Type 2 diabetes (T2D) is changing the burden of disease across Latin America. In this formative, qualitative study, we explored experiences of T2D diagnosis and management among adults in rural Dominican Republic. We conducted 28 in-depth interviews (12 men, 16 women) and used inductive analysis to explore the emotional burden of T2D and identify coping strategies. We found that stress relating to T2D began at diagnosis and persisted throughout management. Stress was produced by concerns about healthy food and medication access, fears about illness-induced injury, and the cyclical process of experiencing stress. Participants identified diabetes care and free medication services as external stress-reducers. Internally, participants’ mitigated stress by not thinking about diabetes (“ no dar mente”). Our study highlights the importance of a contextualized understanding of diabetes-related stress and the need for individual, clinic, and community-level interventions to reduce stressors and improve health outcomes among adults with T2D.
Men who have sex with men (MSM) and transgender women (TGW) have increased risk for syphilis and HIV. Partner notification (PN) is an effective strategy to provide early diagnosis and improve treatment outcomes among sexual partners of individuals diagnosed with an STI. We conducted a qualitative study to examine perceptions, experiences, and preferences for PN among Black and Latino MSM and TGW in North Carolina (NC).
Methods
We conducted seven focus groups (FG) with 50 purposively sampled participants across four NC counties with high rates of HIV and syphilis. Eligible participants were aged 18–44, identified as Black and/or Latino, had ever had sex with men, and identified as male or a TGW. We used a semi-structured guide to facilitate five groups in English and two in Spanish. We inductively analyzed data after each FG via field notes and team debriefs, organizing field notes in a matrix to identify crosscutting themes, and double-coding transcripts to systematically examine differences and similarities across salient themes.
Results
Black males reported more familiarity and experiences with PN than Latino males and Black and Latino TGW. Generally, participants familiar with PN perceived the approach to locating clients as aggressive, while participants unfamiliar with PN viewed its theoretical application positively. All participants worried about personal privacy and stigma, on the part of PN staff or others. Poor communication and feeling harassed by staff during PN characterized negative experiences while empathy, privacy, choice and autonomy, and support with navigating services characterized positive experiences. Participants preferred using PN to notify casual partners but worried PN could antagonize relationships with steady partners.
Conclusion
Participants prefer more choice, support and sensitivity in PN. The systematic integration of shared-decision making and service navigation into PN could transform community perceptions and improve the quality and success of PN.
Abstract Background: Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women’s experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women’s care experience and what women mean by satisfaction in two Ethiopian regions. Methods: Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women’s experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction. Results: Maternal and newborn survival and safety were central to women’s descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as ‘satisfactory’. The texture behind this ‘satisfaction’, however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider’s interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility’s amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women’s experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women’s overall satisfaction, even in the context of poor-quality facilities and limited resources. Conclusion: Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women’s satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women’s care experience.
Abstract Background Shared decision-making tools (SDT) support conversations between healthcare providers (HCPs) and patients around evidence-based care options. With the FDA approval of long-acting injectable (LA) pre-exposure prophylaxis (PrEP) creating the choice of daily oral or LA PrEP for HIV prevention, formative research was conducted to inform the development and assessment of a prototype PrEP SDT. Methods People who may benefit from PrEP (PWBP) (n=41) and PrEP HCPs (n=20) participated in in-depth interviews (IDIs) in Spanish or English at two sites in Washington, D.C. to explore knowledge and perceptions of daily oral and LA PrEP through 2021 and 2022. Based on input from IDIs, including on desired SDT content, a prototype PrEP SDT was developed and piloted in 37 PWBP-HCP mock encounters, including ten in Spanish, at sites in D.C. and North Carolina through 2022 and 2023. Field notes from post-encounter exit interviews were analyzed to identify content and format refinement as well as implementation implications. Matrices were used to synthesize and compare findings across populations and sites. Results A diverse sample of PWBP and HCPs participated in IDIs (Table 1) and exit interviews (Table 2). Participants found the language, visuals, content and flow of the prototype SDT to be broadly acceptable with minor suggestions for additional content. PWBP felt the SDT addressed knowledge deficits about PrEP and that the format aided PrEP decision-making. HCPs liked that the SDT systematized clinic visits and was appropriate for never and ever PrEP users. The SDT was seen to normalize PrEP conversations and reduce stigma around PrEP use by facilitating non-judgmental and more interactive dialogue. Themes related to implementation included: the potential benefit of reviewing the SDT prior to a clinical visit and provider orientation on SDT use; the value of access to additional details on side effects and research on oral and LA PrEP; and the importance of PWBP-HCP dynamics. Conclusion The prototype PrEP SDT supported PrEP knowledge and choice for both ever and never PWBP while reducing stigma around PrEP use across settings and populations. It provided HCPs with content and a format that ensured comprehensive, acceptable delivery of PrEP choice information. Disclosures Aimee A. Metzner, PharmD, AAHIVP, ViiV Healthcare: Full-time employee (salary/benefits/etc.)|ViiV Healthcare: Stocks/Bonds Alan Oglesby, MPH, GlaxoSmithKline: Employment|GlaxoSmithKline: Stocks/Bonds Cindy Garris, MS, GSK: Stocks/Bonds|ViiV Healthcare: Employee David A. Wohl, M.D., Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Janssen: Advisor/Consultant|Theratech: Advisor/Consultant|ViiV: Advisor/Consultant
Type 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.
Access to maternal health services has increased in Ethiopia during the past decades. However, increasing the demand for government birthing facility use remains challenging. In Ethiopia's Afar Region, these challenges are amplified given the poorly developed infrastructure, pastoral nature of communities, distinct cultural traditions, and the more nascent health system. This paper features semi-structured interviews with 22 women who were purposively sampled to explore their experiences giving birth in government health facilities in Afar. We used thematic analysis informed by a cultural safety framework to interpret findings. Our findings highlight how women understand, wield, and relinquish power and agency in the delivery room in government health facilities in Afar, Ethiopia. We found that Afari women are treated as 'others', that they manipulate their care as they negotiate 'cultural safety' in the health system, and that they use trust as a pathway towards more cultural safety. As the cultural safety framework calls for recognizing and navigating the diverse and fluid power dynamics of healthcare settings, the onus of negotiating power dynamics cannot be placed on Afari women, who are already multiply marginalized due to their ethnicity and gender. Health systems must adopt cultural safety in order to ensure health quality. Providers, particularly in regions with rich cultural diversity, must be trained in the cultural safety framework in order to be aware of and challenge the multidimensional power dynamics present in health encounters.
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