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Sharma A, Mwamba C, St Clair-Sullivan N, Chihota BV, Pry JM, Bolton-Moore C, Vinikoor MJ, Muula GK, Daultrey H, Gittelsohn J, Mulenga LB, Siyumbwa N, Wandeler G, Vera JH. The Social Construction of Aging Among a Clinic-Based Population and Their Healthcare Workers in Zambia. Int J Public Health 2024; 69:1606607. [PMID: 38711786 PMCID: PMC11070831 DOI: 10.3389/ijph.2024.1606607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
Objectives We sought to understand the social construction of aging in a clinic-based population, with and without HIV, to address gaps in care for older individuals living with HIV in Zambia. Methods Our exploratory qualitative study included 36 in-depth interviews with clinic clients and four focus group discussions with 36 professional and lay healthcare workers providing services to the clients. We identified themes based on social construction theory. Results At the individual level, aging was multidimensional, perceived both as an achievement in the HIV era and as a period of cognitive, physical, and economic decline. In social interactions, older individuals were often stereotyped and treated as helpless, poor, and "witches." Those living with HIV faced the additional stigma of being labeled as promiscuous. Some of the participants living without HIV refused to take daily medication for non-communicable diseases to avoid being mistaken for taking antiretroviral therapy for HIV. Older individuals wanted quality healthcare and family support to address the intersectional stigma of aging, poverty, and chronic illness. Conclusion Multifaceted interventions are required to combat age-related prejudice, intersectional stigma, and discriminatory practices, particularly for people living with HIV.
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Affiliation(s)
- Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Belinda V. Chihota
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Preclinical Medicine, Faculty of Medicine, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jake M. Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael J. Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Guy K. Muula
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Joel Gittelsohn
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Gilles Wandeler
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Medical Faculty, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Jaime H. Vera
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Clair-Sullivan NS, Bristowe K, Khan I, Maddocks M, Harding R, Bremner S, Levett T, Roberts J, Adler Z, Yi D, Vera JH. Implementation of frailty screening for older people living with HIV in Brighton, UK. HIV Med 2024; 25:484-490. [PMID: 38062917 DOI: 10.1111/hiv.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/20/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK. METHODS Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded. RESULTS A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60-99) years and 21 (0-32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non-frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older. CONCLUSIONS Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services.
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Affiliation(s)
- Natalie St Clair-Sullivan
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Inayat Khan
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Thomas Levett
- University Hospitals Sussex NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Zoe Adler
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Jaime H Vera
- University Hospitals Sussex NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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3
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O'Brien KK, Erlandson KM, Brown DA, Carusone SC, Vera JH, Bergin C, Avery L, Bayoumi AM, Hanna SE, Harding R, Solomon P, Clair-Sullivan NS, O'Shea N, Murray C, Boffito M, Da Silva G, Torres B, McDuff K, Davis AM. Episodic disability questionnaire (EDQ) measurement properties among adults living with HIV in Canada, Ireland, United Kingdom, and United States. BMC Infect Dis 2024; 24:71. [PMID: 38200425 PMCID: PMC10782617 DOI: 10.1186/s12879-023-08958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The Episodic Disability Questionnaire (EDQ) is a generic 35-item patient-reported outcome measure of presence, severity and episodic nature of disability. We assessed the measurement properties of the Episodic Disability Questionnaire (EDQ) with adults living with HIV. METHODS We conducted a measurement study with adults living with HIV in eight clinical settings in Canada, Ireland, United Kingdom, and United States. We electronically administered the EDQ followed by three reference measures (World Health Organization Disability Assessment Schedule; Patient Health Questionnaire; Social Support Scale) and a demographic questionnaire. We administered the EDQ only 1 week later. We assessed the internal consistency reliability (Cronbach's alpha; > 0.7 acceptable), and test-retest reliability (Intra Class Correlation Coefficient; > 0.7 acceptable). We estimated required change in EDQ domain scores to be 95% certain that a change was not due to measurement error (Minimum Detectable Change (MDC95%)). We evaluated construct validity by assessing 36 primary hypotheses of relationships between EDQ scores and scores on the reference measures (> 75% hypotheses confirmed indicated validity). RESULTS Three hundred fifty nine participants completed the questionnaires at time point 1, of which 321 (89%) completed the EDQ approximately 1 week later. Cronbach's alpha for internal consistency ranged from 0.84 (social domain) to 0.91 (day domain) for the EDQ severity scale, and 0.72 (uncertainty domain) to 0.88 (day domain) for the EDQ presence scale, and 0.87 (physical, cognitive, mental-emotional domains) to 0.89 (uncertainty domain) for the EDQ episodic scale. ICCs for test-retest reliability ranged from 0.79 (physical domain) to 0.88 (day domain) for the EDQ severity scale and from 0.71 (uncertainty domain) to 0.85 (day domain) for the EDQ presence scale. Highest precision was demonstrated in the severity scale for each domain (MDC95% range: 19-25 out of 100), followed by the presence (MDC95% range: 37-54) and episodic scales (MDC95% range:44-76). Twenty-nine of 36 (81%) construct validity hypotheses were confirmed. CONCLUSIONS The EDQ possesses internal consistency reliability, construct validity, and test-retest reliability, with limited precision when administered electronically with adults living with HIV across in clinical settings in four countries. Given the measurement properties, the EDQ can be used for group level comparisons for research and program evaluation in adults living with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada.
