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PubMedDate not supplied

A sustainable behavioral intervention to increase condom use and reduce gonorrhea among sex workers in Singapore: 2-year follow-up.

BACKGROUND: Prostitution is the most important source of transmission of AIDS and sexually transmitted diseases in Asia. We developed and evaluated the sustainability of an intervention to increase condom use and reduce gonorrhea among brothel-based sex workers in Singapore. The intervention focused on developing sex workers' negotiation skills, educating clients, and mobilizing support from peers and health staff in promoting condom use. METHODS: A pretest-posttest design with one intervention site (n = 124) and another comparable control site (n = 122) was maintained for 5 months followed by a time series design to follow up the intervention group for 2 years. RESULTS: At 5 months, the intervention group improved significantly in negotiation skills and were almost twice as likely as controls to always refuse unprotected sex (adjusted rate ratio 1.90, 95% CI 1.22-2.94). Gonorrhea incidence declined considerably by 77.1% in the intervention group compared with 37.6% in the controls. Consistent refusals of unprotected sex in the intervention group increased from 44.4% at baseline to 65.2% at 5 months, 73.6% at 1 year, and 90.5% at 2 years with a corresponding decline in gonorrhea. CONCLUSION: Sustained condom use with a corresponding decline in gonorrhea was achieved by a behavioral and environmental intervention for sex workers.

Adult↗
PubMed2006

Understanding the food choice process of adolescents in the context of family and friends.

PURPOSE: To understand from the adolescents' own perspective the decision-making processes they use to make food choices on an everyday basis and how they resolve their need for personal control over food choices with the values of family and peers. METHODS: A sample of 108 adolescents, aged 11-18 years, were individually interviewed. They were asked in a simulated task to choose a lunch from a menu of offerings and give reasons for their choices. In addition, open-ended questions probed for meal structures, dinners, perceptions of degree of choice, role of family and peers. Interviews were audio-taped, transcribed, coded, and analyzed for emerging themes. RESULTS: Primary food choice criteria were taste, familiarity/habit, health, dieting, and fillingness. Lunches had a definite structure, and lunches differed from dinners. The food choice process involved personal food decision-making rules such as trade-offs among choice criteria within a meal (e.g., taste for core items and health for secondary items), and between lunches with peers (taste) and family dinners (health); negotiation patterns with the family (autonomy versus family needs); and interactions with peers. CONCLUSIONS: The food choice process for most adolescents seemed to involve cognitive self-regulation where conflicting values for food choices were integrated and brought into alignment with desired consequences. Educators and practitioners should recognize the dilemmas adolescents face in making food choices and help them develop strategies for balancing less healthful with more healthful food items, through: (a) personal food decision-making rules, (b) effective negotiations with family members; and (c) appropriate interaction patterns with peers.

Adolescent↗
PubMed2005

Reproductive health education and sexual risk among high-risk female adolescents and young adults.

STUDY OBJECTIVE: The objective of this study was to explore the associations of sources, content, and timing of reproductive health education with cognitive and behavioral sexual risk in a sample of high-risk female adolescents and young adults. DESIGN: Female adolescents and young adults (n=113, median age 17 years) receiving treatment for a sexually transmitted disease (STD) reported sources of reproductive health education, topics covered, and when first formal education occurred. Dependent variables included sexual risk knowledge; condom attitudes, negotiation skills, and use (consistent and at last sex); and number of sexual partners. RESULTS: Most participants reported receiving reproductive health education from both parental (80%) and formal sources (92%). Parents discussed the menstrual cycle (94%) more frequently than other sex education topics, while formal sources focused most on teaching about STDs (91%). Although median age of first formal instruction was 12 years, 26% of girls received their first formal education during or after the year they initiated coitus. Girls with a parental source of education and those receiving formal instruction on pregnancy reported greater ability to negotiate condom use. Girls who received education later in relation to the onset of sexual activity and those with a parental source of education reported more sexual partners. CONCLUSIONS: Early reproductive health education and education from both parental and formal sources is associated with reduced sexual risk among high-risk adolescent girls. Interestingly, receiving parental education is also associated with more sexual partners, suggesting that parental educational efforts may be reactive to their daughters' increasing sexual risk behavior. Future research should examine multiple sources of reproductive health education and the timing of education from these sources to enhance understanding the dynamic interactions between reproductive health education and adolescent sexual risk.

