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Ph d proposal_seminar_apurva_pandya 21aug2010
 

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PhD Proposal Seminar in the Department of Human Development and Family Studies, M S University of Baroda. I presented PhD Seminar in front of PhD Committee, post graduate student, and research ...

PhD Proposal Seminar in the Department of Human Development and Family Studies, M S University of Baroda. I presented PhD Seminar in front of PhD Committee, post graduate student, and research scholars. However, after interaction with various experts in USA, I have changed my methodology of my PhD research. To see revised PhD proposal check another presentation: PhD_Proposal Seminar_Revised_

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  • Move the conceptual framework slide before the objectives (that is, after the rationale).
  • Check the spelling of counselors. Keep it single l at all places. Need to state the main domains in the survey. Keep the draft questionnaire with you in case of need.
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Ph d proposal_seminar_apurva_pandya 21aug2010 Ph d proposal_seminar_apurva_pandya 21aug2010 Presentation Transcript

  • HIV Counseling Practices: Experiences and Perspectives of Counselors Working with Targeted Interventions in Gujarat PhD Research ProposalApurva Pandya, MA Shagufa Kapadia,PhD Researcher ResearchGuide Department of Human Development and Family Studies Faculty of Family and Community Sciences, M S University of Baroda, Vadodara 21 August 2010 1
  • A GLOBAL VIEW OF HIV INFECTION 33 million people [30–36 million] living with HIV, 2007 Number of people living with HIV 33.2 Million Young people aged 15–24 living with HIV 5.4 million Children below 15 years living with HIV 2.5 Million 2
  • GLOBAL SCENARIO Everyday 6800 people get HIV infection. 96% are belong to poor and middle income countries. 5600 are adult,1200 are children and out of which 50% are women and 40% are young (15-24 years of age). Negative impact on life ( life expectancy, orphans, economic crisis, stigma and discrimination). 3
  • TYPES OF HIV/AIDS EPIDEMICNASCENT EPIDEMIC An HIV epidemic in a country in which less than 5% of individuals in high-risk groups are infected.CONCENTRATED EPIDEMIC An HIV epidemic in a country in which 5% or more of individuals in high-risk groups, but less than 5% of women attending urban ante-natal clinics are infected.GENERALISED EPIDEMIC An HIV epidemic in a country where more than 5% of individuals in high-risk groups as well as women attending urban ante-natal clinics are infected.(World Bank, 1997, 87) It is easier to control a nascent epidemic than a generalised one. 4
  • HIV/AIDS: INDIAN SCENARIO 120000 104087 100000 80000 Number of AIDS cases 56615 60000 40000 12193 20000 8890 0 0-14 years 15-29 years 30-49 years >49 years Age Group Total 1,81,785 people are living with HIV (June,2007). Out of them, 31.2 are women. 5
  • HIV PREVALANCE IN DIFFERENT GROUPS 8.00 IDU, 6.95 7.00 MSM, 6.48 6.00 FSW, 4.9 5.00 4.00 STD, 3.74 3.00onPeyvcsrti 2.00 1.00 ANC, 0.6 0.00 6
  • HIV PREVALANCE IN GUJARAT AND INDIA 7
  • Mode of Transmission of HIV In India 8
  • GLOBAL EFFORTS IN PREVENTION AND CONTROL OF HIV/AIDSPhase-1 Phase 2: Phase3:Up to mid 1990s Mid 1990s to 2000 2000 to dateCharacterised by Health Characterised by Period of paradigmBelief Model [a medical Primary Behaviour ‘shift’, recognition thatproblem] Change (informed by social, community and Health Belief Model and structural factors areMedically and various behaviour important, butepidemiologically driven. change theories and biomedical andEducation and knowledgeare regarded as ‘the key to models) [a behavioural behavioural approacheseffective prevention’ problem] still dominant [a(UNESCO, 2005, 6) development issue]. 9
  • Biomedical and Health BeliefResponse to HIV/AIDS epidemics 10
  • But infections continued to rise… questions asked… Appropriateness for sexual behaviour A Western approach Onus on the individual No understanding of the risk taking environment 11
  • GLOBAL EFFORTS IN PREVENTION AND CONTROL OF HIV/AIDSPhase-1 Phase 2: Phase3:Up to mid 1990s Mid 1990s to 2000 2000 to dateCharacterised by Health Characterised by Period of paradigmBelief Model [a medical Primary Behaviour ‘shift’, recognition thatproblem] Change (informed by social, community and Health Belief Model and structural factors areMedically and various behaviour important, butepidemiologically driven. change theories and biomedical andEducation and knowledgeare regarded as ‘the key to models) [a behavioural behavioural approacheseffective prevention’ problem] still dominant [a(UNESCO, 2005, 6) UN agencies development issue]. combined forces Multi-sectoral approach (SIPPA, 2005, 11) ABC 12 12