| | | | - Darren A Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, ON, Canada
- Casey House, Toronto, ON, Canada
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Colm Bergin
- GUIDE Clinic, St. James's Hospital, Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lisa Avery
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Steven E Hanna
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Noreen O'Shea
- GUIDE Clinic, St. James's Hospital, Hospital, Dublin, Ireland
| | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Aileen M Davis
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
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4
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O'Brien KK, Ibáñez-Carrasco F, Birtwell K, Donald G, Brown DA, Eaton AD, Kasadha B, Stanmore E, St Clair-Sullivan N, Townsend L, Vera JH, Solomon P. Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative. AIDS Res Ther 2023; 20:86. [PMID: 38071351 PMCID: PMC10709904 DOI: 10.1186/s12981-023-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations. METHODS We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework. RESULTS Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A-Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C-Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community. CONCLUSION Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada.
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, M5G 1V7, Canada.
| | - Francisco Ibáñez-Carrasco
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kelly Birtwell
- Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Graeme Donald
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Andrew D Eaton
- Faculty of Social Work, University of Regina, Saskatoon Campus, The Concourse, 111-116 Research Drive, Saskatoon, SK, S7N 3R3, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Emma Stanmore
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
- Healthy Ageing Research Group (HARG), University of Manchester, Manchester, United Kingdom
| | - Natalie St Clair-Sullivan
- The Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom
| | - Liam Townsend
- Department of Infectious Diseases, St James's Hospital, Dublin 8, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, St. James's Hospital, Dublin 8, Dublin, Ireland
| | - Jaime H Vera
- The Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, East Sussex, United Kingdom
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON, L8S 1C7, Canada
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5
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Alford K, Sidat S, Bristowe K, St Clair-Sullivan N, Parteger G, Matthew M, Yi D, Harding R, Levett T, Bremner S, Vera JH. People with HIV and healthcare workers views on screening for cognitive impairment in people with HIV: A qualitative study. HIV Med 2023; 24:1244-1252. [PMID: 37990635 DOI: 10.1111/hiv.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES People with HIV are an ageing population with an increased risk of cognitive impairment. Although cognitive impairment is dependent upon assessment, the acceptability of screening for cognitive impairment is unclear. This study aimed to explore the views of people with HIV and healthcare workers regarding routine screening for cognitive impairment. METHODS In-depth individual qualitative interviews were conducted with purposively sampled people with HIV and focus groups of healthcare workers from a UK HIV service. Verbatim pseudonymized transcripts were analysed using reflexive thematic analysis supported by NVivo. RESULTS Twenty people with HIV were interviewed and 12 healthcare workers participated in three focus groups. People with HIV were concerned about developing cognitive issues and were receptive to routine screening. Screening was seen as relevant and an important part of managing health in older age. Healthcare workers expressed concerns regarding the capacity of HIV services to implement routine screening and questioned the validity of screening measures used. People with HIV felt that screening and subsequent detection of cognitive impairment, if present, may help them to prepare for future issues and promote active management strategies and care pathways that would support cognitive health. People with HIV felt that screening should be brief and delivered by the HIV service and that they should be given a choice of administration method. Indications of cognitive impairment detected by a brief screening assessment should be discussed face to face and followed up with a comprehensive assessment. CONCLUSIONS People with HIV are concerned about cognitive impairment and would welcome regular screening for this as part of the holistic care provided by the HIV team. Both people with HIV and healthcare workers would like more information on cognitive impairment, its screening and ways to support cognitive health.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Shiraaz Sidat
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Maddocks Matthew
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Deokhee Yi
