwhile to examine the integration of this group in the workplace. OBJECTIVE To investigate how the operationalization of GIPA/MEPA supports workplace policies and practices for PLHIV. The study aims to explore what is being offered to support PLHIV in community-based agencies and what can be done to enhance the offerings. METHODS For this community-based research, 2 bilingual online surveys were sent to 150 Canadian organizations that work closely with PLHIV or offer support to them. One of the surveys was for Executive Directors of these organizations while the other was sent to peers; i.e. PLHIV whose job is to offer services to PLHIV. Questions in the surveys varied between open-ended, binary, and Likert. RESULTS GIPA/MEPA are implemented in most organizations and Executive Directors affirmed that PLHIV and their impacts on the workplace are valued. There is a consensus among Executive Directors that formal support is provided but most respondents argued that this support is not specific for PLHIV. More than half of respondents were either unaware or uncertain about the existence of informal support. Peer-employees claimed that one of the challenges of disclosing HIV to receive peer support is that they may face stigma. CONCLUSION The application of GIPA/MEPA results in positive outcomes in the workplace. The study emphasizes the need to facilitate access to informal support.
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Affiliation(s)
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Alan Tai-Wai Li
- CAAT-Community Alliance for Accessible Treatment, Toronto, Canada
| | | | - Marvelous Muchenje
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - A McGee
- Memorial University, St. John's, Canada
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Riccardi M, Pettinicchio V, Di Pumpo M, Altamura G, Nurchis MC, Markovic R, Šagrić Č, Stojanović M, Rosi L, Damiani G. Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review. Health Policy 2023; 137:104905. [PMID: 37716190 DOI: 10.1016/j.healthpol.2023.104905] [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: 01/28/2022] [Revised: 05/12/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.
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Affiliation(s)
- MariaTeresa Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Marcello Di Pumpo
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Roberta Markovic
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | | | - Miodrag Stojanović
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | - Luca Rosi
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità, ISS), Rome, Italy
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Lo Hog Tian JM, Watson JR, Deyman M, Tran B, Kerber P, Nanami K, Norris D, Samson K, Cioppa L, Murphy M, Mcgee A, Ajiboye M, Chambers LA, Worthington C, Rourke SB. Building capacity in quantitative research and data storytelling to enhance knowledge translation: a training curriculum for peer researchers. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:69. [PMID: 36474277 PMCID: PMC9724271 DOI: 10.1186/s40900-022-00390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Many community-based HIV research studies incorporate principles of greater involvement and meaningful engagement of people living with HIV (GIPA/MEPA) by training people with HIV as peer researchers. Unfortunately, there are still some aspects of research (e.g., quantitative data analysis and interpretation) where many projects fall short in realizing GIPA/MEPA principles. To address these gaps, we developed an eight-week training course that aimed to build the capacity of peer researchers around the understanding and interpretation of quantitative data and incorporating lived experience to increase the impact of the knowledge transfer and exchange phase of a study. METHODS Peer researchers (n = 8) participated from British Columbia, Alberta, and Ontario and lessons learned from the training were implemented throughout the dissemination of research findings from the People Living with HIV Stigma Index study. This paper presents the curriculum and main training components, course evaluation results, and challenges and lessons learned. The manuscript was created in collaboration with and includes the perspectives of both the peer researchers involved in the training, as well the course facilitators. RESULTS Throughout the course, peer researchers' self-assessed knowledge and understanding of quantitative research and data storytelling improved and, through interactive activities and practice, they gained the confidence to deliver a full research presentation. This improved their understanding of research findings, which was beneficial for discussing results with community partners and study participants. The peer researchers also agreed that learning about integrating lived experience with quantitative data has helped them to make research findings more relatable and convey key messages in a more meaningful way. CONCLUSIONS Our training curriculum provides a template for research teams to build capacity in areas of research where peer researchers and community members are less often engaged. In doing so, we continue to uphold the principles of GIPA/MEPA and enhance the translation of research knowledge in communities most greatly affected.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Megan Deyman
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Billy Tran
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Paul Kerber
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Kajiko Nanami
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Deborah Norris
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Kim Samson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Michael Murphy
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A Mcgee
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lori A Chambers
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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Gutman T, Kelly A, Scholes-Robertson N, Craig JC, Jesudason S, Tong A. Patient and Caregiver Experiences and Attitudes about Their Involvement in Research in Chronic Kidney Disease. Clin J Am Soc Nephrol 2022; 17:215-227. [PMID: 35131928 PMCID: PMC8823931 DOI: 10.2215/cjn.05960521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Although patient and caregiver involvement in research is widely advocated to improve the relevance and uptake of study findings, barriers and uncertainties in achieving this goal remain. This study aimed to describe patient and caregiver experiences and perspectives of their previous involvement in research, to inform strategies to strengthen patient involvement in research. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Semistructured interviews were conducted with 23 adult patients with CKD and caregivers who had previously been involved in research, from Australia, the United States, the United Kingdom, and Denmark. Transcripts were analyzed thematically. RESULTS We identified six themes: grappling with CKD diagnosis (overwhelmed by the burden of illness, silenced by stigma and shame, absence of advocacy, and awareness), bearing the responsibility for involvement (autonomy in their own care, forced to be proactive to access opportunities, infrastructural support to connect researchers and patients), battling big agendas (struggling in a system of disincentive, changing research culture, becoming equals), seeing the person behind the patient (harnessing broader knowledge, expertise, skills and interests, understanding patient needs, motivations for involvement), sensitivity to complexities of payment (accounting for individual circumstances, denoting value, enabling diverse involvement), and championing the patient voice (links to important stakeholders, drivers of innovation, responsibility to end users). CONCLUSIONS The burden of CKD, limited opportunities, and power asymmetry between patients/caregivers and researchers were challenges to meaningful involvement in research. Building trust, awareness of opportunities, and recognizing the broad expertise and value of patients/caregivers, including and beyond their illness experience, may better support patient and caregiver involvement in research in CKD.