Adolescent↗
PubMed2004

Improving client-provider communication: evaluation of a training program for women, infants and children (WIC) professionals in New York state.

Results are presented from evaluation of an intensive 1 day training program to improve the growth monitoring counseling skills of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) providers. The training was framed by the patient-centered approach, and focused on a seven-step technique that emphasized eliciting client perspective on the child's health and negotiating follow-up strategies. Changes in skill were assessed during audiotaped mock counseling sessions with simulated clients. Observed intervention effects were moderate but encouraging for future training programs. After the training, more providers elicited client perspective, and provider level of engagement in negotiating with the client increased. At post-test providers asked more open-ended questions than at pre-test, and provider-to-client talk ratio decreased. Increases in provider total and competence-related satisfaction paralleled improvements in counseling proficiency. Study results suggest that counseling skills of non-physician health providers can change after a 1 day focused training: providers were more client-centered in their discussions. Limitations and implications of the study are discussed.

Attitude of Health Personnel↗
PubMed2006

The role of power, process, and relationships in participatory research for statewide HIV/AIDS programming.

This paper presents a case study of a participatory process that was used to understand the needs of persons living with HIV/AIDS in a US state. The case illustrates that participation in a community-based research project is a dynamic phenomenon that must be negotiated among an evolving web of roles and relationships. Using a continuum to model the multiple modes of community participation, we follow the changing nature of participation over the course of a single project. Our analysis illustrates the different levels of participation given by the continuum as well as the dynamic nature of participation. A shared understanding of participation evolves as the roles and relationships of those involved are negotiated and renegotiated. However, lack of reflection over power differentials can lead to disempowering outcomes even after achieving a seemingly participatory process. The case reveals that failing to resolve divergent assumptions about power and purpose can lead to fissures that are difficult to overcome.

Acquired Immunodeficiency Syndrome↗
PubMed2002

'Could you please pass one of those health leaflets along?': exploring health, morality and resistance through focus groups.

This paper derives from research in which focus groups were used as a preliminary method of eliciting peoples' perceptions, attitudes and opinions towards health and health promotion in a Northern British city. However, applying criticisms associated with social constructionist theories (e.g. discourse analysis and rhetorical analysis), some recently emerging work on focus groups (see The challenge and promise of focus groups, in: Barbour, Kitzinger (Eds.), Developing Focus Group Research: Politics, Theory and Practice, Sage, London, 1999, p. 1; Focus Groups in Social Research, Sage, London, 2001) has suggested that their traditional use, as a kind of 'window' onto peoples' attitudes and opinions, misses important dimensions of the way in which these phenomena are actively negotiated and constructed during the course of the focus group. Working on the premise that these observations are particularly pertinent to health issues, this paper draws on data from one focus group in order to provide a detailed working example of the way in which attitudes and opinions towards health issues are actively constructed during the course of interaction. In addition, in accordance with social constructionist theories, attention will be paid to the way in which such construction is inextricably linked to social and moral actions such as the negotiation of blame and allocation of responsibility. Through an analysis of six extracts, the paper ultimately identifies three 'positions' or 'stances', which develop over the course of the focus group, often in opposition to one another. These are: (1) 'positive mental attitude'; (2) 'genes and luck'; and (3) 'resistance'. Each of these positions becomes associated, not only with certain moral values, but also 'attached' to certain people within the group. One of the main aims of this analysis is to illustrate how, through the everyday nature of such debates, health remains an intrinsically moral phenomenon.