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Tom Levett
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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St Clair-Sullivan N, Bristowe K, Adler Z, Bremner S, Harding R, Levett T, Maddocks M, Pargeter G, Roberts J, Yi D, Vera J. Silver Clinic: protocol for a feasibility randomised controlled trial of comprehensive geriatric assessment for people living with HIV and frailty. BMJ Open 2023; 13:e070590. [PMID: 37208140 DOI: 10.1136/bmjopen-2022-070590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Many people ageing with HIV are also living with multiple comorbidities and geriatric syndromes including frailty and cognitive deterioration. These complex needs can be challenging to meet within existing HIV care services. This study investigates the acceptability and feasibility of screening for frailty and of using a comprehensive geriatric assessment approach, delivered via the Silver Clinic, to support people living with HIV affected by frailty. METHODS AND ANALYSIS Mixed-methods, parallel-group, randomised, controlled feasibility trial aiming to recruit 84 people living with HIV≥50, identified as frail. Participants will be recruited from the HIV unit at the Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK. Participants will be randomised 1:1 to receive usual HIV care or the Silver Clinic intervention, which uses a comprehensive geriatric assessment approach. Psychosocial, physical and service use outcomes will be measured at baseline, 26 weeks and 52 weeks. Qualitative interviews will be conducted with a subset of participants from both arms. Primary outcome measures include recruitment and retention rates and completion of clinical outcome measures. These will be used in conjunction with a priori progression criteria and the qualitative data (acceptability of trial procedures and intervention) to determine the feasibility and design of a definitive trial. ETHICS AND DISSEMINATION This study has been approved by East Midlands-Leicester Central Research Ethics Committee (reference 21/EM/0200). All participants will receive written information about the study and be required to provide informed consent. Results will be disseminated via peer-reviewed journals, conferences and community engagement. TRIAL REGISTRATION NUMBER ISRCTN14646435.
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Affiliation(s)
- Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Zoe Adler
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Stephen Bremner
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Richard Harding
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Thomas Levett
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | | | - Deokhee Yi
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Jaime Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
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7
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O'Brien KK, Erlandson KM, Brown DA, Carusone SC, Vera JH, Bergin C, Avery L, Bayoumi AM, Hanna SE, Harding R, Solomon P, St Clair-Sullivan N, O'Shea N, Murray C, Boffito M, Da Silva G, Torres B, McDuff K, Davis AM. Episodic Disability Questionnaire (EDQ) measurement properties among adults living with HIV in Canada, Ireland, United Kingdom, and United States. Res Sq 2023:rs.3.rs-2758163. [PMID: 37066168 PMCID: PMC10104244 DOI: 10.21203/rs.3.rs-2758163/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background The Episodic Disability Questionnaire (EDQ) is a generic 35-item patient-reported outcome measure of presence, severity and episodic nature of disability. We assessed the measurement properties of the Episodic Disability Questionnaire (EDQ) with adults living with HIV. Methods We conducted a measurement study with adults living with HIV in eight clinical settings in Canada, Ireland, United Kingdom, and United States. We electronically administered the EDQ followed by three reference measures (World Health Organization Disability Assessment Schedule; Patient Health Questionnaire; Social Support Scale) and a demographic questionnaire. We administered the EDQ only 1 week later. We assessed the internal consistency reliability (Cronbach's alpha; >0.7 acceptable), and test-retest reliability (Intra Class Correlation Coefficient; >0.7 acceptable). We estimated required change in EDQ domain scores to be 95% certain that a change was not due to measurement error (Minimum Detectable Change (MDC95%)). We evaluated construct validity by assessing 36 primary hypotheses of relationships between EDQ scores and scores on the reference measures (> 75% hypotheses confirmed indicated validity). Results 359 participants completed the questionnaires at time point 1, of which 321 (89%) completed the EDQ approximately 1 week later. Cronbach's alpha for internal consistency ranged from 0.84 (social domain) to 0.91 (day domain) for the EDQ severity scale, and 0.72 (uncertainty domain) to 0.88 (day domain) for the EDQ presence scale, and 0.87 (physical, cognitive, mental-emotional domains) to 0.89 (uncertainty domain) for the EDQ episodic scale. ICCs for test-retest reliability ranged