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Affiliation(s)
- Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia,Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - Ayano Kelly
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia,Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia,Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
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Liboro R, Despres J, Ranuschio B, Bell S, Barnes L. Forging Resilience to HIV/AIDS: Personal Strengths of Middle-aged and Older Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV/AIDS. Am J Mens Health 2021; 15:15579883211049016. [PMID: 34587823 PMCID: PMC8488414 DOI: 10.1177/15579883211049016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
HIV-positive gay, bisexual, two-spirit, and other men who have sex with men (MSM) have exhibited significant resilience to HIV/AIDS in Canada since the start of the epidemic. Since 2012, most of the research that has been conducted on resilience to HIV/AIDS has utilized quantitative methods and deficits-based approaches, with a preferential focus on the plight of young MSM. In order to address apparent gaps in research on HIV/AIDS resilience, we conducted a community-based participatory research qualitative study that utilized a strengths-based approach to examine the perspectives and lived experiences of HIV-positive, middle-aged and older MSM on their individual attributes that helped forge their HIV/AIDS resilience. We conducted 41 semistructured interviews with diverse, HIV-positive, middle-aged and older MSM from Central and Southwestern Ontario, Canada. From our thematic analysis of our interviews, we identified four themes, which represented personal strengths that fostered resilience to HIV/AIDS: (a) proactiveness, (b) perseverance, (c) having the right mindset, and (d) self-awareness with self-control. This article discusses the importance of these personal strengths to fostering HIV/AIDS resilience, and how community-based resources could potentially lessen the need to muster such personal strengths, or alternatively, cultivate them.
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Affiliation(s)
- R Liboro
- University of Nevada, Las Vegas, Las Vegas, NV, USA.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - J Despres
- University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - B Ranuschio
- University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - S Bell
- University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - L Barnes
- University of Nevada, Las Vegas, Las Vegas, NV, USA
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Barriers and Facilitators to Promoting Resilience to HIV/AIDS: A Qualitative Study on the Lived Experiences of HIV-Positive, Racial and Ethnic Minority, Middle-Aged and Older Men Who Have Sex with Men from Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158084. [PMID: 34360376 PMCID: PMC8345717 DOI: 10.3390/ijerph18158084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
Evidence-based research has highlighted the need for exploring factors that support the mental health of men who have sex with men living with HIV/AIDS (MSMLWH), and environmental influences that promote their resilience to HIV/AIDS. This exploratory study utilized a community-based participatory research approach to investigate barriers and facilitators to promoting resilience to HIV/AIDS, specifically among racial and ethnic minority, middle-aged and older MSMLWH, a population that continues to be significantly impacted by HIV/AIDS today. This collaborative, qualitative study recruited participants who identified as racial or ethnic minority MSMLWH, were aged 40 or older, and resided in Ontario, Canada. Participants (n = 24) discussed in their interviews barriers and facilitators to promoting resilience to HIV/AIDS, which they recognized from their lived experiences. Utilizing thematic analysis, themes related to barriers and facilitators to promoting resilience to HIV/AIDS were identified. Themes related to identified barriers included: (1) language proficiency, (2) racism, (3) pernicious norms in North American gay culture, and (4) HIV stigma. Themes related to identified facilitators included: (1) compartmentalization, (2) perseverance, and (3) community-based health and social services. This article discusses the implications of the study’s findings, particularly on how they may influence the development of future services for racial and ethnic minority, middle-aged and older MSMLWH.
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O’Brien KK, Ibáñez-Carrasco F, Solomon P, Harding R, Brown D, Ahluwalia P, Chan Carusone S, Baxter L, Emlet C, Restall G, Casey A, Ahluwalia A, Quigley A, Terpstra AR, Ononiwu N. Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC). AIDS Res Ther 2020; 17:21. [PMID: 32429973 PMCID: PMC7236512 DOI: 10.1186/s12981-020-00280-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. METHODS We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. RESULTS Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation interventions for healthy aging with HIV; and (7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. CONCLUSIONS These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation (IHPME), 155 College Street, 4th Floor, Toronto, ON Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| | | | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | - Richard Harding
- Cicely Saunders Institute, King’s College London, Bessemer Road, London, UK
| | - Darren Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Charles Emlet
- University of Washington, Tacoma, Social Work, 1900 Commerce Street, Tacoma, WA USA
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, R127 Rehab Building, Winnipeg, MB Canada
| | - Alan Casey
- Department of Physical Medicine and Rehabilitation, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB Canada
| | | | - Adria Quigley
- Faculty of Health, Dalhousie University, 5968 College Street, Room 316, Halifax, NS Canada
| | - Alex R. Terpstra
- Department of Psychology, 2136 West Mall, Room 2405, Vancouver, BC Canada
| | - Nkem Ononiwu
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
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Bever A, Salters K, Tam C, Moore DM, Sereda P, Wang L, Wesseling T, Grieve S, Bingham B, Barrios R. Cohort profile: the STOP HIV/AIDS Program Evaluation (SHAPE) study in British Columbia, Canada. BMJ Open 2020; 10:e033649. [PMID: 32404387 PMCID: PMC7228510 DOI: 10.1136/bmjopen-2019-033649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) Program Evaluation (SHAPE) study is a longitudinal cohort developed to monitor the progress of an HIV testing and treatment expansion programme across the province of British Columbia (BC). The study considers how sociostructural determinants such as gender, age, sexual identity, geography, income and ethnicity influence engagement in HIV care. PARTICIPANTS Between January 2016 and September 2018, 644 BC residents who were at least 19 years old and diagnosed with HIV were enrolled in the study and completed a baseline survey. Participants will complete two additional follow-up surveys (18 months apart) about their HIV care experiences, with clinical follow-up ongoing. FINDINGS TO DATE Analyses on baseline data have found high levels of HIV care engagement and treatment success among SHAPE participants, with 95% of participants receiving antiretroviral therapy and 90% having achieved viral suppression. However, persistent disparities in HIV treatment outcomes related to age, injection drug use and housing stability have been identified and require further attention when delivering services to marginalised groups. FUTURE PLANS Our research will examine how engagement in HIV care evolves over time, continuing to identify barriers and facilitators for promoting equitable access to treatment and care among people living with HIV. A qualitative research project, currently in the formative phase, will compliment quantitative analyses by taking a strengths-based approach to exploring experiences of engagement and re-engagement in HIV treatment among individuals who have experienced delayed treatment initiation or treatment interruptions.
