JOGNN
IN FOCUS EDITORIAL
The Role of Environmental Context, Faith, and Patient Satisfaction in HIV Prevention among African American Women Jillian Lucas Baker and Loretta Sweet Jemmott, Guest Editors
Correspondence Jillian Lucas Baker, DrPH, EdM, La Salle University, School of Nursing & Health Sciences, Department of Urban Public Health & Nutrition, 1900 W. Olney Ave., St. Benilde Tower, 3rd Floor, Office 3334. Philadelphia, PA 19144. [email protected]
Jillian Lucas Baker, DrPH, EdM, is an assistant professor of public health, School of Nursing & Health Sciences, Department of Urban Public Health & Nutrition, La Salle University, Philadelphia, PA.
Loretta Sweet Jemmott, PhD, FAAN, RN, is a van Ameringen Professor in Psychiatric Mental Health Nursing and Director of the Center for Health Disparities Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
The authors report no conflict of interest or relevant financial relationships.
http://jognn.awhonn.org
omen of color, particularly African American women, are disproportionately affected by HIV/AIDS. Nurses and public health practitioners continue to play a crucial role in HIV prevention. The holistic approach of nursing provides a foundation upon which to promote sexual health via education, empowerment, and personalized interventions that are consistent with the contexts of women’s lives. Nurses are well equipped to provide holistic care as they have a solid understanding of the biological, psychosocial, and theoretical underpinnings of the HIV disease. Moreover, nurses and public health practitioners have promoted an ecological approach to HIV prevention that has resulted in the development of interventions that address individual-level factors as well as social and structural inequities. In the four articles presented in this series, the authors highlight work from the disciplines of nursing and public health paradigms with concrete implications to enhance HIV prevention efforts among African American women.
W
In the first article, Brawner asserts that behavioral interventions cannot operate in isolation when inequitable social and structural conditions and individual barriers shape health outcomes. She uses the term geobehavioral vulnerability to HIV to partially explain gross HIV disparities among African American women compared to other racial/ethnic groups. The concept emphasizes that in regards to risk factors for HIV, it is not just what you do, but also where you do it, and with whom. Brawner explores how multilevel inequities, including concentrated disadvantaged environments, hyperincarceration of African American men, geographically and socially constrained sexual networks, and the intersectionality of race, gender, and class increase HIV risk among African American women. The framework provided can be used to develop comprehensive HIV assessments and
guide prevention programs in African American communities. In the second article, Stevens et al. explore how racial/ethnic minority female youth living in disadvantaged urban neighborhoods make decisions related to sexual debut and HIV prevention. This in-depth qualitative investigation is based on interviews from 30 adolescent girls, most of whom are African American. Grounded in in a socioecological approach, findings indicated that pathways by which the neighborhood environment influences the adolescent social environment and sexual decision making. Normative beliefs related to perceived peer behavior or parental expectations greatly influenced sexual decision making for the majority of the girls in the study. Stevens et al. recommended that prevention efforts account for the neighborhood context as well as structural interventions to create social environments that support healthy sexual decision making to slow the spread of HIV among young girls of color. Despite its significance in the African American community, the church has not been a common setting for implementation of evidence-based interventions (EBIs) for HIV prevention among African American women. In the third article, Stewart conducted a mixed methods study with two aims: (a) to investigate the risk behaviors of church attending African American women age 18 to 25 (N = 30) and (b) to assess barriers and facilitators to the implementation of HIV EBIs in church settings from the perspective of pastors, church leaders, and female participants. Stewart found that overall the congregations were in support of implementing an HIV related EBI in their church. Church leaders expressed the need for HIV related information for their congregants, including abstinence-based messages. The women
C 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
631
IN FOCUS EDITORIAL
were also in support of HIV related EBIs being offered at their churches and expressed the need for both abstinence and safer sex messages.
632
The Role of Environmental Context, Faith
enhancement of their clinical care and their health outcomes.
Satisfaction with health care can influence the quality of care received and health outcomes among patients living with HIV/AIDS. Few researchers have focused specifically on the health care experiences of African American women living with HIV/AIDS (AALWHA). To help fill this gap in the literature, Baker and colleagues examined drivers of satisfaction with healthcare among AALWHA. Communication with providers, education, income, and self-reported health status were significant predictors of satisfaction with health care. The authors found that the ability of health care providers to elicit satisfaction from their patients may be just as important as the health care services they provide. Continued exploration of factors that may enhance satisfaction with healthcare among AAWLWHA may contribute to
The articles presented in this In Focus series provide a snapshot of the current status of HIV among African American women. The authors discuss an ecological framework for understanding the specific vulnerabilities that place African American women at risk for HIV, the HIV prevention needs of young, African American women in different settings (one community based and one in the church setting), and the healthcare needs of African American women living with HIV. Together these articles provide short-term and long-term recommendations on the delivery and evaluation of HIV prevention models to effectively meet the multifaceted needs of African American women. The authors also recommend that nurses and public health researchers continue to develop, implement, and evaluate theory-driven interventions that address the structural and sociocultural barriers that make African American women vulnerable to HIV/AIDS.