from 0.79 (physical domain) to 0.88 (day domain) for the EDQ severity scale and from 0.71 (uncertainty domain) to 0.85 (day domain) for the EDQ presence scale. Highest precision was demonstrated in the severity scale for each domain (MDC95% range: 19-25 out of 100), followed by the presence (MDC95% range: 37-54) and episodic scales (MDC95% range:44-76). Twenty-nine of 36 (81%) construct validity hypotheses were confirmed. Conclusions The EDQ possesses internal consistency reliability, construct validity, and test-retest reliability, with limited precision when administered electronically with adults living with HIV across in clinical settings in four countries. Given the measurement properties, the EDQ can be used for group level comparisons for research and program evaluation in adults living with HIV.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust
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8
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O'Brien KK, Brown DA, McDuff K, St Clair-Sullivan N, Solomon P, Chan Carusone S, McCorkell L, Wei H, Goulding S, O'Hara M, Thomson C, Roche N, Stokes R, Vera JH, Erlandson KM, Bergin C, Robinson L, Cheung AM, Torres B, Avery L, Bannan C, Harding R. Conceptualising the episodic nature of disability among adults living with Long COVID: a qualitative study. BMJ Glob Health 2023; 8:bmjgh-2022-011276. [PMID: 36863719 PMCID: PMC9979585 DOI: 10.1136/bmjgh-2022-011276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/09/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Our aim was to describe episodic nature of disability among adults living with Long COVID. METHODS We conducted a community-engaged qualitative descriptive study involving online semistructured interviews and participant visual illustrations. We recruited participants via collaborator community organisations in Canada, Ireland, UK and USA.We recruited adults who self-identified as living with Long COVID with diversity in age, gender, race/ethnicity, sexual orientation and duration since initial COVID infection between December 2021 and May 2022. We used a semistructured interview guide to explore experiences of disability living with Long COVID, specifically health-related challenges and how they were experienced over time. We asked participants to draw their health trajectory and conducted a group-based content analysis. RESULTS Among the 40 participants, the median age was 39 years (IQR: 32-49); majority were women (63%), white (73%), heterosexual (75%) and living with Long COVID for ≥1 year (83%). Participants described their disability experiences as episodic in nature, characterised by fluctuations in presence and severity of health-related challenges (disability) that may occur both within a day and over the long-term living with Long COVID. They described living with 'ups and downs', 'flare-ups' and 'peaks' followed by 'crashes', 'troughs' and 'valleys', likened to a 'yo-yo', 'rolling hills' and 'rollercoaster ride' with 'relapsing/remitting', 'waxing/waning', 'fluctuations' in health. Drawn illustrations demonstrated variety of trajectories across health dimensions, some more episodic than others. Uncertainty intersected with the episodic nature of disability, characterised as unpredictability of episodes, their length, severity and triggers, and process of long-term trajectory, which had implications on broader health. CONCLUSION Among this sample of adults living with Long COVID, experiences of disability were described as episodic, characterised by fluctuating health challenges, which may be unpredictable in nature. Results can help to better understand experiences of disability among adults living with Long COVID to inform healthcare and rehabilitation.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Termerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada.,Long COVID Physio, Toronto, Ontario, Canada
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Long COVID Physio, London, UK
| | - Kiera McDuff
- Department of Physical Therapy, Termerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Royal Sussex Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lisa McCorkell
- Patient-Led Research Collaborative, Oakland, California, USA
| | - Hannah Wei
- Patient-Led Research Collaborative, Ottawa, Ontario, Canada
| | - Susie Goulding
- COVID Long-Haulers Support Group Canada, Toronto, Ontario, Canada
| | | | | | | | | | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Royal Sussex Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Colm Bergin
- GUIDE Clinic, St. James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Larry Robinson
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela M Cheung
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Termerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Avery
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ciaran Bannan
- GUIDE Clinic, St. James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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9