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Affiliation(s)
- Andrea Bever
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Clara Tam
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - D M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tim Wesseling
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sean Grieve
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Brittany Bingham
- Aboriginal Health Program, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Community Health Services, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Switzer S, Flicker S, McClelland A, Chan Carusone S, Ferguson TB, Herelle N, Yee D, Guta A, Strike C. Journeying together: A visual exploration of "engagement" as a journey in HIV programming and service delivery. Health Place 2020; 61:102247. [PMID: 32329724 DOI: 10.1016/j.healthplace.2019.102247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/02/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022]
Abstract
The experiences of people living with, or impacted by HIV, who participate in research and programming are relatively-well documented. However, how stakeholders within the HIV sector understand engagement, or how it functions discursively, is undertheorized. We used a comparative case study design and photovoice to explore engagement in three community-based organizations providing HIV programs or services in Toronto, Canada. We invited stakeholders to photograph their subjective understandings of engagement. We employ a visual and thematic analysis of our findings, by focusing on participants' use of journey metaphors to discuss engagement within and across sites. Visual metaphors of journey were employed by participants to make sense of their experience, and demonstrated that for many, engagement was a dynamic, affective and relational process. Our findings illustrate how journey may be an apt metaphor to explore the relational, contingent and socio-spatial/political specificities of engagement within and across HIV organizations. We conclude with a discussion on implications for practice.
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Affiliation(s)
| | | | | | - Soo Chan Carusone
- Casey House Hospital, Toronto, Ontario, M4Y 1P2, Canada; McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Tatiana B Ferguson
- Empower, Parkdale Queen West Community Health Centre, Gendering Adolescent AIDS Prevention, Toronto, Ontario, M5V 2R4, Canada
| | - Neil Herelle
- Toronto People with AIDS Foundation, Toronto, Ontario, M5A 2E6, Canada
| | - Derek Yee
- Casey House Hospital, Toronto, Ontario, M4Y 1P2, Canada
| | - Adrian Guta
- University of Windsor, Windsor, Ontario, N9B 3P4, Canada
| | - Carol Strike
- University of Toronto, Toronto, Ontario, M5T 3M7, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
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McKie RM, Davies AWJ, Nixon KD, Lachowsky NL. A theoretical examination using governmentality to understand gay men’s risk and sexual behaviours. CANADIAN JOURNAL OF HUMAN SEXUALITY 2019. [DOI: 10.3138/cjhs.2018-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article explores the link between Foucault’s (1991) governmentality theory, specifically as it relates to gay men’s sexual practices and perceptions of HIV risk. Foucault’s (1991) theory of governmentality elucidates the means through which individual behaviours and norms (at a micro level) are governed through the production of disciplinary norms and structures that are instantiated at a broader structural and institutional level (the macro-level). Foucauldian theoretical conversations pertaining to what is meant by conceptions and definitions of HIV/STI risk are furthered through this paper’s theoretical contributions as they relate to gay men. From a Foucauldian perspective, we assess how gay men may alter or monitor their sexual practices through governmental scripts produced at a state level and manifested through micro- and macro-level behavioural and ideological shifts based on dominant socio-sexual norms. A model of the interrelationship between governmentality, scripting, the micro/macro levels, and the situation-specific is presented for future consideration when examining gay men’s sexual practices. Historical oppression and segregation of gay men are considered when exploring these theories from a critical social scientific lens.
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Affiliation(s)
| | - Adam W. J. Davies
- Department of Curriculum Studies and Teacher Development, University of Toronto, Toronto, ON
| | - Kevin D. Nixon
- Department of Anthropology, University of Toronto, Toronto, ON
| | - Nathan L. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
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Kaida A, Carter A, Nicholson V, Lemay J, O'Brien N, Greene S, Tharao W, Proulx-Boucher K, Gormley R, Benoit A, Bernier M, Thomas-Pavanel J, Lewis J, de Pokomandy A, Loutfy M. Hiring, training, and supporting Peer Research Associates: Operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV. Harm Reduct J 2019; 16:47. [PMID: 31319894 PMCID: PMC6637632 DOI: 10.1186/s12954-019-0309-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A community-based research (CBR) approach is critical to redressing the exclusion of women-particularly, traditionally marginalized women including those who use substances-from HIV research participation and benefit. However, few studies have articulated their process of involving and engaging peers, particularly within large-scale cohort studies of women living with HIV where gender, cultural and linguistic diversity, HIV stigma, substance use experience, and power inequities must be navigated. METHODS Through our work on the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), Canada's largest community-collaborative longitudinal cohort of women living with HIV (n = 1422), we developed a comprehensive, regionally tailored approach for hiring, training, and supporting women living with HIV as Peer Research Associates (PRAs). To reflect the diversity of women with HIV in Canada, we initially hired 37 PRAs from British Columbia, Ontario, and Quebec, prioritizing women historically under-represented in research, including women who use or have used illicit drugs, and women living with HIV of other social identities including Indigenous, racialized, LGBTQ2S, and sex work communities, noting important points of intersection between these groups. RESULTS Building on PRAs' lived experience, research capacity was supported through a comprehensive, multi-phase, and evidence-based experiential training curriculum, with mentorship and support opportunities provided at various stages of the study. Challenges included the following: being responsive to PRAs' diversity; ensuring PRAs' health, well-being, safety, and confidentiality; supporting PRAs to navigate shifting roles in their community; and ensuring sufficient time and resources for the translation of materials between English and French. Opportunities included the following: mutual capacity building of PRAs and researchers; community-informed approaches to study the processes and challenges; enhanced recruitment of harder-to-reach populations; and stronger community partnerships facilitating advocacy and action on findings. CONCLUSIONS Community-collaborative studies are key to increasing the relevance and impact potential of research. For women living with HIV to participate in and benefit from HIV research, studies must foster inclusive, flexible, safe, and reciprocal approaches to PRA engagement, employment, and training tailored to regional contexts and women's lives. Recommendations for best practice are offered.
