Community-engaged approaches were used to recruit 18 transgender women living with HIV in Indiana for a research study. The recruitment process took 21 months and involved partnering with community organizations, advisory boards, and community leaders. Most participants were referred by recruitment sites and community advisory board members, highlighting the importance of community engagement. The study found that relationship-building, giving back to the community, and addressing issues of importance to transgender women were key to overcoming barriers to research participation.
A presentation by Arlene Hackbarth, LCPC about empowering homeless veterans presented at the 2018 National Coalition of Homeless Veterans’ Annual Conference in Washington, D.C.
When serving homeless veterans, a one-size-fits-all approach doesn’t work. Effective organizations adapt their programs
over time to meet the needs of the veterans they serve. This session focused on the innovative approaches of two organizations: The Leg Up Program and Baltimore Station. The Leg Up Program changed from being a provider of qualitative life skills to providing quantitative employment and housing readiness using a success coaching model. Baltimore Station transformed its organizational culture from hierarchical to a partnership, with a focus on daily interactions and alternative treatments modalities.
Annual Report for Runaway and Homeless Youth Organization The National Runawa...National Runaway Safeline
Annual report containing statistics and financial information on activities performed by runaway and homeless youth crisis call center the National Runaway Safeline.
Part of a training program aimed at encouraging faculty, staff and students at Fanshawe College to become "Positive Space" allies for GLBTTQQ students. If you wish to have this workshop presented in your classroom or department, contact Candice in the Counselling and Student Life Department, F2010, Fanshawe College.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
Slides presented May 11, 2011 at the live webinar titled Elder Abuse, Neglect and Exploitation and presented by Dr. Paula Kupstas and Lisa Furr (discussion moderated by Dr. Ayn Welleford) - view the full recording at www.alzpossible.org
A presentation by Arlene Hackbarth, LCPC about empowering homeless veterans presented at the 2018 National Coalition of Homeless Veterans’ Annual Conference in Washington, D.C.
When serving homeless veterans, a one-size-fits-all approach doesn’t work. Effective organizations adapt their programs
over time to meet the needs of the veterans they serve. This session focused on the innovative approaches of two organizations: The Leg Up Program and Baltimore Station. The Leg Up Program changed from being a provider of qualitative life skills to providing quantitative employment and housing readiness using a success coaching model. Baltimore Station transformed its organizational culture from hierarchical to a partnership, with a focus on daily interactions and alternative treatments modalities.
Annual Report for Runaway and Homeless Youth Organization The National Runawa...National Runaway Safeline
Annual report containing statistics and financial information on activities performed by runaway and homeless youth crisis call center the National Runaway Safeline.
Part of a training program aimed at encouraging faculty, staff and students at Fanshawe College to become "Positive Space" allies for GLBTTQQ students. If you wish to have this workshop presented in your classroom or department, contact Candice in the Counselling and Student Life Department, F2010, Fanshawe College.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
Slides presented May 11, 2011 at the live webinar titled Elder Abuse, Neglect and Exploitation and presented by Dr. Paula Kupstas and Lisa Furr (discussion moderated by Dr. Ayn Welleford) - view the full recording at www.alzpossible.org
Summary of findings from qualitative study that examined circumstances prompting HIV testing among trans women in Indiana. This presentation was delivered at the Association of Nurses in AIDS Care Conference in Atlanta, GA in November 2016. The paper, HIV testing and entry to care among trans women in Indiana was published in the Journal of the Association of Nurses in AIDS Care: http://dx.doi.org/10.1016/j.jana.2017.05.003
Here is the methodology and results of the 2013 Youth Count! conducted in Billings, Montana. This was the first ever survey of homeless youth in this community.
The Canadian Cancer Survivor Network (CCSN) conducted a survey in April 2013 the discover the impact that being involved in volunteer advocacy and/or the development of public policy has on cancer patients, survivors, caregivers and family members. 51 people completed the survey. Findings were that patient advocacy generally has a positive impact on the self-image of those doing it, that many volunteer advocates felt better, prouder, more useful, more hopeful, more effective and more powerful. Still others felt less angry, less anxious, and less sad. But some survey respondents did feel sadder, angrier, less hopeful and less content. CCSN recommends that organizations ensure that cancer patients involved in advocacy activities receive skills to help them and support to deal with the often slow-moving and sometimes frustrating healthcare, cancer care and government systems in Canada.