  • Sexual Behaviour and BiomedicalDeterminants and Responses to HIV/AIDS 13
  • Health Belief Model and PrimaryBehaviour Change Responses to HIV/AIDS 14
  • But infections continued to rise… questions asked… Why are people still continuing to take risks? Research showing that individual agency is constrained by social, economic and structural factors, such as poverty, mobility and migration patterns and gender inequality (Parker, 2000). 15
  • GLOBAL EFFORTS IN PREVENTION AND CONTROL OF HIV/AIDSPhase-1 Phase 2: Phase3:Up to mid 1990s Mid 1990s to 2000 2000 to dateCharacterised by Health Characterised by Period of paradigmBelief Model [a medical Primary Behaviour ‘shift’, recognition thatproblem] Change (informed by social, community and Health Belief Model and structural factors areMedically and various behaviour important, butepidemiologically driven. change theories and biomedical andEducation and knowledgeare regarded as ‘the key to models) [a behavioural behavioural approacheseffective prevention’ problem] still dominant [a(UNESCO, 2005, 6) UN agencies development issue]. combined forces Tackling HIV/AIDS Multi-sectoral becomes a approach (SIPPA, Millennium 2005, 11) ABC Development Goal 16 16
  • THE WIDER PICTURE OF THE FACTORSTHAT FACILITATE HIV TRANSMISSION 17
  • SOME ISSUES Less number people who need ARV, receiving ARV. Patient compliance -especially in deprived communities. Fears of drug resistance and strains of development of viral load. Focus diverted to care and treatment - Prevention need is ignored. Infection and death from HIV and AIDS continue to rise. Despite knowledge risky sexual behaviour 18
  • PARADIGM SHIFT AIDS is a ‘behavioural problem with behavioural solutions.’ (Green, 2003).Questioned by Farmer. ‘AIDS is also surely, a social problem with social solutions.’ (Farmer, 2003). 19
  • “AIDS is rooted in problems of poverty, food and livelihood insecurity, socio-cultural inequalities and poor support services and infrastructure.” ( Hemrich & Topouzis, 2000).‘...there is a need to focus on the psycho-social and community leveldeterminants of sexuality. We need to pay attention to the social changethat needs to take place to support the likelihood of healthier sexualbehaviour. Sexual behaviour, and the possibility of sexual behaviouralchange, are determined by an interlocking series of multi-level processes,ranging from the intra-psychological to the macro-social.’ (Campbell , 2003.p. 183) 20
  • CHALLENGES IN HIV PREVENTION The HIV/AIDS epidemic is hidden, often concentrated among already marginalized groups. [female sex workers (FSW), Injecting Drug Users (IDUs) and spouses of Men who have Sex with Men (MSM)]. Number of people are testing for HIV. HIV/AIDS related stigma. Programmes that exist are based on clinical services reaching out to a limited number of those in need. The programmes pay little attention to the psycho-social needs of the high risk groups (HRGs). 21
  • Behaviour change is the key !Hence counseling remains significant aspect of HIVprevention, care, support and treatment. AIDS responses have grown and improved considerably over the past decade. But they still do not match the scale or the pace of a steadily worsening epidemic.’ (UNAIDS, 2005,5) ‘…the AIDS epidemic continues to outstrip global efforts to contain it.’ (UNAIDS, 2005,6‘…responses to the epidemic came too late and were not commensurate to the magnitude and urgency of the challenge.’ (UNESCO, 2005, 5) 22
  • CURRENT NEED People need knowledge to enable them to be able to make choices about their life styles. But this alone cannot guarantee behavioural change. There are many intervening factors that prevent individuals adopting safer behaviour. 23
  • BEHAVIOUR CHANGE THEORIES AND MODELS1. INDIVIDUAL FOCUSED THEORIESHealth belief modelSocial learning theory 2. SOCIAL THEORIES AND MODELSTheory of reasoned action Diffusion of innovation theoryStages of change model  Social influence or social inoculation modelAIDS risk reduction model Social Network theory Theory of gender and power3. STRUCTURAL ANDENVIRONMENTALTHEORIES AND MODELS 4. CONSTRUCTS ALONE ANDTheory for individual and social change TRANSTHEORETICALor empowerment modelSocial ecological model for health MODELSpromotion Perception of risk controlSocio economic factors Sexual communication 24