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Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Canadian Aboriginal AIDS Network, Vancouver, BC, Canada.,Positive Living British Columbia, Vancouver, BC, Canada
| | - Jo Lemay
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | | | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Anita Benoit
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mélina Bernier
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Jamie Thomas-Pavanel
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Johanna Lewis
- Department of History, York University, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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Switzer S, Chan Carusone S, Guta A, Strike C. A Seat at the Table: Designing an Activity-Based Community Advisory Committee With People Living With HIV Who Use Drugs. QUALITATIVE HEALTH RESEARCH 2019; 29:1029-1042. [PMID: 30499367 DOI: 10.1177/1049732318812773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recently, scholars have begun to critically interrogate the way community participation functions discursively within community-based participatory research (CBPR) and raise questions about its function and limits. Community advisory committees (CACs) are often used within CBPR as one way to involve community members in research from design to dissemination. However, CACs may not always be designed in ways that are accessible for communities experiencing the intersections of complex health issues and marginalization. This article draws on our experience designing and facilitating Research Rec'-a flexible, and activity-based CAC for a project about the acute-care hospital stays of people living with HIV who use drugs. Using Research Rec' as a case study, we reflect on ethical, methodological, and pedagogical considerations for designing and facilitating CACs for this community. We discuss how to critically reflect on the design and facilitation of advisory committees, and community engagement processes in CBPR more broadly.
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Affiliation(s)
| | - Soo Chan Carusone
- 2 Casey House Hospital, Toronto, Ontario, Canada
- 3 McMaster University, Hamilton, Ontario, Canada
| | - Adrian Guta
- 4 University of Windsor, Windsor, Ontario, Canada
| | - Carol Strike
- 5 University of Toronto, Toronto, Ontario, Canada
- 6 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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14
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Greer AM, Amlani A, Burmeister C, Scott A, Newman C, Lampkin H, Pauly B, Buxton JA. Peer engagement barriers and enablers: insights from people who use drugs in British Columbia, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:227-235. [PMID: 30610564 PMCID: PMC6964581 DOI: 10.17269/s41997-018-0167-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Globally, engaging people who have used drugs, or peers, in decision-making has been increasingly touted as a best practice approach to developing priorities, programs, and policies. Peer engagement ensures decisions are relevant, appropriate, and effective to the affected community. However, ensuring that inclusion is accessible and equitable for those involved remains a challenge. In this study, we examined the perspectives of people who use or have used illicit drugs (PWUD) on peer engagement in health and harm reduction settings across British Columbia (BC), Canada. METHODS The Peer Engagement and Evaluation Project used a participatory approach to conducting 13 peer-facilitated focus groups (n = 83) across BC. Focus group data were coded and analyzed with five peer research assistants. Themes about the nature of peer engagement were generated. From this analysis, peer engagement barriers and enablers were identified. RESULTS Barriers to peer engagement included individual, geographical, systemic, and social factors. Issues related to stigma, confidentiality, and mistrust were intensely discussed among participants. Being "outed" in one's community was a barrier to engagement, particularly in rural areas. Participants voiced that compensation, setting, and the right people help facilitate and motivate engagement. Peer networks are an essential ingredient to engagement by promoting support and advocacy. CONCLUSION PWUD are important stakeholders in decisions that affect them. This cross-jurisdictional study investigated how PWUD have experienced engagement efforts in BC, identifying several factors that influence participation. Meaningful engagement can be facilitated by attention to communication, relationships, personal capacity, and compassion between peers and other professionals.
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Affiliation(s)
- Alissa M Greer
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
- Interdisciplinary Graduate Studies Program, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- SPPH, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
- Technology Enterprise Facility, Canadian Institute for Substance Use Research, 2300 Mackenzie Avenue, Victoria, BC, V8P 5C2, Canada.
| | - Ashraf Amlani
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Charlene Burmeister
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Alex Scott
- Providence Health, 3080 Prince Edward St, Vancouver, BC, V5T 3N4, Canada
| | - Cheri Newman
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Hugh Lampkin
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Bernie Pauly
- Technology Enterprise Facility, Canadian Institute for Substance Use Research, 2300 Mackenzie Avenue, Victoria, BC, V8P 5C2, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- SPPH, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
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15
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Damon W, Callon C, Wiebe L, Small W, Kerr T, McNeil R. Community-based participatory research in a heavily researched inner city neighbourhood: Perspectives of people who use drugs on their experiences as peer researchers. Soc Sci Med 2017; 176:85-92. [PMID: 28135693 DOI: 10.1016/j.socscimed.2017.01.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 12/16/2022]
Abstract
Community-based participatory research (CBPR) has become an increasingly common approach to research involving people who use(d) drugs (PWUD), who are often employed as peer researchers on these projects. This paper seeks to understand the impact of CBPR on PWUD, particularly those living in heavily researched and stigmatized neighbourhoods where CBPR projects are often located. This study draws on 14 in-depth interviews with PWUD who had previous experience as both peer researchers and research participants in CBPR projects conducted between July 2010 and February 2011. The study employed a CBPR approach in its study design, recruitment, interviewing, and analysis. Our analysis indicates that participants were supportive of CBPR in principle and described the ways in which it helped contest stigmatizing assumptions and researcher bias. Participants also reported positive personal gains from participation in CBPR projects. However, many participants had negative experiences with CBPR projects, especially when CBPR principles were implemented in a superficial or incomplete manner. Participants emphasized the importance of inclusiveness and active deconstruction of hierarchy between researchers and community members to successful CBPR among drug using populations. CBPR has been widely adopted as a research approach within marginalized communities but has often been implemented inconsistently. Still, CBPR can empower communities to contest forms of social stigma that are often reproduced through academic research on marginalized communities. Our findings describe how the benefits of CBPR are maximized when CBPR principles are consistently applied and when community-based researchers are supported in ways that reduce power hierarchies. This suggests a need for capacity building within affected communities to develop independent support, training, and grievance processes for peer researchers.
