Disclosure Of Status Research Articles

Familial disclosure of mutational status and cascade testing: Relationships with cancer-predisposing genes and race/ethnicity.

10605 Background: Patients (pts) with cancer-predisposing genes may differ in the patterns of genetic testing disclosure to family members and cascade testing. We examined the relationships between varying levels of cancer-predisposing gene penetrance and racial/ethnic differences in familial disclosure and cascade testing. Methods: Between July-September 2023, we conducted a follow-up survey of pts enrolled in the University of Chicago Cancer Prone Study, a longitudinal cohort of high-risk families initiated in 1992. Pts were asked questions about familial disclosure and cascade testing, including whether they 1) carry a gene mutation(s); 2) told any family member about their mutation status; 3) received a family letter from their genetic counselors after testing; and 4) had any family member having undergone testing for the familial mutation(s). Chi-squared or Fisher’s exact tests were performed. Results: Of 912 respondents, 35.3% (n=312) reported carrying a genetic mutation. The mean age was 54.8 years (SD=13.7); 86.9% were White, followed by 4.8% Black, 5.1% Hispanic, and 3.2% other/multiracial; 45.8% had a graduate/professional degree; 31.5% had an annual household income of ≥$200,000; 70.9% and 23.9% were privately insured and on Medicare/Medicaid, respectively. Among pts with a genetic mutation, 37.8% had a BRCA1 (n=63) or BRCA2 (n=55) mutation. The vast majority (96.5%) disclosed their mutation status to a family member. The disclosure status differed significantly by race/ethnicity (Hispanic 100.0%, White 98.5%, Black 92.3%, vs. other/multiracial 80.0%; p=0.013). First-degree relatives were the most communicated to, and the most cited reasons for disclosure were “awareness of potential risk” (n=264) and “support preventive measures” (n=224). Among pts carrying a gene mutation, 50.6% (n=158) reported having received a letter from their genetic counselors to share with any family member and of these, 82.2% (n=129) did share their family letters. Among pts who did not receive or did not know if they received a letter (n=149), 41.6% stated that the letter would have helped them disclose the information to their family members. Further, 79.1% of the pts reported that their family members underwent genetic testing, with no significant differences in cascade testing by race/ethnicity and other demographic characteristics. However, pts with a positive mutation in BRCA1or BRCA2 (92.6%) were more likely to have a cascade testing, when compared to pts with other mutations (76.8%; p<0.001). Conclusions: Although familial disclosure of mutational status was high, cascade testing was not high enough and it depends on the penetrance of cancer-predisposing genes. Understanding genetic testing disclosure and cascade testing from a gene-to-gene basis could help improve genetic counseling and risk communication particularly for racial/ethnic minority pts.

Patient’s perception of cancer treatment outcomes in geriatric age groups: A retrospective analysis from a tertiary care centre in India.

e13774 Background: Geriatric population forms a significant part of the total cancer patients in any given country and their expectations, their needs and challenges are different from younger patients. Patients may perceive their “chances” differently from what is expected with cancer treatment. In our analysis we aimed to look at such perceived intent of therapy in geriatric patients and factors that might influence these perceptions. Methods: We retrospectively looked at data of comprehensive geriatric assessment (CGA) which is maintained by the geriatric clinic at our institute. Patients are referred to our geriatric clinic after their joint clinic meetings and after their meetings with their primary oncologists. We identified 2962 patients who underwent CGA and collected data of age, gender, social support, marital status, education level, actual intent of therapy, patients’ perception of intent, their desire of disclosure of disease status. We also collected objective scores of GDS, GAD 7, TUG and ECOG performance status. Descriptive statistics were performed to find out the factors significantly affecting patient’s perception of intent of therapy. Results: The median age of our cohort was 68 years (Interquartile range- 64-72 years). Results are shown (Table). 70.6% wanted full disclosure of disease. Out of 1404 patients who were in palliative setting, 40.2 percent patient had misperception of treatment. Conclusions: Our data highlights the significant impact of patient’s general wellbeing both physical and mental on the perception of their treatment goals. It brings forth the need to address these issues along with cancer therapy in an already vulnerable geriatric population. Our data also highlights the desire to know about the disease status in majority which may empower terminal patients to spend their time and energy on things they value. A nearly 41% misperception in palliative patients is indicative of an urgent need for better communication practices to help patients be more aware of outcomes and thus may be able to put more quality in the limited time they have. [Table: see text]

RETRACTION: Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts.