  • RATIONALE OF THE STUDY HIV is the virus which can be prevented from transmission through change in behaviour. Change in knowledge about STI/HIV and risky sexual behavior is the way to prevent HIV transmission among High Risk Groups (HRGs). The programmes pay little attention to the psycho-social needs of the high risk groups (HRGs). Many theories of behaviour change exist but none is depicting counselors’ experiences and explore counselors’ perspectives. Indigenous counseling practices are not known in Indian context. 25
  • OBJECTIVES OF THE STUDY Main Objective The intent of this research is to examine personal experiences of counselors’, and juxtapose them with their preferred counseling theories to evolve a culturally appropriate theory or model of HIV counseling. Specific Objectivesn Study existing counselling practices of counselors working with Targeted Intervention projects supported by National AIDS Control Organization (NACO), Ministry of Health and Family Welfare, Government of India.n Examine counselors’ ways of relating psychological concepts and theories to everyday counseling practice.n Explore counselor’s perspectives on HIV current counseling practice.n Explore challenges faced by counselors in everyday counseling practice.n Explore innovative HIV counseling skills and techniques being used by the counselors.n Explore counselors’ reflective journey of counseling practice and their personal counseling approaches. 26
  • RESEARCH QUESTIONSTotal 16 questions 9 questions address quantitative aspects and 7 questions deal with qualitative aspectsNOTE: Questions are given in the handout. 27
  • Existing major behaviour change models/theories for Orientation training on Targeted Intervention HIV prevention project and Counselling provided by State Training Resource Centre (STRC) Knowledge of counselling approaches, theories skills and techniques Knowledge of High Risk Groups and sensitivity Knowledge of toward their issues Knowledge of Targeted Counselling and Intervention project and behaviour change theories HIV issues Process of counselling Counselors’ cultural reference Reflections of knowledge in actual counselling practice Innovative use ofPersonalized counselling knowledge of targetedstyle and practicing Intervention and HIVindigenous counseling Innovative use ofapproaches/ strategies counseling skills Challenges faced in and techniques application of counselling Working model/theory of HIV principles and theories Counselling CONCEPTUAL MODELOF THE STUDY 28
  • RESARCH DESIGNA Mixed Method Model III (Smith, 1997) with sequentialexploratory design (Creswell,2003) is ideal for this proposedresearch. QUANTI QUALI The study will use the grounded theory-GT (Strauss &Corbin, 1990) approach, which has emerged as one of themost popular and rigorous methods of deriving theoriesfrom qualitative data. 29
  • OVERVIEW OF RESEARCH DESIGN AND METHODS Research Phase Objectives Tools Sample Groups Questions 1 RQ-1 - RQ-9 Assess knowledge in three Structured Survey Instrument All counselors workingQuantitative domains, relationship with with Targeted knowledge, cultural Intervention projects in Gujarat (approx. 87) sensitivity and counseling practice. Assess gender differences in knowledge , cultural sensitivity and counseling practice. Obj.-1 Overview 2 RQ-10 - RQ 16 Application of knowledge, Telephone In-depth Interviews 30 counselors workingQualitative skills and techniques in with Targeted practice, challenges, Intervention projects in Gujarat. indigenous practices. [Objectives-1, 2, 4,5,6 ] 3 RQ-16 Counselors’ perspectives Focus Group Interviews 22 counselorsQualitative on current HIV counseling through Satellite (11 men counselors + 11 practice and context Communication Technology, women counselors) BISAG, Department of Information Communication and Technology, Govt. of [Objective-3] Gujarat, Gandhinagar. 4 RQ-14 - RQ 15 Counselor client- Naturalist observation of 5 counselors (oneQualitative interaction, clients’ counselling sessions counselor from each TI response to counseling project typology i.e. MSM, FSW, IDU,