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Affiliation(s)
- Will Damon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Cody Callon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lee Wiebe
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Anema A, Fielden SJ, Shurgold S, Ding E, Messina J, Jones JE, Chittock B, Monteith K, Globerman J, Rourke SB, Hogg RS. Association between Food Insecurity and Procurement Methods among People Living with HIV in a High Resource Setting. PLoS One 2016; 11:e0157630. [PMID: 27487041 PMCID: PMC4972395 DOI: 10.1371/journal.pone.0157630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/02/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE People living with HIV in high-resource settings suffer severe levels of food insecurity; however, limited evidence exists regarding dietary intake and sub-components that characterize food insecurity (i.e. food quantity, quality, safety or procurement) in this population. We examined the prevalence and characteristics of food insecurity among people living with HIV across British Columbia, Canada. DESIGN This cross-sectional analysis was conducted within a national community-based research initiative. METHODS Food security was measured using the Health Canada Household Food Security Scale Module. Logistic regression was used to determine key independent predictors of food insecurity, controlling for potential confounders. RESULTS Of 262 participants, 192 (73%) reported food insecurity. Sub-components associated with food insecurity in bivariate analysis included: < RDI consumption of protein (p = 0.046); being sick from spoiled/unsafe food in the past six months (p = 0.010); and procurement of food using non-traditional methods (p <0.05). In multivariable analyses, factors significantly associated with food insecurity included: procurement of food using non-traditional methods [AOR = 11.11, 95% CI: 4.79-25.68, p = <0.001]; younger age [AOR = 0.92, 95% CI: 0.86-0.96, p = <0.001]; unstable housing [AOR = 4.46, 95% CI: 1.15-17.36, p = 0.031]; household gross annual income [AOR = 4.49, 95% CI: 1.74-11.60, p = 0.002]; and symptoms of depression [AOR = 2.73, 95% CI: 1.25-5.96, p = 0.012]. CONCLUSIONS Food insecurity among people living with HIV in British Columbia is characterized by poor dietary quality and food procurement methods. Notably, participants who reported procuring in non-traditional manners were over 10 times more likely to be food insecure. These findings suggest a need for tailored food security and social support interventions in this setting.
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Affiliation(s)
- Aranka Anema
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Division of International Nutrition, Department of Food, Nutrition and Health, Faculty of Land and Food Systems University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Sarah J. Fielden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Shurgold
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Erin Ding
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Messina
- Immune Deficiency Clinic, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | | | | | - Ken Monteith
- Coalition des organismes communautaires québécois de lutte contre le sida, Montréal, Quebéc, Canada
| | | | - Sean B. Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert S. Hogg
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
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17
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A Mixed-Methods Outcome Evaluation of a Mentorship Intervention for Canadian Nurses in HIV Care. J Assoc Nurses AIDS Care 2016; 27:677-97. [PMID: 27039195 DOI: 10.1016/j.jana.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022]
Abstract
We assessed the impact of an HIV care mentorship intervention on knowledge, attitudes, and practices with nurses and people living with HIV (PLWH) in Canada. We implemented the intervention in two urban and two rural sites with 16 mentors (eight experienced HIV nurses and eight PLWH) and 40 mentees (nurses with limited HIV experience). The 6- to 12-month intervention included face-to-face workshops and monthly meetings. Using a mixed-methods approach, participants completed pre- and postintervention questionnaires and engaged in semistructured interviews at intervention initiation, mid-point, and completion. Data from 28 mentees (70%) and 14 mentors (87%) were included in the quantitative analysis. We analyzed questionnaire data using McNemar test, and interview data using content analysis. Results indicated positive changes in knowledge, attitudes, and practices among nurse mentees, with qualitative interviews highlighting mechanisms by which change occurred. Mentorship interventions have the potential to engage and educate nurses in HIV treatment and care.
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Bromley E, Mikesell L, Jones F, Khodyakov D. From subject to participant: ethics and the evolving role of community in health research. Am J Public Health 2015; 105:900-8. [PMID: 25790380 PMCID: PMC4386538 DOI: 10.2105/ajph.2014.302403] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2014] [Indexed: 11/04/2022]
Abstract
Belmont Report principles focus on the well-being of the research subject, yet community-engaged investigators often eschew the role of subject for that of participant. We conducted semistructured interviews with 29 community and academic investigators working on 10 community-engaged studies. Interviews elicited perspectives on ethical priorities and ethical challenges. Interviewees drew on the Belmont Report to describe 4 key principles of ethical community-engaged research (embodying ethical action, respecting participants, generalizing beneficence, and negotiating justice). However, novel aspects of the participant role were the source of most ethical challenges. We theorize that the shift in ethical focus from subject to participant will pose new ethical dilemmas for community-engaged investigators and for other constituents interested in increasing community involvement in health research.