M. Kekic, A. Rose, C. Baker, and D. Bayley, 'Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts,' Journal of Psychiatric and Mental Health Nursing (Early View), https://doi.org/10.1111/jpm.13036. The above article, published online on 05 March 2024 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Hugh McKenna, and John Wiley & Sons Ltd. The retraction has been agreed due to an undisclosed conflict of interest by the authors, which was reported in a complaint by a third party. Following an investigation, it was confirmed that, while the authors reported their employment status with Oxehealth Ltd. in their personal affiliations section, they failed to do so in a conflict of interest statement as required by the journal. Because the journal uses a double-blind peer review process, neither the names of the authors nor their affiliations were visible to the reviewers and editors during evaluation of the manuscript. Had an employment status disclosure been made clear in a conflict-of-interest statement in accordance with the journal's submission guidelines, the Editor-in-Chief and all associate editors would have considered author employment by Oxehealth Ltd., the developer of the technology evaluated by the authors, as a major competing interest and would have rejected the manuscript without peer review. Therefore, the article must be retracted. Dr. Kekic disagrees with the retraction, on behalf of all the authors.

Designing Empathetic Service Experiences Using Storytelling Approach: A Case Study

Storytelling is a well-known technique to emphasize emotions. This paper explores the integration of storytelling techniques into service design to cultivate empathetic service experiences. Emphasizing the significance of emotional connection in social service contexts, we designed services for Adolescents Living with HIV (ALHIV) in India. Due to a lack of awareness and social stigma, ALHIV are unable to make timely and responsible life decisions around intimacy and HIV status disclosure. We designed services that disseminate essential information and enable ALHIV to make informed life decisions. The solution is an interactive story media where users make decisions around in-design encounters that parallel with possible real-life encounters. As a result, they get to explore multiple possibilities in a safe space, leading to improved real-life decision-making. This paper demonstrates the replicable framework of orchestration of human and technology touchpoints through multiple dynamic and choice-based scenarios. The study examines the synergy between service design and narrative frameworks. Through a detailed case study, the research underscores the pivotal role of storytelling in fostering genuine user engagement by infusing empathy-driven narratives into service encounters. Overall, this research contributes a novel perspective on designing empathetic services, demonstrating the role of storytelling in crafting meaningful service experiences.

Experiences of Caregivers in Disclosing HIV Status to Children Infected with HIV in Mopani District, South Africa

Background Caregivers are confronted with difficulties in determining the ideal period to initiate HIV disclosure to the child infected with HIV. Moreover, caregivers are uncertain about how to facilitate the HIV disclosure process, and opportunities to start the discussion are frequently missed until a later stage. Caregivers often fear that the child will be affected psychologically and have poor cognitive ability to comprehend the nature of the illness. Objective The objective of the study is to explore and describe the experiences of primary caregivers regarding HIV disclosure to children infected with HIV. Methods A qualitative, explorative, and descriptive study was conducted at 4 selected ART facilities in the Mopani district. Where face-to-face semi-structured interviews were conducted until data saturation with 16 primary caregivers. Data was analysed and coded using the ATLAS.ti 9 program, according to the thematic method of analysis. Results Analysis of data identified three main themes that described the experience of caregivers regarding HIV disclosure in children, which are cues to disclose HIV status to children, experiences of the event of HIV status disclosure to children, and caregiver’s experiences of healthcare providers’ role in HIV disclosure process. Conclusion Caregivers revealed that they initiated the HIV disclosure process to the children because of their personal and child-related factors. However, they perceived HIV disclosure as a difficult process to initiate, because of lack of skills, knowledge, and support from healthcare providers. Caregivers perceived children as too young to receive HIV disclosure information and they feared that the child would react negatively.

Health-related quality of life in reproductive-age women on antiretroviral therapy: a cross sectional study in Ethiopia.