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Woldesemayat EM, St Clair-Sullivan N, Kassa A, Gari T, Gutema K, Chea N, Woubshet K, Bogale N, Assefa A, Vera J. Frailty status and associated factors among older PLHIV in Southern Ethiopia. PLoS One 2023; 18:e0284376. [PMID: 37093810 PMCID: PMC10124866 DOI: 10.1371/journal.pone.0284376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Studies addressing frailty are limited in the global south, including Ethiopia. We estimated the prevalence of frailty and associated factors among older people living with HIV (PLHIV) attending a large Comprehensive Specialized Hospital in southern Ethiopia. METHODS A systematic sample of 187 PLHIV and 187 HIV-negative controls > 50 years old were recruited between October 1 and November 30, 2021. Data on socio-demographic, behavioural and clinical characteristics were collected using a structured questionnaire. Frailty assessments were completed using the brief frailty instrument (B-FIT-2), which consists of 6 components. Scoring 5-6 points was frail, 2-4 points were pre-frail and below 2 was considered as non-frail. Logistic regression model was used to measure association between variables. RESULTS Median (IQR) age was 53 (50, 80) for PLWH and 59 (55-66) for controls. Prevalence of frailty was 9.1% for PLHIV Versus 5.9% for controls. A significant proportion of PLHIV was pre-frail; 141 (75.4%) compared to controls 110 (58.8%). Pre-frailty status was associated with HIV diagnosis (adjusted odds ratio (aOR) 4.2; 95% CI 1.8-9.9), low age (aOR 0.3; 95% CI 0.1-0.6), lower educational attainment (aOR 2.2; 95% CI 1.0-4.9), being farmer (aOR 3.2; 95% CI 1.0-10.2) and having high or low body mass index (BMI) (aOR 11.3; 95% CI 4.0-25.8). HIV diagnosis (aOR 9.7; 95% CI 1.6-56.8), age (aOR 0.2; 95% CI 0.1-0.7), lower educational attainment (aOR 5.2; 95% CI 1.5-18.2), single status (aOR 4.2; 95% CI 1.3-13.6), farmer (aOR 19.5; 95% CI 3.5-109.1) and high or low BMI (aOR 47.3; 95% CI 13.8-161.9) predicted frailty. CONCLUSION A high proportion of frailty and pre-frailty was observed in a cohort of older PLHIV attending care in Southern Ethiopia. Future research should focus on interventions targeting factors associated with frailty.
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Affiliation(s)
| | - Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Andargachew Kassa
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Taye Gari
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Keneni Gutema
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nana Chea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kindie Woubshet
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Netsanet Bogale
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Amare Assefa
- College of Health Sciences, Jima University, Jima, Ethiopia
| | - Jaime Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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10
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St Clair-Sullivan N, Simmons K, Harding-Swale R, Levett T, Maddocks M, Roberts J, Trotman D, Yi D, Vera JH, Bristowe K. Frailty and frailty screening: A qualitative study to elicit perspectives of people living with HIV and their healthcare professionals. HIV Med 2022; 24:480-490. [PMID: 36229192 DOI: 10.1111/hiv.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES People living with HIV are an ageing population with an increasing prevalence of frailty. Management of frailty requires assessment, communication and information sharing with patients. However, evidence regarding the meaning of frailty for this population, and the acceptability of frailty screening, is limited. This study aimed to explore the perceptions of older people living with HIV and HIV professionals towards frailty and routine screening for frailty. METHODS Data collection consisted of in-depth individual qualitative interviews with older people living with HIV and focus groups with HIV professionals purposively sampled from outpatient HIV clinics in London and Brighton, UK. Verbatim pseudonymised transcripts were analysed using reflexive thematic analysis supported by NVivo. RESULTS A total of 45 people living with HIV were interviewed, and 12 HIV professionals participated in two focus groups. Frailty was described as a series of losses around mobility, social inclusion, independence and mental acuity, which could happen at any age. Regarding language, for people living with HIV, explicitly using the word frail was acceptable during screening when approached sensitively and alongside provision of information and support to slow the progression of frailty. However, HIV professionals described concerns about using the word frail for fear of causing distress or offence. CONCLUSION Professionals described frailty in terms of functional deficits, whereas people living with HIV described a loss of personhood. Although there is a clear desire among people living with HIV to be informed of their frailty status, approaching conversations about frailty with understanding and compassion is vital. To gain the most from the screening, it is essential that frailty status is shared alongside a clear plan of actionable steps in their care.