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Affiliation(s)
- Elizabeth Bromley
- Elizabeth Bromley is with the Semel Institute Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles and the VA Mental Illness Research, Education and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, CA. Lisa Mikesell is with the Communication Department, School of Communication and Information and the Institute of Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ. Felica Jones is with Healthy African American Families II, Los Angeles, CA. Dmitry Khodyakov is with the RAND Corporation, Santa Monica, CA
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Flicker S, O'Campo P, Monchalin R, Thistle J, Worthington C, Masching R, Guta A, Pooyak S, Whitebird W, Thomas C. Research Done in "A Good Way": The Importance of Indigenous Elder Involvement in HIV Community-Based Research. Am J Public Health 2015; 105:1149-54. [PMID: 25880963 DOI: 10.2105/ajph.2014.302522] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the role that Indigenous Elders can play in ensuring that community-based research (CBR) is conducted ethically. METHODS We present data from a larger qualitative study exploring ethical issues that occur in HIV-related CBR through the experiences of researchers engaged in CBR. Between May 2010 and July 2011, we interviewed 51 academic and community research team leaders of federally funded HIV CBR studies. We used thematic analysis techniques to identify themes. RESULTS Participating researchers engage Elders in research because Elders are keepers of Indigenous knowledge, dynamic ethical consultants, community protectors, and credible sources of information who are able to counsel and support, mediate conflict, provide local context and history, and conduct ceremonial roles. Potential challenges cited by participants to engaging Elders in research include finding the right "fit," approaching Elders in a culturally appropriate way, and bureaucratic environments that do not honor Indigenous processes. CONCLUSIONS Culturally appropriate Elder engagement in HIV CBR with Indigenous communities is vital for promoting positive relationships and culturally safe research that respects ceremony and Indigenous ways of knowing.
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Affiliation(s)
- Sarah Flicker
- Sarah Flicker, Renée Monchalin, and Jesse Thistle are with the Faculty of Environmental Studies, York University, Toronto, Ontario. Patricia O'Campo is with the Centre for Research on Inner City Health, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Catherine Worthington is with the School of Public Health and Social Policy, Victoria, British Columbia. Renée Masching is with the Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia. Adrian Guta is with Carleton University, Ottawa, Ontario. Sherri Pooyak is with the Canadian Aboriginal AIDS Network, Victoria, British Columbia. Wanda Whitebird is with the Ontario Aboriginal HIV/AIDS Strategy, Toronto, Ontario. Cliff Thomas is with the Canadian Aboriginal AIDS Network, Ottawa, Ontario
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Restall GJ, Carnochan TN, Roger KS, Sullivan TM, Etcheverry EJ, Roddy P. Collaborative priority setting for human immunodeficiency virus rehabilitation research: A case report. The Canadian Journal of Occupational Therapy 2015; 83:7-13. [PMID: 26755039 DOI: 10.1177/0008417415577423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The inclusion of community members and other stakeholders in the establishment of research priorities is vital to ensuring that priorities are congruent with the main concerns of affected communities. PURPOSE The purpose of this project was to identify priority research topics for addressing the activity and community participation needs of people living with human immunodeficiency virus (HIV) and meaningfully involve multiple stakeholders in the development of those priorities. METHOD We invited people living with HIV, researchers, service providers, and policy makers to a 2-day forum. Twenty-six people participated in developing priorities through the application of two methodologies, the World Café and Dotmocracy. We evaluated the forum though immediate dialogue and a postproject survey. FINDINGS Participants identified 10 high-priority research topics. Evaluation findings highlighted positive substantive, instrumental, personal, and normative outcomes of stakeholder involvement. IMPLICATIONS The identified priority topics can guide future occupational therapy practice and research in this emerging area.
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Carter A, Greene S, Nicholson V, O'Brien N, Sanchez M, de Pokomandy A, Loutfy M, Kaida A. Breaking the Glass Ceiling: Increasing the Meaningful Involvement of Women Living With HIV/AIDS (MIWA) in the Design and Delivery of HIV/AIDS Services. Health Care Women Int 2014; 36:936-64. [PMID: 25256222 DOI: 10.1080/07399332.2014.954703] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The meaningful involvement of women living with HIV/AIDS (MIWA) is a key feature of women-centred HIV care, yet little is known about transforming MIWA from principle to practice. Drawing on focus group data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), we explored HIV-positive women's meaningful involvement in the design and delivery of HIV/AIDS services in British Columbia, Canada. In this article, we highlight the benefits and tensions that emerge as women traverse multiple roles as service users and service providers within their care communities, and the impact this has on their access to care and overall health.
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Affiliation(s)
- Allison Carter
- a Faculty of Health Sciences, Simon Fraser University , Burnaby , British Columbia , Canada
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22
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Guta A, Strike C, Flicker S, Murray SJ, Upshur R, Myers T. Governing through community-based research: lessons from the Canadian HIV research sector. Soc Sci Med 2014; 123:250-61. [PMID: 25074512 DOI: 10.1016/j.socscimed.2014.07.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 05/22/2014] [Accepted: 07/12/2014] [Indexed: 11/20/2022]
Abstract
The "general public" and specific "communities" are increasingly being integrated into scientific decision-making. This shift emphasizes "scientific citizenship" and collaboration between interdisciplinary scientists, lay people, and multi-sector stakeholders (universities, healthcare, and government). The objective of this paper is to problematize these developments through a theoretically informed reading of empirical data that describes the consequences of bringing together actors in the Canadian HIV community-based research (CBR) movement. Drawing on Foucauldian "governmentality" the complex inner workings of the impetus to conduct collaborative research are explored. The analysis offered surfaces the ways in which a formalized approach to CBR, as promoted through state funding mechanisms, determines the structure and limits of engagement while simultaneously reinforcing the need for finer grained knowledge about marginalized communities. Here, discourses about risk merge with notions of "scientific citizenship" to implicate both researchers and communities in a process of governance.