Attitude to Health↗
PubMed1997

"Popular" health and the state: dialectics of the peace process in El Salvador.

The poor performance of large-scale "vertical" rural health programs tied to state Ministries of Health in Third World countries has often been attributed to a lack of "political will". But that term tells little about the conditions that favor health reform and may obscure disparate power relations and struggles over development. This work explores such a struggle over community health that emerged as part of the peace process in a former war zone of El Salvador since the 1992 ceasefire. The formalized negotiations (and behind-the-scenes confrontations) over health in Chalatenango province took place between Ministry of Health administrators and proponents of a "popular" health system that has functioned in repopulated villages of rebel-controlled Chalatenango since 1987. The Ministry has set up its own national (U.S. AID-designed) community health worker program, and agreed in theory with the popular system's emphasis on village-based lay health promoters; however, in negotiations and efforts at collaboration in Chalatenango the Ministry has been unwilling to support the promoters in the popular system, to accommodate local participation in health decision-making, or to restructure its own physician-centered practices around the need for more comprehensive approaches to health.

Civil Disorders↗
PubMed2003

A multi-agent intelligent environment for medical knowledge.

AMPLIA is a multi-agent intelligent learning environment designed to support training of diagnostic reasoning and modelling of domains with complex and uncertain knowledge. AMPLIA focuses on the medical area. It is a system that deals with uncertainty under the Bayesian network approach, where learner-modelling tasks will consist of creating a Bayesian network for a problem the system will present. The construction of a network involves qualitative and quantitative aspects. The qualitative part concerns the network topology, that is, causal relations among the domain variables. After it is ready, the quantitative part is specified. It is composed of the distribution of conditional probability of the variables represented. A negotiation process (managed by an intelligent MediatorAgent) will treat the differences of topology and probability distribution between the model the learner built and the one built-in in the system. That negotiation process occurs between the agents that represent the expert knowledge domain (DomainAgent) and the agent that represents the learner knowledge (LearnerAgent).

Artificial Intelligence↗
PubMed2006

The Mpondombili Project: preventing HIV/AIDS and unintended pregnancy among rural South African school-going adolescents.

Unintended pregnancy, HIV and other sexually transmitted infections are major threats to the health of South African youth. Gendered social norms make it difficult for young women to negotiate safer sex, and sexual coercion and violence are prevalent. Sexual activity among adolescents is influenced strongly by conservative social norms, which favour abstinence. In reality, most young people are sexually active by the end of the teen years. Girls' decision to have sex is often a passive one, influenced by partners. The Mpondombili Project is a school-based intervention in rural KwaZulu-Natal that aims to promote delay in the onset of sexual activity and condom use as complementary strategies for both sexually experienced and inexperienced youth. Interactive training was carried out with peer educators, teachers and nurses over a 15-month period, and a manual developed. The intervention was implemented in late 2003 with 670 adolescents in two schools. Issues covered included HIV/STI transmission, risk behaviours, HIV testing, pregnancy and contraception, gender inequality, sexual communication and negotiation, managing abusive situations, fear of AIDS, stigma and discrimination and sexual rights. The diversity of young people's relationships and vulnerability to sexual risk call for the promotion of both risk avoidance (delay in sexual initiation) and risk reduction (condom use) together, regardless of ideology, especially where HIV is well-established, to protect their health.

Adolescent↗
PubMedDate not supplied

Understanding barriers to condom usage among HIV-infected African American women.

Drawing on focus group discussions with adolescent and adult HIV-infected women between the ages of 16 and 45, this study explores the barriers to condom use among women infected with HIV. Although most of the participants were comfortable discussing condoms and sexuality, there was little, if any, negotiation of condom use with their male partners. Most of the participants used condoms inconsistently or not at all. Reasons for nonuse included a lack of trust in the reliability of condoms to protect them, a lack of desire for pregnancy prevention, and the male partner's refusal to use condoms. Women in discordant relationships explained their uninfected partner's refusal to use condoms as denial of the risk of contracting HIV or as a way of expressing their love for the infected partner. Women also had great difficulty in disclosing their HIV status to both family and partners. Prevention efforts to increase condom use among HIV-infected women should target both men and women and focus on negotiation and communication skills.