While numerous studies have explored the impact of gender on Health-Related Quality of Life (HRQOL), there is a lack of evidence specifically among reproductive-age women undergoing Antiretroviral Therapy (ART). Therefore, this study aims to investigate HRQOL and its associated factors among reproductive-age women receiving ART at Hiwot Fana Comprehensive Specialized Hospital in Eastern Ethiopia. A cross-sectional study included 418 women of ART. The World Health Organization quality of Life Questionnaire (WHOQOL-HIV BREF) was used to assess HRQOL. Binary logistic regression was used to determine the factors that could predict HRQOL. The study found that the median age of the participants was 37years, and the overall percentage of women with good HRQOL was 40.7%. Women who stayed on ART for more than 6years had higher odds of overall good HRQOL (AOR 6.73, 95% CI 3.31-13.71) compared to those with a duration of 6years or less. Besides, women having no child (AOR 25.03, 95% CI 4.93-127.06), one child (AOR 18.60, 95% CI 3.95-87.65), two children (AOR 12.89, 95% CI 3.66-45.37) and three children (AOR 3.77, 95% CI 1.06-13.34) had higher odds of overall good HRQOL compared to those with four/more children. The study found that the majority of women on ART had poor HRQOL. Factors such as longer duration of taking ART, higher CD4+ cell count, disclosure of HIV status, and receiving care from adherence support teams were associated with better quality of life. Thus, strengthening adherence support teams, promoting safe disclosure of HIV status, and providing comprehensive support for HIV-positive women are required to improve their overall HRQOL.

Study on HIV Status Disclosure and Treatment Adherence Amongst Support Group Members in Mushin Local Government Area (LGA), Lagos State

Human Immunodeficiency Virus (HIV) remains a significant global health concern, particularly in sub-Saharan Africa, where the burden of the epidemic is highest. Lagos State, in Southwest Nigeria, faces a significant challenge with HIV prevalence, particularly in the Mushin Local Government Area (LGA). This study investigates the relationship between HIV status disclosure and adherence to Antiretroviral Therapy (ART) medication among members of the God is Good Support Group in Mushin LGA, Lagos State, Nigeria. The study used a qualitative framework design and conducted semi-structured interviews with twenty members of the support group who were purposely selected due to the specific nature of the target population. Collected data was manually transcribed, while thematic analysis was used to analyze the interview data. The results showed that the majority of participants in the support group had disclosed their HIV status to their partners, and those who hadn't disclosed often confided in children or close relatives. Participants reported receiving strong support from their confidantes after disclosure. Participants believed that effective treatment adherence is crucial for achieving viral suppression, and a significant majority believed that disclosing their HIV status helped them achieve viral suppression. Most participants had positive experiences disclosing their status to partners, with nearly all reporting supportive partners. Only a small minority reported negative impacts on their sexual life, suggesting that disclosure may not necessarily harm relationships. Based on these findings, the study concludes that there is a high level of disclosure among support group members, and participants with good adherence were more likely to have disclosed their status. Disclosure was associated with achieving viral suppression, potentially due to the support received. The study suggests that strengthening support groups through funding from local, state, and international organizations could be beneficial in encouraging disclosure and improving health outcomes for individuals living with HIV.

Non-response to ACE items is associated with demographic variables and health indicators in the 2021 Behavioral Risk Factor Surveillance System

BackgroundAdverse childhood experiences (ACE) encompass traumatic events occurring before age 18, with lasting impacts on health. While ACE disclosure is important for understanding these effects, some individuals decline to respond to ACE-related survey items due to sensitivity, privacy concerns, or psychological distress. This study explores the relationship between non-response to ACE items and health outcomes, shedding light on the implications for those who choose not to disclose. MethodsWe performed a secondary analysis of the 2021 Behavioral Risk Factor Surveillance System (BRFSS)—a national telephone survey querying health behaviors and conditions. Sociodemographic factors, ACE exposure, and non-response to ACE items were analyzed. ResultsIndividuals who decline to respond to ACE items exhibit similar patterns of health behaviors and conditions as those reporting ACE exposure. Non-response is linked to both healthier behaviors (lifetime HIV testing) and riskier behaviors (higher odds of smoking and e-cigarette use). Moreover, non-responders have higher odds of being underweight or obese, experiencing concentration difficulties, reporting poor self-rated health, and reporting multiple health diagnoses including depression, diabetes, high blood pressure, heart attack, and stroke. ConclusionsThe study underscores the need to address health disparities associated with ACE, regardless of disclosure status. Healthcare interventions should target respondents and non-respondents of ACE screeners, tailoring strategies to promote healthier coping mechanisms and mitigate maladaptive behaviors. These results emphasize the importance of trauma-informed care, early intervention, and targeted public health initiatives for individuals affected by ACE, irrespective of their disclosure choices.

Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis.

Despite advances in HIV treatment, the burden of viral non-suppression (VNS) remains a treatment success concern, particularly in Sub-Saharan African (SSA) countries. We determined the prevalence and factors associated with VNS for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). This review, registered with PROSPERO (CRD42023470234), conducted an extensive search for evidence, focusing on PLHIV living in SSA on ART from the year 2000 to 19th October 2023, across databases including PubMed/MEDLINE, Embase, Web of Science, and Scopus. A total of 2357 articles were screened, from which 32 studies met the criteria for the final analysis, involving 756,620 PLHIV of all ages. The pooled prevalance for VNS was found to be 20.0% (95% CI: 15.43%-25.52%, I2=100%, p-value <0.01) Children and adolescents demonstrated the highest prevalence of VNS (viral load ≥1000 copies/mL) at 27.98% (95% CI: 21.91%-34.97%, I2=94%, p-value <0.01). The study revealed various factors associated with increased odds (risk) of VNS, p-value <0.05. These factors encompassed socio-demographics such as sex, age, education level, and marital status. Additionally, aspects related to HIV care, such as the facility attended, HIV status disclosure and adherence exhibited higher odds of VNS. Suboptimal ART adherence, longer duration on ART, socio-economic factors, lack of family and social support, presence of co-morbidities, advanced WHO HIV clinical stage, ART regimens, lower CD4+ count, abnormal body mass index, history of treatment interruptions, and progression of HIV illness were associated with VNS. Furthermore, behavioural/psychological factors including depression, substance use, negative perceptions towards ART, experiences of abuse, alcohol use, stigma, and certain patterns of sexual behaviour were also identified as factors for VNS. The occurrence of two VNS to every ten PLHIV on ART poses a threat to the progress made towards reaching the third 95% UNAIDS target in SSA. Additionally, these findings highlight the intricate interplay of various factors, encompassing patient characteristics, behavioural patterns, sociocultural influences, and pharmacological factors, all impacting VNS among PLHIV. Recognising its multifaceted nature, we recommend designing and implementing high impact interventions to effectively address VNS in SSA.

A Review of the Information Disclosure Status of Universities: Focusing on Case of the Ruling of the Central Administrative Appeals Commission

A Review of the Information Disclosure Status of Universities: Focusing on Case of the Ruling of the Central Administrative Appeals Commission

Level of adherence to option B+ program and associated factors among HIV-positive women in Ethiopia: A systematic review and meta-analysis.

Despite policy initiatives and strategic measures highly focused on preventing mother-to-child transmission through the implementation of the Option B+ program, adherence to the treatment is still challenging. The level of adherence and determinants of Option B+ program utilization reported by different studies were highly inconsistent in Ethiopia. Hence, this systematic review and meta-analysis aimed to estimate the pooled prevalence of adherence to the Option B+ program and its predictors among HIV-positive women in Ethiopia. PubMed, Google Scholar, EMBASE, HINAR, Scopus, and Web of Sciences were searched for published articles from March 2010 to March 2022. The pooled prevalence of adherence was estimated using a weighted DerSimonian-Laird random effect model. The I2 statistics was used to identify the degree of heterogeneity. Publication bias was also assessed using the funnel plot and Egger's regression test. A total of 15 studies were included. The pooled estimate of the option B+ program among HIV-positive women in Ethiopia was 81.58% (95% CI: 77.33-85.84). Getting social and financial support (AOR = 3.73, 95% CI: 2.12, 6.58), disclosure of HIV status to partners (AOR = 2.05, 95% CI: 1.75, 2.41), time to reach a health facility (AOR = 0.33, 95% CI: 0.16, 0.67), receiving counseling on drug side effects (AOR = 4.09, 95% CI: 2.74, 6.11), experience of drug side effects (AOR = 0.17, 95% CI: 0.08, 0.36), and knowledge (AOR = 4.73, 95% CI: 2.62, 8.51) were significantly associated with adherence to the Option B+ program. This meta-analysis showed that the level of adherence to the Option B+ program in Ethiopia is lower than the 95% level of adherence planned to be achieved in 2020. Social and financial support, disclosure of HIV status, time to reach the health facility, counseling, drug side effects, and knowledge of PMTCT were significantly associated with option B+ adherence. The findings of this meta-analysis highlight that governmental, non-governmental, and other stakeholders need to design an effective strategy to scale up the level of disclosing one's own HIV status, access health facilities, improve knowledge of PMTCT, and counsel the potential side effects of Option B+ drugs, and advocate the program to reduce the multidimensional burden of HIV/AIDS. Prospero registration: CRD42022320947. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320947.