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Affiliation(s)
- Natalie St Clair-Sullivan
- Brighton and Sussex Medical School, Brighton, UK.,King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Richard Harding-Swale
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Daniel Trotman
- King's College Hospital NHS Foundation Trust, London, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Jaime H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
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11
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O'Brien KK, Solomon P, Carusone SC, Erlandson KM, Bergin C, Bayoumi AM, Hanna SE, Harding R, Brown DA, Vera JH, Boffito M, Murray C, Aubry R, O'Shea N, St Clair-Sullivan N, Boyd M, Swinton M, Torres B, Davis AM. Assessing the sensibility and utility of a short-form version of the HIV Disability Questionnaire in clinical practice settings in Canada, Ireland and the USA: a mixed methods study. BMJ Open 2022; 12:e062008. [PMID: 36175103 PMCID: PMC10098270 DOI: 10.1136/bmjopen-2022-062008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The Short-Form HIV Disability Questionnaire (SF-HDQ) was developed to measure the presence, severity and episodic nature of health challenges across six domains. Our aim was to assess the sensibility, utility and implementation of the SF-HDQ in clinical practice. DESIGN Mixed methods study design involving semistructured interviews and questionnaire administration. PARTICIPANTS We recruited adults living with HIV and HIV clinicians in Canada, Ireland and the USA. METHODS We electronically administered the SF-HDQ followed by a Sensibility Questionnaire (face and content validity, ease of usage, format) and conducted semistructured interviews to explore the utility and implementation of the SF-HDQ in clinical practice. The threshold for sensibility was a median score of >5/7 (adults living with HIV) and>4/7 (HIV clinicians) for ≥80% of items. Qualitative interview data were analysed using directed content analysis. RESULTS Median sensibility scores were >5 (adults living with HIV; n=29) and >4 (HIV clinicians; n=16) for 18/19 (95%) items. Interview data indicated that the SF-HDQ represents the health-related challenges of living with HIV and other concurrent health conditions; captures the daily episodic nature of HIV; and is easy to use. Clinical utility included measuring health challenges and change over time, guiding referral to specialists and services, setting goals, facilitating communication and fostering a multidisciplinary approach to care. Considerations for implementation included flexible, person-centred approaches to administration, and communicating scores based on personal preferences. CONCLUSIONS The SF-HDQ possesses sensibility and utility for use in clinical settings with adults living with HIV and HIV clinicians in three countries.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Instiute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Casey House, Toronto, Ontario, Canada
| | | | - Colm Bergin
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven E Hanna
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Noreen O'Shea
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
| | | | - Mallory Boyd
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Swinton
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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O'Brien KK, Brown DA, Bergin C, Erlandson KM, Vera JH, Avery L, Carusone SC, Cheung AM, Goulding S, Harding R, McCorkell L, O'Hara M, Robinson L, Thomson C, Wei H, St Clair-Sullivan N, Torres B, Bannan C, Roche N, Stokes R, Gayle P, Solomon P. Long COVID and episodic disability: advancing the conceptualisation, measurement and knowledge of episodic disability among people living with Long COVID - protocol for a mixed-methods study. BMJ Open 2022; 12:e060826. [PMID: 35256450 PMCID: PMC8905414 DOI: 10.1136/bmjopen-2022-060826] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION As the prevalence of Long COVID increases, there is a critical need for a comprehensive assessment of disability. Our aims are to: (1) characterise disability experiences among people living with Long COVID in Canada, UK, USA and Ireland; and (2) develop a patient-reported outcome measure to assess the presence, severity and episodic nature of disability with Long COVID. METHODS AND ANALYSIS In phase 1, we will conduct semistructured interviews with adults living with Long COVID to explore experiences of disability (dimensions, uncertainty, trajectories, influencing contextual factors) and establish an episodic disability (ED) framework in the context of Long COVID (n~10 each country). Using the conceptual framework, we will establish the Long COVID Episodic Disability Questionnaire (EDQ). In phase 2, we will examine the validity (construct, structural) and reliability (internal consistency, test-retest) of the EDQ for use in Long COVID. We will electronically administer the EDQ and four health status criterion measures with adults living with Long COVID, and readminister the EDQ 1 week later (n~170 each country). We will use Rasch analysis to refine the EDQ, and confirm structural and cross-cultural validity. We will calculate Cronbach's alphas (internal consistency reliability), and intraclass correlation coefficients (test-retest reliability), and examine correlations for hypotheses theorising relationships between EDQ and criterion measure scores (construct validity). Using phase 2 data, we will characterise the profile of disability using structural equation modelling techniques to examine relationships between dimensions of disability and the influence of intrinsic and extrinsic contextual factors. This research involves an academic-clinical-community partnership building on foundational work in ED measurement, Long COVID and rehabilitation. ETHICS AND DISSEMINATION This study was approved by the University of Toronto Research Ethics Board. Knowledge translation will occur with community collaborators in the form of presentations and publications in open access peer-reviewed journals and presentations.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabiltation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Long COVID Physio, Toronto, Ontario, Canada