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Maina G, Sutankayo L, Chorney R, Caine V. Living with and teaching about HIV: engaging nursing students through body mapping. NURSE EDUCATION TODAY 2014; 34:643-647. [PMID: 23714039 DOI: 10.1016/j.nedt.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 04/21/2013] [Accepted: 05/03/2013] [Indexed: 06/02/2023]
Abstract
Body mapping, an artistic method of narrating experiences alongside people living with HIV/AIDS (PHAs), was used to educate first year nursing students about social and personal aspects of the illness, including stigma. Body mapping creates a safe space where individuals can discuss personal, emotional, cultural, political and socio-economic dimensions of their lives in relation to HIV/AIDS. The aim of this study is to understand how individuals from multiple perspectives experience body mapping as an educational tool, including a nursing student, an expert facilitator, a PHA and a course professor. The stories they live and tell motivate and inform the content of this study. We conducted three individual in-depth interviews with a student, a PHA and an expert facilitator on their experiences of participating in body mapping. The interviews were transcribed and analyzed thematically. Field and observational notes were also collected and reflections have been incorporated in this paper. Three themes were derived from our analyses: 1) stock taking narratives, where body mapping serves as a mediator for reflecting, accessing and organizing past experiences; 2) transactional narratives where body mapping creates safe spaces within which relationships are created, and experiences are shared, and 3) give and take narratives that connote transformation of self as a result of participating in body mapping. In conclusion, the body mapping exercise as an educational tool is an opportunity to share experiences, and to learn about and to shift attitudes surrounding HIV/AIDS. Thus, body mapping can be a valuable tool for HIV education for first year nursing students.
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Affiliation(s)
| | - Lynn Sutankayo
- Community Service Learning, University of Alberta, Canada
| | | | - Vera Caine
- Faculty of Nursing, University of Alberta, Canada.
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O'Brien KK, Solomon P, Worthington C, Ibáñez-Carrasco F, Baxter L, Nixon SA, Baltzer-Turje R, Robinson G, Zack E. Considerations for conducting Web-based survey research with people living with human immunodeficiency virus using a community-based participatory approach. J Med Internet Res 2014; 16:e81. [PMID: 24642066 PMCID: PMC3971118 DOI: 10.2196/jmir.3064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/27/2014] [Accepted: 02/11/2014] [Indexed: 12/03/2022] Open
Abstract
Background Web or Internet-based surveys are increasingly popular in health survey research. However, the strengths and challenges of Web-based surveys with people living with human immunodeficiency virus (HIV) are unclear. Objective The aim of this article is to describe our experience piloting a cross-sectional, Web-based, self-administered survey with adults living with HIV using a community-based participatory research approach. Methods We piloted a Web-based survey that investigated disability and rehabilitation services use with a sample of adults living with HIV in Canada. Community organizations in five provinces emailed invitations to clients, followed by a thank you/reminder one week later. We obtained survey feedback in a structured phone interview with respondents. Participant responses were transcribed verbatim and analyzed using directed content analysis. Results Of 30 people living with HIV who accessed the survey link, 24/30 (80%) initiated and 16/30 (53%) completed the survey instrument. A total of 17 respondents participated in post-survey interviews. Participants described the survey instrument as comprehensive, suggesting content validity. The majority (13/17, 76%) felt instruction and item wording were clear and easy to understand, and found the software easy to navigate. Participants felt having a pop-up reminder directing them to missed items would be useful. Conclusions Strengths of implementing the Web-based survey included: our community-based participatory approach, ease of software use, ability for respondents to complete the questionnaire on one’s own time at one’s own pace, opportunity to obtain geographic variation, and potential for respondent anonymity. Considerations for future survey implementation included: respondent burden and fatigue, the potentially sensitive nature of HIV Web-based research, data management and storage, challenges verifying informed consent, varying computer skills among respondents, and the burden on community organizations. Overall, results provide considerations for researchers conducting community-based participatory Web-based survey research with people living with HIV.
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Stärkung von Gemeinschaften: Partizipative Forschung zu HIV-Prävention mit Migrant/innen. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2013. [DOI: 10.1007/s11553-013-0399-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ti L, Tzemis D, Buxton JA. Engaging people who use drugs in policy and program development: a review of the literature. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2012; 7:47. [PMID: 23176382 PMCID: PMC3551750 DOI: 10.1186/1747-597x-7-47] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 11/08/2012] [Indexed: 11/14/2022]
Abstract
Health policies and programs are increasingly being driven by people from the community to more effectively address their needs. While a large body of evidence supports peer engagement in the context of policy and program development for various populations, little is known about this form of engagement among people who use drugs (PWUD). Therefore, a narrative literature review was undertaken to provide an overview of this topic. Searches of PubMed and Academic Search Premier databases covering 1995–2010 were conducted to identify articles assessing peer engagement in policy and program development. In total, 19 articles were included for review. Our findings indicate that PWUD face many challenges that restrict their ability to engage with public health professionals and policy makers, including the high levels of stigma and discrimination that persist among this population. Although the literature shows that many international organizations are recommending the involvement of PWUD in policy and program development, our findings revealed a lack of published data on the implementation of these efforts. Gaps in the current evidence highlight the need for additional research to explore and document the engagement of PWUD in the areas of policy and program development. Further, efforts to minimize stigmatizing barriers associated with illicit drug use are urgently needed to improve the engagement of PWUD in decision making processes.
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Affiliation(s)
- Lianping Ti
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
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Community-Based Research among Marginalized HIV Populations: Issues of Support, Resources, and Empowerment. Interdiscip Perspect Infect Dis 2012; 2012:601027. [PMID: 22997513 PMCID: PMC3444842 DOI: 10.1155/2012/601027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/22/2012] [Indexed: 11/17/2022] Open
Abstract
A research question was posed to us by a local HIV-resource organization interested in exploring the educational and service needs of those unreached. In order to properly address this inquiry, we developed a community-based participatory research by training peer-led volunteers to facilitate focus-group discussions within Aboriginal and refugees participants following an interview guide. We gathered Aboriginal people and refugees separated into three focus groups each, enrolling a total of 41 self-identified HIV-positive, 38 males. The discussions were tape recorded upon consent and lasted between 59 and 118 minutes. We analyzed the thematic information collected interactively through constant comparison. The qualitative data leading to categories, codes, and themes formed the basis for the spatial representation of a conceptual mapping. Both groups shared similar struggles in living with HIV and in properly accessing local nonmedical HIV resources and discussed their concerns towards the need for empowerment and support to take control of their health.