Disclosure Events and Psychosocial Well-Being Among Young South African Adults Living with HIV.

Poor psychological well-being is both prevalent among South Africans living with HIV and has been associated with poor HIV clinical outcomes. However, the relationship between disclosure and psychological well-being remains unclear. This analysis sought to examine the relationship between two disclosure-related variables, disclosure status and reaction received, and psychosocial well-being among a sample of young adults living with HIV (YALWH) in urban South Africa. This was a secondary analysis using observational data from Standing Tall, a randomized controlled trial that recruited 100 participants ages 18-24 who tested positive for HIV after initially presenting to two well-established mobile clinics for HIV testing. Interviews investigating primary and secondary outcomes of interest were done at baseline and 6 months following recruitment. About half (51%) of participants disclosed their HIV status within 6 months after recruitment. Simple linear regression analyses revealed that disclosure of HIV status within 6 months after study enrollment predicted significantly lower levels of disclosure concerns and internalized stigma (p < 0.05). Reactions to disclosure were not significantly associated with any of the measures of psychosocial well-being considered in this analysis (p > 0.05). The results suggest that the act of disclosure among newly diagnosed YALWH may be associated with reductions in internalized stigma. In addition, the finding that the act of disclosure may be a more important determinant of psychosocial well-being than the reaction to disclosure has important implications for interventions designed to promote disclosure and psychosocial well-being in YALWH.

Attitudes toward COVID‐19 vaccination status disclosure in the provider–patient relationship: Findings from a population survey

AbstractThe coronavirus disease 2019 (COVID‐19) pandemic ignited heated discussions on social media as well as in the medical, legal, and political communities, about whether health‐care providers should have the right to refuse to see unvaccinated patients. Another discussed idea during the pandemic, though it attracted less attention, was about patients' right to learn about the vaccination status of their health‐care providers. In this paper, we examined public attitudes toward these two rights using data from a cross‐sectional survey conducted in South Dakota in the summer of 2021. We utilized registration‐based sampling to recruit participants. The survey collected data on some of the most significant variables reported in the literature that shape people's attitudes toward COVID‐19 vaccines. Specifically, participants provided information on their age, gender, educational level, household income, COVID‐19 vaccination status, stress induced by the pandemic, and political partisan identification. The health‐care providers' rights as well as the patients' rights were gauged with one item each using a five‐point Likert scale. We analyzed data from 573 respondents (Mage = 56.6 years, SD = 16.48), which showed that older participants, those with higher levels of COVID‐19‐related stress, and vaccinated individuals expressed higher support, while Republicans expressed lower support for the two policies. Gender, education, and income did not influence participants' attitudes. Although the findings might have limited generalizability to populations outside South Dakota, they offer valuable insights for developing comprehensive ethical codes where vaccination status might be at the center stage for clinician‐patient relationships in future pandemic responses.

Exploring experiences of HIV care to optimize patient-centred care in Conakry, Guinea: a qualitative study.

Studies on the organisation of care and the power dynamic between providers and patients with HIV in sub-Saharan Africa are rare. This study aims to describe the patient-provider relationship and explore the challenges to optimal and patient-centred care for HIV patients. This was a qualitative exploratory descriptive study using in-depth individual interviews and focus group discussions. In total, 17 individual interviews and 5 focus group discussions were conducted. This was conducted in four urban health facilities in Conakry, the capital of Guinea. Three group of participants were included in this study namely patients with HIV; health providers including facilities and services managers; and psychosocial counsellors. Psychosocial counsellors provide emotional and psychosocial support to HIV patients. Their role in the organization care in Guinea is new and they contribute to strengthening adherence of patients with HIV to ARV treatment. Patients with HIV, health providers, and psychosocial counsellors have a positive perception of the patient-provider relationship. This relationship was characterized essentially by maintaining confidentiality of HIV status disclosure, caring attitudes towards patients (being available, adjusting locations for accessing ART, based on patients' preferences), and participating in HIV patient's social life. However, scolding and miscommunication about the interpretation of viral load tests were reported. The shortage of human resources, low salaries of health staff, poor infrastructure, and the financial burden borne by patients with HIV impede the implementation of optimal patient-centred care. Integrating psychosocial counsellors in HIV care organization, improving access to ARV, infrastructure, increasing human resources, and removing the financial burden for HIV patients are needed to optimal patient-centred care in Guinea.