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Long COVID Physio, London, UK
| | - Colm Bergin
- Department of Genitourinary and Infectious Diseases (GUIDE Clinic), St. James's Hospital, Dublin, Ireland
- Trinity College Dublin, School of Medicine, Dublin, Ireland
| | | | - Jaime H Vera
- Brighton and Sussex Medical School, University of Sussex Brighton, Brighton, UK
- Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Brighton, UK
| | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Angela M Cheung
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susie Goulding
- COVID Long-Haulers Support Group Canada, Toronto, Ontario, Canada
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | | | - Larry Robinson
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Hannah Wei
- Patient-Led Research Collaborative, Ottawa, Ontario, Canada
| | - Natalie St Clair-Sullivan
- Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Brighton, UK
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ciaran Bannan
- Department of Genitourinary and Infectious Diseases (GUIDE Clinic), St. James's Hospital, Dublin, Ireland
- Trinity College Dublin, School of Medicine, Dublin, Ireland
| | | | | | - Patriic Gayle
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), London, UK
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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13
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St Clair-Sullivan N, Mwamba C, Whetham J, Bolton Moore C, Darking M, Vera J. Barriers to HIV care and adherence for young people living with HIV in Zambia and mHealth. Mhealth 2019; 5:45. [PMID: 31620472 PMCID: PMC6789205 DOI: 10.21037/mhealth.2019.09.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The control of HIV/AIDS has been a contemporary public health success story however, whilst infection rates are falling and people are living longer due to antiretroviral therapy, adolescents and young people remain disproportionally affected. Infection rates and AIDS-related deaths continue to increase in these age groups in some areas globally. This has been primarily attributed to structural barriers including HIV-services not being youth friendly with opening hours conflicting with school time, fears around unintended disclosure and confidentiality, and the attitudes of healthcare professionals-but research targeting these specific age groups remains limited. Early mHealth (i.e., the use of mobile and wireless devices to assist in achieving health objectives) projects have been shown to improve health outcomes in other disease areas and health settings however, amongst people living with HIV, current research is limited. The aim of this study was to explore barriers to HIV care and the acceptability and feasibility of using mHealth to improve retention into care and ART adherence for young people living with HIV (16-24 years old) in Lusaka, Zambia. METHODS Qualitative in-depth interviews and focus group discussions were carried out in four CIDRZ-supported health facilities in Lusaka, Zambia. Six interviews were carried out with nurses and peer-support workers working with young people living with HIV and three focus groups with a total of 24 young people. Recruitment was via purposive sampling. Interviews and focus groups were recorded, translated and transcribed and entered into NVivo for thematic analysis. RESULTS Twenty-four of the young persons interviewed had access to mobile phones and reported using them for social networking, information gathering and regular communication. Barriers to HIV care and adherence were largely underpinned by stigma. Participants described healthcare facilities as not being conducive for confidentiality and therefore were reluctant to be seen attending or collecting medication from the pharmacy due to possible unintended disclosure and consequential HIV-related stigma. Clinic opening and waiting times and experiences with healthcare professionals also served as barriers. It was felt unanimously by participants that mHealth would be beneficial in improving retention into care and ART adherence in young people living with HIV. CONCLUSIONS HIV-related stigma remains a barrier to care. With growing access to mobile phones and internet, and a growing population of adolescents who are already using their phones to support each other and seek information, mHealth appears to be both a feasible and acceptable tool to support retention, provide young people with information, and potentially reduce time spent at health facilities via appointment reminders and electronic drug refill requests.
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Affiliation(s)
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Mass Media, Zambia
| | | | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Mass Media, Zambia
- University of Alabama at Birmingham, Birmingham, USA
| | | | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, East SussexUK
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