JOGNN, 43, 631-632; 2014. DOI: 10.1111/1552-6909.12490
http://jognn.awhonn.org
IN FOCUS EDITORIAL
The Role of Environmental Context, Faith, and Patient Satisfaction in HIV Prevention among African American Women Jillian Lucas Baker and Loretta Sweet Jemmott, Guest Editors
Correspondence Jillian Lucas Baker, DrPH, EdM, La Salle University, School of Nursing & Health Sciences, Department of Urban Public Health & Nutrition, 1900 W. Olney Ave., St. Benilde Tower, 3rd Floor, Office 3334. Philadelphia, PA 19144. [email protected]
Jillian Lucas Baker, DrPH, EdM, is an assistant professor of public health, School of Nursing & Health Sciences, Department of Urban Public Health & Nutrition, La Salle University, Philadelphia, PA.
Loretta Sweet Jemmott, PhD, FAAN, RN, is a van Ameringen Professor in Psychiatric Mental Health Nursing and Director of the Center for Health Disparities Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
The authors report no conflict of interest or relevant financial relationships.
http://jognn.awhonn.org
omen of color, particularly African American women, are disproportionately affected by HIV/AIDS. Nurses and public health practitioners continue to play a crucial role in HIV prevention. The holistic approach of nursing provides a foundation upon which to promote sexual health via education, empowerment, and personalized interventions that are consistent with the contexts of women’s lives. Nurses are well equipped to provide holistic care as they have a solid understanding of the biological, psychosocial, and theoretical underpinnings of the HIV disease. Moreover, nurses and public health practitioners have promoted an ecological approach to HIV prevention that has resulted in the development of interventions that address individual-level factors as well as social and structural inequities. In the four articles presented in this series, the authors highlight work from the disciplines of nursing and public health paradigms with concrete implications to enhance HIV prevention efforts among African American women.
W
In the first article, Brawner asserts that behavioral interventions cannot operate in isolation when inequitable social and structural conditions and individual barriers shape health outcomes. She uses the term geobehavioral vulnerability to HIV to partially explain gross HIV disparities among African American women compared to other racial/ethnic groups. The concept emphasizes that in regards to risk factors for HIV, it is not just what you do, but also where you do it, and with whom. Brawner explores how multilevel inequities, including concentrated disadvantaged environments, hyperincarceration of African American men, geographically and socially constrained sexual networks, and the intersectionality of race, gender, and class increase HIV risk among African American women. The framework provided can be used to develop comprehensive HIV assessments and
guide prevention programs in African American communities. In the second article, Stevens et al. explore how racial/ethnic minority female youth living in disadvantaged urban neighborhoods make decisions related to sexual debut and HIV prevention. This in-depth qualitative investigation is based on interviews from 30 adolescent girls, most of whom are African American. Grounded in in a socioecological approach, findings indicated that pathways by which the neighborhood environment influences the adolescent social environment and sexual decision making. Normative beliefs related to perceived peer behavior or parental expectations greatly influenced sexual decision making for the majority of the girls in the study. Stevens et al. recommended that prevention efforts account for the neighborhood context as well as structural interventions to create social environments that support healthy sexual decision making to slow the spread of HIV among young girls of color. Despite its significance in the African American community, the church has not been a common setting for implementation of evidence-based interventions (EBIs) for HIV prevention among African American women. In the third article, Stewart conducted a mixed methods study with two aims: (a) to investigate the risk behaviors of church attending African American women age 18 to 25 (N = 30) and (b) to assess barriers and facilitators to the implementation of HIV EBIs in church settings from the perspective of pastors, church leaders, and female participants. Stewart found that overall the congregations were in support of implementing an HIV related EBI in their church. Church leaders expressed the need for HIV related information for their congregants, including abstinence-based messages. The women
C 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
631
IN FOCUS EDITORIAL
were also in support of HIV related EBIs being offered at their churches and expressed the need for both abstinence and safer sex messages.
632
The Role of Environmental Context, Faith
enhancement of their clinical care and their health outcomes.
Satisfaction with health care can influence the quality of care received and health outcomes among patients living with HIV/AIDS. Few researchers have focused specifically on the health care experiences of African American women living with HIV/AIDS (AALWHA). To help fill this gap in the literature, Baker and colleagues examined drivers of satisfaction with healthcare among AALWHA. Communication with providers, education, income, and self-reported health status were significant predictors of satisfaction with health care. The authors found that the ability of health care providers to elicit satisfaction from their patients may be just as important as the health care services they provide. Continued exploration of factors that may enhance satisfaction with healthcare among AAWLWHA may contribute to
The articles presented in this In Focus series provide a snapshot of the current status of HIV among African American women. The authors discuss an ecological framework for understanding the specific vulnerabilities that place African American women at risk for HIV, the HIV prevention needs of young, African American women in different settings (one community based and one in the church setting), and the healthcare needs of African American women living with HIV. Together these articles provide short-term and long-term recommendations on the delivery and evaluation of HIV prevention models to effectively meet the multifaceted needs of African American women. The authors also recommend that nurses and public health researchers continue to develop, implement, and evaluate theory-driven interventions that address the structural and sociocultural barriers that make African American women vulnerable to HIV/AIDS.
JOGNN, 43, 631-632; 2014. DOI: 10.1111/1552-6909.12490
http://jognn.awhonn.org
