Friday, 14 January 2005 - 8:00 AM

This presentation is part of: HIV Prevention and Treatment

Lessons learned from African American women about participation in a family-based HIV prevention program

Objective: To explore the influences of three ecological domains on participation in an NIMH-funded family-based HIV prevention program – the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP) – designed to bolster key aspects of family life, such as communication, and to enhance problem solving and refusal skills.

Methods: This study examined qualitative baseline data from a cohort of 92 women. Mean age was 33.3 years (SD = 7.7), most were unmarried (73%), and 74% received public assistance. A framework of service utilization advancing that participation is influenced by these ecological domains – individual, program, social network – was used. The phrasing, level of language and style of open-ended questions were sensitive to the sample. Questions included, “What motivates you to participate,” “Can African-Americans be treated fairly by white people,” “Did you have any concerns about participating.” The text of answers was analyzed by two independent coders who identified major themes and subthemes. Following standard procedure for content analysis, coders identified specific text that fit within the theoretical domains of influences. In order to provide an indication of theme salience, we calculated frequency of occurrence for each influence. Moreover, we examined lower occurrence themes aiming to identify infrequent influences with potential large attendance implications.

Results: Raw percents were used to report the level of agreement, as coders independently categorized statements in the text of answers as indicating influences on participation. Reliability was high for each influence, 0.84 to 1.0. At the individual domain, development of personal and social skills afforded by the program, and the perception that program staff is fair toward racial minorities appear to influence participation ( “The program helped me with my attitude because I had a bad attitude and a temper;” “I know some white people are real nice and they treat you the way you treat them”). At the program domain, program characteristics, such as friendliness and monetary incentive also influence participation (“I started to participate because the classes were fun;” “I like the staff, they were pretty nice;” “First I came for the money but then as I continued to attend”). At the network domain, social influence and emotional support fostered by the program also appear to influence participation. (“My daughter wanted me to participate in it;” “ You sit down and get to talk to people about different issues”).

Conclusion: This study identified several important modifiable factors that could contribute to increasing participation of multi-session HIV prevention programs targeting low-income minority women. Although programs clearly are unable to change the background characteristics or current social networks of clients, training staff to confront racism and to develop a warm, friendly environment has the potential to increase participation among clients at most risk for HIV exposure. Moreover, the influences found can be used guide both the selection of quantitative variables for statistical models of participation, and the development of instruments for measuring participation.

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