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Mburu G, Iorpenda K, Muwanga F. Expanding the role of community mobilization to accelerate progress towards ending vertical transmission of HIV in Uganda: the Networks model. J Int AIDS Soc 2012; 15 Suppl 2:17386. [PMID: 22789643 PMCID: PMC3499846 DOI: 10.7448/ias.15.4.17386] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/13/2012] [Accepted: 05/04/2012] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Efforts to prevent vertical transmission of HIV have gained momentum globally since the launch of the "Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive", reflecting the growing consensus that we now have low-cost, efficacious interventions that promise to end vertical transmission of HIV. Uganda is one of the 22 focus countries in the global plan and one of the 10 countries with the highest need for prevention of vertical transmission globally. In the context of current shortfalls in the prevention of vertical HIV transmission, this paper presents the results of the Networks project, a community mobilisation model implemented by the International HIV/AIDS Alliance in Uganda, and draws out the theoretical foundations and promising community mobilization practices relevant to prevention of vertical transmission. METHODS A retrospective review of the Network project's activities, documentation and evaluation was performed. RESULTS The Networks project, through community mobilisation and greater involvement of people living with HIV, reached an estimated 1.3 million people with at least one health service. By clustering 750 groups of people living with HIV into larger coalitions, the project supported existing groups to amalgamate their collective strengths and skills in outreach, referral and literacy activities; and improved reach and coverage of HIV services through strengthened linkages with healthcare facilities. Our analysis of the Networks model shows that it could contribute to the prevention of vertical transmission of HIV as a replicable and sustainable community mobilisation approach. In particular, the Networks model increased the uptake of decentralized interventions for preventing vertical transmission through community referrals; promoted male involvement through peer sensitisation; and linked communities to advocacy channels for advancing maternal health and prevention of vertical HIV transmission. CONCLUSIONS BY placing persons living with HIV at the centre, the Networks model offers a mechanism for strengthening community and male involvement in preventing vertical transmission of HIV. The role of communities and networks of people living with HIV in planning, service delivery and monitoring of national targets for prevention of vertical transmission should be further strengthened through greater community engagement in service delivery and advocacy and through the regular sharing of data between communities and health facilities.
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Affiliation(s)
- Gitau Mburu
- International HIV AIDS Alliance, Hove, United Kingdom
| | - Kate Iorpenda
- International HIV AIDS Alliance, Hove, United Kingdom
| | - Fred Muwanga
- International HIV AIDS Alliance, Kampala, Uganda
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Hayashi K, Fairbairn N, Suwannawong P, Kaplan K, Wood E, Kerr T. Collective empowerment while creating knowledge: a description of a community-based participatory research project with drug users in Bangkok, Thailand. Subst Use Misuse 2012; 47:502-10. [PMID: 22428818 DOI: 10.3109/10826084.2012.644110] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In light of growing concerns regarding the ongoing drug war in Thailand and a lack of support for people who inject drugs in this setting, in 2008, we undertook a community-based participatory research project involving a community of active drug users at a peer-run drop-in center in Bangkok. This case study describes a unique research partnership developed between academic and active drug users and demonstrates that participatory approaches can help empower this vulnerable population while generating valid research. Further research is needed to explore ways of optimizing community-based participatory research methods when applied to drug-using populations.
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Affiliation(s)
- Kanna Hayashi
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Wilson MG, Lavis JN, Travers R, Rourke SB. Community-based knowledge transfer and exchange: helping community-based organizations link research to action. Implement Sci 2010; 5:33. [PMID: 20423486 PMCID: PMC2873302 DOI: 10.1186/1748-5908-5-33] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/27/2010] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Community-based organizations (CBOs) are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery efforts. CBOs increasingly turn to community-based research (CBR) given its participatory focus and emphasis on linking research to action. In order to further facilitate the use of research evidence by CBOs, we have developed a strategy for community-based knowledge transfer and exchange (KTE) that helps CBOs more effectively link research evidence to action. We developed the strategy by: outlining the primary characteristics of CBOs and why they are important stakeholders in health systems; describing the concepts and methods for CBR and for KTE; comparing the efforts of CBR to link research evidence to action to those discussed in the KTE literature; and using the comparison to develop a framework for community-based KTE that builds on both the strengths of CBR and existing KTE frameworks. DISCUSSION We find that CBR is particularly effective at fostering a climate for using research evidence and producing research evidence relevant to CBOs through community participation. However, CBOs are not always as engaged in activities to link research evidence to action on a larger scale or to evaluate these efforts. Therefore, our strategy for community-based KTE focuses on: an expanded model of 'linkage and exchange' (i.e., producers and users of researchers engaging in a process of asking and answering questions together); a greater emphasis on both producing and disseminating systematic reviews that address topics of interest to CBOs; developing a large-scale evidence service consisting of both 'push' efforts and efforts to facilitate 'pull' that highlight actionable messages from community relevant systematic reviews in a user-friendly way; and rigorous evaluations of efforts for linking research evidence to action. SUMMARY Through this type of strategy, use of research evidence for CBO advocacy, program planning, and service delivery efforts can be better facilitated and continually refined through ongoing evaluations of its impact.
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Affiliation(s)
- Michael G Wilson
- Health Research Methodology Program, Department of Clinical Epidemiology and Biostatistics, McMaster University 1200 Main Street West, Hamilton, ON, Canada
- Ontario HIV Treatment Network, 1300 Yonge St,, Suite 600, Toronto, ON, Canada
- McMaster Health Forum, McMaster University, 1280 Main Street West, L417, Hamilton, ON, Canada
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, L417, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University 1200 Main Street West, Hamilton, ON, Canada
- Department of Political Science, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Robb Travers
- Ontario HIV Treatment Network, 1300 Yonge St,, Suite 600, Toronto, ON, Canada
- Department of Psychology, Wilfrid Laurier University, Science Building, 75 University Ave. W., Waterloo, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Sean B Rourke
- Ontario HIV Treatment Network, 1300 Yonge St,, Suite 600, Toronto, ON, Canada
- Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, Canada
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