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The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) affects all populations, regardless of race, education, or socioeconomic status, but Black women experience higher rates of IPV (43.7%) in comparison with White women (34.6%). Although evidence indicates that faith-based organizations and clergy play key roles in preventing and responding to IPV among Black women, limited research has been conducted in this area, and existing studies have focused on Black male clergy leaders' response to IPV. Using transcendental phenomenology, we interviewed 12 Black female clergy regarding their role as responders to IPV among Black women in their congregation. Each clergy leader participated in a face-to-face interview. Data analysis followed the modified Van Kaam seven-step process. One overarching theme emerged— We Are Our Sister's Keeper, as well as three primary themes: Support Advocate, Spiritual Advisor, and Roadblocked Leader. The themes indicated that Black female clergy respond to the emotional and spiritual needs of Black women despite barriers (e.g., few outside resources, limited support from the Black church). The themes also suggested that clergy lack knowledge and training for responding to IPV. However, Black female clergy are passionate about providing holistic, culturally centered care by bridging the gap between the church and the community to better serve Black women who have experienced IPV. Findings support the importance of incorporating spiritual and emotional healing among this population when providing care and services. Further research is needed to develop interventions, such as a faith-based toolkit that incorporates community resources and guidance to better support Black female clergy leaders' ability to respond to IPV. [ABSTRACT FROM AUTHOR]

Black men who have sex with men (MSM) have a 1 in 2 lifetime risk of acquiring HIV infection; yet are underrepresented in biomedical HIV prevention behaviors. In-depth interviews were conducted with Midwestern Black MSM (n = 12) taking PrEP for more than one year. A strength of this study was that it utilized qualitative methodology, which allows the revelation of perceptions that researchers cannot predict a priori. Black MSM in this study were educated and privately insured; even so, an overarching theme that emerged was that obtaining PrEP was a "long, hard road." Facilitators to PrEP access included having an important person, insight into stigma, wariness of sexual partners, and desire to be a part of something greater than oneself. Findings have important implications for research and clinical practice. Strategies that decrease healthcare system barriers and simplify PrEP access are urgently needed for MSM at risk for HIV acquisition. [ABSTRACT FROM AUTHOR]

This study aimed to identify patterns of barriers to help inform adherence interventions for the most at-risk people living with HIV. Ethnographic data from two peer-led HIV medication adherence intervention studies (N = 35) were analyzed. Trained Peer Interventionists met with intervention participants for six weeks and wrote semi-structured field notes about participants' adherence experiences. The most common challenges were physical illness (HIV and non-HIV related), mental health, isolation, poverty, homelessness, substance abuse, and hunger or poor diet. Successful interventions necessitate connections to various multileveled services that address trauma and multiple challenges and are preferably available in one location. [ABSTRACT FROM AUTHOR]

This qualitative study examined the role of experienced HIV-infected lay individuals who work in HIV medical care settings as educators. Participants in this study had been in the role an average of 4 years, and referred to their work as 'peering,' a newly coined verb in the vein of nursing. An overarching theme was that the title 'peer educator' captured neither the scope of their work, nor the skill set they contribute to patient care. Peers brought unique contributions to the HIV care team that were vital to encouraging patients to stay engaged in care. Peers felt undervalued and expressed the wish to be 'professionalized.' Results from this study suggest that peers show promise as behavior change agents who can model healthful behaviors, particularly for newly diagnosed patients or those struggling with engagement in HIV care and adherence to treatment. However, peers need and want more formal training in behavior change science, and peer-led services must become more uniform and readily available to patients across HIV care settings. Research is needed to document the positive impact that peers can have on HIV-related health outcomes and to increased knowledge about the attributes of successful peers. [ABSTRACT FROM AUTHOR]