Adolescent↗
PubMedDate not supplied

Nuclear cardiology in a managed care environment.

Health maintenance organizations (HMO) and nuclear cardiology represent mutual threats and mutual opportunities for each other. On the one hand, nuclear cardiology represents a cost center with HMOs exerting tremendous financial pressure on nuclear cardiology programs. On the other hand, nuclear cardiology can act as a sage gatekeeper to the cardiac catheterization laboratory and help HMOs effectively control the health care of an increasing percentage of the population. Through the process of negotiation, of determining each other's needs, an accommodation can take place between the two. The ability to correlate scan results with coronary angiography provides individual nuclear cardiology programs with the opportunity to demonstrate their accuracy. A Nuclear Cardiology Report Card based on these data can be developed for use, with HMOs creating the opportunity to compete not only on price but also on value. Carved out capitation rates for nuclear cardiology can be estimated on the basis of actual experience with an HMO population and by extrapolation from test frequency of the U.S. population. The financial disincentives of capitation and of managed care challenge the physician-patient relationship. Advocacy of the role of nuclear cardiology and an understanding of negotiation strategies can aid nuclear cardiologists in their attempts to provide quality care with commensurate compensation.

Capitation Fee↗
PubMed2002

Promoting pollution prevention through community-industry dialogues: the good neighbor model in Minnesota.

This article examines five attempts by communities to promote pollution prevention through direct negotiations with local manufacturing plants. These projects were Good Neighbor Dialogues spearheaded by Citizens for a Better Environment-Minnesota, an environmental advocacy organization. Three community-company partnerships (a container plant, a foundry, and a cabinet manufacturer) were successful and two (a munitions plant and a petroleum refinery) were not. Successful dialogues all shared certain characteristics: the company was open to negotiating with the community; there was an effective "champion" within the company; a skilled, independent facilitator served as moderator; community participants received independent technical assistance; and both the company and community understood the value of cooperative environmental decision making. Results suggest that Good Neighbor Dialogues can, under the right settings and circumstances, be an effective mechanism for building social capital by fostering greater understanding and trust between companies and communities. They offer the prospect of community-company partnerships that promote pollution prevention and other environmental improvements, while at the same time reinforcing and amplifying traditional pollution control strategies.

Community-Institutional Relations↗
PubMed2004

The relationship between alcohol and individual differences variables on attitudes and behavioral skills relevant to sexual health among heterosexual young adult men.

The purpose of this experiment was to investigate the effects of alcohol, alcohol sex expectancies, and sexual sensation seeking on determinants of sexual health behavior according to the Information-Motivation-Behavioral Skills (IMB) model. The participants were 48 heterosexual young adult males who attended 2 laboratory sessions. During Session 1, participants completed a set of screening and individual differences measures, and during Session 2 they were randomly assigned to 1 of 3 beverage conditions: control, alcohol (0.65 g alcohol/kg body weight), or placebo. Following the experimental manipulation, all participants completed measures regarding attitudes toward condom use, intention to engage in risky sex, and condom use negotiation skills. The results showed that participants who consumed alcohol had poorer negotiation skills and greater intention to engage in risky sex compared to participants who did not drink alcohol. Although alcohol did not affect any dimension of attitude regarding condom use, attitude about condoms' effects on sex, as well as sexual sensation seeking, were correlated with both intention ratings and skills. Multiple regression models, including both attitudes and sensation seeking, showed that attitudes accounted for 20-25% of variance independent of beverage condition in predicting intention ratings and skills. The findings were consistent with past research showing that alcohol consumption can have detrimental effects on determinants of sexual health behavior and that individual differences factors can enhance the power of models like the IMB to predict such behavior.