  • UNIVERSECounselors working with Targeted Interventions in the Gujarat stateDATA COLLECTION TOOLSIn this study, survey instrument, in-depth interview, Focus Group Interview andnaturalistic observation will be used to gather data.STUDY SITEGujaratSAMPLE SIZEAll counsellors (87) working with NGOs implementing Targeted Interventionprojects willing to participate in the study will be selected for the survey.Sample size determination for the in-depth interview will be dependent onsaturation of themes. Approximately 30 participants will be selected for the in-depth interview.Up to 11 men and women counsellors will be requested to participate in satellitebased Focus Group Interview (FGI). Determination of no. of FGI will be basedon saturation of themes. 31
  • ETHICAL CONSIDERATIONS Informed consent in written- counselors and clients (in case of naturalistic observation) Voluntary participation. Any form of moral, physical or emotional harm . Adequate training on ethics in social science research and research methodology from- Tata Institute of Social Sciences, Mumbai; Mailman School of Public Health, Columbia University, New York Harvard University, Boston and Centre for Disease Control (CDC), Atlanta. Prior approval from Gujarat State AIDS Control Society, Department of Health and Family Welfare, Government32
  • PLAN OF ANALYSISANALYSIS OBJECTIVESQuantitative analysis using SPSS Find correlation between knowledge, cultural sensitivity, andCorrelation test; counseling skillsT test Gender difference in knowledge and counselling skills and techniquesQualitative analysis using Maxqda® Explore emerging themes around following concepts andor ATLAS- Ti new themes. •Indigenous counseling skills, techniques and strategies •Ways counselor relate psychological concepts •Reflections on everyday counseling practice Evolve culture specific counseling theory or modelA grounded theory based analytic approach will be used. The conceptual framework proposed inthis study will provide an initial list of themes, while allowing for new themes to emerge fromthe data. 33
  • ANALYTICAL ISSUES AND THEIR RESOLUTION No tested and validated scale to measure counselors’ knowledge and counseling practice in Indian context for HIV counselling investigator intends to develop survey instrument. Self-reported and explanatory survey responses incomplete information will be sought from the participant. Non-generalizability of the results focuses on personal experiences and existing counseling, not generalizations. Mixed method study with prime focus on qualitative approach thus reliability and validity of the study will be challenging Multiple methods: methodological triangulation and theory triangulation, Denzin, 1984 will be used. Thick description (Denzin & Lincoln, 1994) External audit (Emerson & Pollner, 2002; Miles & Huberman, 1994, pp.275-77) by experts from India and USA will be done. Member checks (Emerson & Pollner, 2002; Miles & Huberman, 1994, pp.275-77). 34
  • EXPECTED OUTCOME Inform culturally appropriate HIV counseling theory or model to National AIDS Control Programme Phase III of National AIDS Control Organization (NACO). Facilitate policy development on HIV counseling to support decision- making to improve the quality of HIV counselors’ training and counseling practices. Contribute to the development of counselors’ training modules, counseling tool kit and counseling best practices specific to Targeted Intervention programme of the Gujarat state. Facilitate development of culturally appropriate counseling theory or model for the country to guide Targeted Intervention programme. 35
  • REFERENCES Bogdan, R. & Biklen, R.C. (1992). Qualitative research for education: An introduction to theory and methods. Boston: Allyn-Bacon. Byrne, M. (2001). Grounded theory as a qualitative research methodology. AORN Journal, 73 (6), 1155-1156. Centers for Disease Control and Prevention. (1997). Perspectives in disease prevention and health promotion: Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. Morb Mortal Wkly Rep 1987; 36:509–15.[Medline] Denzin, N.K. & Lincoln, Y.S. (1994). Handbook of qualitative research. Thousand Oaks, CA: Sage. Emerson, R. M. & Pollner, M. (1988). On the use of member’s responses to research account. Human Organization, 47, 189-198 Lincoln, Y. & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage. Maxwell, J.A. (1996). Qualitative research design: An interactive approach. Thousand Oaks, CA: Sage. Miles, M.B. & Huberman, A.M. (1994). Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage. National AIDS Control Organization (2009). 2009-10 Annual Report. Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi. Strauss, A. and Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications. 36
  • THANK YOU VERY MUCH!! 37