Inadvertent Disclosure of HIV Status to Adolescents Living with HIV and Subsequent Impact on Medico-Social Wellbeing in Kaduna, Nigeria

Background: Inadvertent disclosure of HIV status poses significant challenges for adolescents living with HIV, particularly in settings where stigma and discrimination are prevalent. Objective: This research seeks to delve into the prevalence and ramifications of accidental disclosures of HIV status among adolescents frequenting a Youth Friendly Clinic (YFC) at a major hospital in Kaduna, Nigeria. It further aims to uncover the medical and social repercussions following such incidents. Methods: Employing a comprehensive mixed-methods strategy, this study combined quantitative and qualitative analyses. Initially, a survey was conducted among 217 adolescents aged between 10 and 19 years, who were patients at the YFC of a tertiary care facility. This survey gathered information on demographic factors, experiences related to the disclosure of HIV status, and the effects of accidental disclosures on emotional health and the consistency of antiretroviral treatment adherence. Subsequently, the study engaged in qualitative research through detailed interviews and group discussions with 85 adolescents who had unintentionally disclosed their HIV status. This allowed for an exploration of the experiences surrounding these disclosures, the coping strategies adopted, and their perceptions of available support. Ethical clearance was secured to ensure the confidentiality and integrity of the research process. Results: The initial analysis revealed that a significant portion (39.2%) of the adolescent participants had inadvertently disclosed their HIV status, mostly by overhearing conversations (56%) and through discussions with peers at the clinic (17%). The qualitative exploration identified key themes such as heightened experiences of stigma and discrimination, difficulties in securing social support, and detrimental effects on mental health. Following these unintended disclosures, adolescents reported feelings of social isolation, changed perceptions by family members, and battles with depression and anxiety. The findings highlight the intricate relationship between accidental disclosure and its social and medical impacts, emphasizing the necessity for bespoke interventions aimed at addressing the needs of this at-risk demographic. Conclusion: The confidentiality of adolescent patients must be a top priority for healthcare professionals, alongside the development of preventative measures against accidental disclosures and the provision of comprehensive support services to counteract the adverse outcomes. By enhancing privacy protection and offering individualized support, it is feasible to mitigate the negative effects associated with unintended disclosures, including stigma and mental health challenges. This investigation enriches our comprehension of accidental HIV status disclosure among adolescents and accentuates the critical need for creating interventions that improve their overall well- being and social inclusion.

간호리더십 함양을 위한 학습성과 평가체계 연구

Purpose : This study aims to develop an evaluation system for assessing the learning outcomes and achievements of leadership development programs intended for personal and professional growth. Method : The research involved measuring the leadership qualities of nursing students, nursing educators, and clinical nurses through surveys, analyzing their general characteristics and nursing leadership scores. Additionally, a comparative analysis of existing leadership-related evaluation systems from 18 universities was conducted. The development of the leadership learning outcome evaluation system followed the procedures outlined in the evaluation system development. Results : The priorities of nursing leadership demands were different among nursing students, nursing educators, and clinical nurses. Nursing students identified major professional competence (4.43 points) as most crucial, while nursing educators and clinical nurses emphasized that communication skills (4.77 points, 4.82 points) were the most important. The analysis of existing leadership evaluation systems revealed a variety of components, including structure and criteria, performance standards, and achievement levels, performance levels, goal attainment, related courses and extracurricular activities, evaluation (timing, methods, tools, stakeholders, etc.), results analysis (stakeholders, disclosure status, disclosure methods, etc.), and improvements (evaluation and improvement timing). Conclusion : The program learning outcome evaluation system should undergo continuous improvement through regular analysis and feedback. This process will enhance the leadership skills of prospective nurses, enabling them to adapt to the evolving nursing and healthcare environment.