Adult↗
PubMed2004

Self-concept and adolescents' refusal of unprotected sex: a test of mediating mechanisms among African American girls.

During adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.

Adolescent↗
PubMed2001

The carer's place in the cancer situation: where does the carer stand in the medical setting?

Recent thinking about policy on cancer services in the UK has highlighted the importance of recognising the needs of carers, but is unclear about the ways in which this might be done. Our recent study on the psychosocial needs of cancer patients and their main informal carers was unusual in its combined focus on patients and carers experiencing the 'cancer journey' together. One of our aims was to contribute to an understanding of what it means to be the main carer of someone with cancer. Using the qualitative data from the 79 carers and patients we interviewed, we ask how carers negotiate their place in the cancer situation, and particularly how do carers identify their role in relation to the patient and the medical setting? We posit carers as taking part in a shifting process of 'carerhood' in which competing needs vie for space. Our evidence suggests carers actively negotiate the challenges of their position in dealing with issues of identity, support, and sharing. We suggest that when the carer's involvement in the cancer scenario is recognised and legitimised by others it is easier for them to attend to their own needs alongside those of the patient.

Caregivers↗
PubMed2001

Self-harm behavior and no-suicide contracting in psychiatric inpatient settings.

Although negotiation of no-suicide contracts is common practice, research regarding the outcomes of contracting is inadequate. The purpose of this retrospective review of medical records was to examine how no-suicide contracting affected the likelihood of self-harm behavior in psychiatric inpatient settings. Thirty-one patients (4.8%) engaged in self-harm behaviors representing 2.64% of all patients admitted to both study settings during the 6 (1/2)-month period from which data were collected. Approximately half of those patients expressed suicidal intent. Logistic regression analysis suggested that patients with no-suicide contracts and with higher levels of restriction had a significantly higher likelihood of self-harm behavior (OR = 7.43 and 2.47, respectively, p = .005). Consistency of nursing assignment is likely associated with a lower probability of self-harm (OR = .07) but p.068 when this variable was included in the model. Prevention of self-harm behaviors by the use of no-suicide contracting is not shown. Negotiation of a contract is likely a reflection of staff assessment that the patient was at high risk for suicide. These findings confirm the need for thorough, ongoing assessment of suicidal risk, whether or not a patient has agreed to a no-suicide contract.

Female↗
PubMed2002

Effects of conflict resolution training integrated into a high school social studies curriculum.

The authors examined the effectiveness of conflict resolution and peer mediation training among California high school students. The authors randomly assigned 2 of 4 classes to receive 5 weeks of conflict resolution and peer mediation training integrated into the required social studies curriculum. The remaining 2 classes studied the same social studies curriculum for an identical amount of time (105 min every other day) without conflict resolution and peer mediation training. The authors investigated 2 issues. The 1st was the effectiveness of the conflict resolution and peer mediation training. The trained students, compared with the untrained students, learned the integrative negotiation and peer mediation procedures better, applied the procedures more completely, chose an integrative over a distributive approach to negotiation, and developed more positive attitudes toward conflict. The 2nd issue was the impact of the training program on academic achievement. Integrating conflict resolution and peer mediation training into an academic course promoted higher achievement, greater long-term retention of the academic learning, and greater transfer of academic learning in social studies to language arts.

Adolescent↗
PubMedDate not supplied

Questioning, resisting, acquiescing, balancing: new mothers' career reentry strategies.

As part of a larger study on the processes by which career-committed women experience the transitions in becoming new mothers and returning to their careers, I conducted 70 interviews with 35 participants across the trajectory of becoming pregnant, being pregnant, giving birth, taking time out from their careers, and reentering their careers. Using the constant-comparative method, I analyzed data from these interviews to discover a major process, Improvising Identities, supported by two subprocesses, Negotiating Relationships and Managing Practicalities. I report these women's strategies for negotiating their major relationships and managing the practicalities of career reentry, that is, improvising an identity as a career woman with a baby.

Adaptation, Psychological↗