Disclosure Status and Associated Factors among Caregivers of Children on Antiretroviral Therapy in Addis Abeba, Ethiopia: Hospital Based Cross Sectional Study Design

Disclosure Status and Associated Factors among Caregivers of Children on Antiretroviral Therapy in Addis Abeba, Ethiopia: Hospital Based Cross Sectional Study Design

“What if I got rejected by the girl? I would rather stop the pills”: barriers and facilitators of adherence to antiretroviral therapy for emerging adults aged 18–29 living with HIV in Zimbabwe

ABSTRACT Emerging adults aged 18–29 have high rates of viral non-suppression, and poorer adherence to ART when compared to older adults. Semi-structured interviews were conducted with 24 emerging adults in Zimbabwe who had a recent history of viral non-suppression, to explore barriers and facilitators of adherence to ART. Interviews were coded using inductive thematic analysis. The mean age of participants was 23, 65% were male, and 79% reported acquiring HIV at birth. Twelve barriers to adherence were identified. Hiding HIV status due to the possible negative consequences of disclosure had a significant impact on adherence to ART. This was particularly important for emerging adults navigating starting intimate relationships. Being away from home, poverty, poor mental health, isolation, significant life events, alcohol, health systems barriers, and stigma were reported as barriers to adherence. Support from peers and family after disclosure of HIV status, phone-based reminders, problem-solving strategies to adhere, knowing others living with HIV, acted as facilitators to adherence to ART. Beliefs about medicines and relationships with health care providers acted as both barriers and facilitators to adherence. Interventions to reduce stigma, foster peer support, and therapy for common mental disorders could facilitate emerging adults aged 18–29 to adhere to ART.

Self-employed workers with chronic health conditions: A qualitative study.

Chronic health conditions affect many individuals of working age, who cope with physical, psychological, and social difficulties that often involve limited work ability. This qualitative study explored experiences of self-employed individuals with chronic health conditions to advance our understanding of the effect of chronic illness on work. In-depth semi-structured interviews were conducted with 23 self-employed individuals coping with cancer, heart disease, inflammatory bowel disease, lung disease, or asthma. Data were analyzed with thematic analysis. Analysis of the interviews revealed four themes: uncertainty in planning work and committing to customers, acceptance versus denial of reduced work abilities, disclosure of health status to workers and customers, and temporal substitutes as a source of both support and concern. The results indicate that self-employed workers with a chronic health condition cope with unique challenges due to the need to sustain their business in the face of illness and a sense of sole responsibility.

A qualitative analysis of self-management needs of adolescents and young adults living with perinatally acquired HIV in rural, southwestern Uganda.

The number of adolescents living with HIV remains high in sub-Saharan Africa with poorer HIV treatment outcomes among adolescents and young adults compared to individuals in other age groups. For adolescents and young adults living with perinatally acquired HIV (AYLPHIV), the transition from pediatric to adult HIV care is a particularly high-risk period. We conducted a qualitative study to understand self-management needs of AYLPHIV in rural, southwestern Uganda as they prepare to transition to adult HIV care in order to inform relevant interventions that can enable AYLPHIV acquire the necessary skills to manage their illness as they age into adulthood. We conducted 60 in-depth interviews with AYLPHIV (n = 30), caregivers (n = 20) and health care providers (n = 10) from the HIV clinic at Mbarara Regional Referral Hospital. We used an interview guide that focused on perceptions about transition to adult HIV care, challenges with transitioning, navigating HIV care, and self-management needs for AYLPHIV (from the perspectives of AYLPHIV, their caregivers, and health care providers). We used thematic analysis to identify themes related to AYLPHIV's self-management skills. We identified several self-management needs that we grouped under two major themes; social support and empowerment for AYLPHIV to assume responsibility for their own health and to navigate adult HIV care independently. The sub-themes under social support were information support, instrumental support, and emotional support as the sub themes while sub-themes under empowerment included self-advocacy skills, interpersonal skills, self-care skills, and disclosure skills. Taken together, these findings indicate that AYLPHIV need to be supported and empowered to maximize their chances of successfully transitioning to adult HIV care. Support comes from peers and caregivers. AYLPHIV require knowledge about their HIV status and empowerment with different skills including: self-advocacy skills, interpersonal skills, self-care skills, and HIV status disclosure skills, in order to assume responsibilities related to independent HIV care.