Technology Use in Peer Education for HIV PreventionYTH
Join us for a discussion on how peer education can incorporate technology to engage youth and how the perspective of youth can be used to create state and federal policies. We will highlight two programs. One is a peer education program that uses social media to bring voice and perspective of youth into the conversation about addressing HIV. The other is an advocacy organization focused on making sure the needs of women living with and affected by HIV are addressed in the national response to HIV.
Webinar: What Did I Miss? The Hidden Costs of Depriortizing Diversity in User...Mad*Pow
Characteristics like race, ethnicity, gender, and disability status can have a significant impact on how we experience the world, and how the world experiences us. In UX research, diversity is the first thing to vanish from the recruit when the going gets tough; Megan will talk about what we miss when that happens, and what researchers can do about it in their own practice. This presentation will demonstrate why a diverse recruit is imperative for a strong user research study, provide examples of what we miss when the recruit is homogeneous, and offering tactics for addressing the issue.
Presented by Megan Campos, Experience Research Director, Mad*Pow
Watch the presentation at https://youtu.be/E41q8Nx67Do
This is an older, though slighlty updated, presentation that we gave to a group defining the "careguider" and showing how important "she" is in healthcare buying decisions.
HIV Prevention And Health Service Needs Of The Transgender Community In San F...Santé des trans
HIV Prevention and Health Service Needs of the Transgender Community in San Francisco by Kristen Clements, MPH, Willy Wilkinson, Kerrily Kitano, Rani Marx.
Il s'agit de l'un des articles parus dans le numéro spécial de l'International Journal of Transgenderism consacré en 1999 à "Transgenders and HIV : risks, prevention and care" (référence : IJT Volume 3, Number 1+2, January - June 1999).
Time to TRANSform: Creating Transfriendly Spaces & PlacesDana D. Hines, PhD
The transgender population is increasingly becoming more visible, thereby increasing the need for gender diversity and inclusion education. Staff at institutions such as universities, places of employment, and health care settings should have a basic knowledge level regarding the transgender population, the differences between gender identity and sexual orientation, and ways to make their workplace setting more transgender friendly.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Aims
• Summary challenges with recruiting marginalized populations into health
research
• Describe recruitment efforts used to engage 18 trans women living with HIV
in health research
• Outline strategies that can be employed when engaging traditionally hard to
reach populations in research
3. Organizing Lens
The Network Episode Model (NEM) was used as an organizing lens for
study
Assertions of the NEM
Social networks and health are inextricably linked
Individuals socialize with those who are most like them
Social networks are a primary source for health information
Pescosolido BA (1992).
4. Recruitment Challenges
• Researcher Level
• No personal connections to the
community of interest
• Being an “outsider”
• Establishing trust
• Lack of time to build/sustain community
partnerships
• Participant Level
• Mistrust
• Fear of being outed
• Lack of transportation to study site
• Lack of shared social
identities/experiences with research team
• Leads to:
• Slow recruitment
• Inability to achieve/attain set sample size
• Inability to carry out research aims
• Inability to create new knowledge,
interventions, so on.
• **Hard to Reach**
6. Study Details
• Setting
• Large Midwestern city in central
Indiana
• Inspiration for the study
• Community informed/inspired
• Lack of data/information
• Aims
• Describe the illness trajectories of
transgender women living with
HIV
• Eligibility
• Living with HIV, self-identify as a
transgender woman, 18+ years of
age, diagnosed with HIV within
the past five years, and had
accessed HIV-related care within
the previous 12 months.
• Methods
• Grounded theory
• Face-to-face interviews
• $25 incentive
7. Active
Recruitment
Community/
Stakeholder
engagement
Passive
Recruitment
Met with community partners
Identified champions/supporters
Guidance on recruitment approach
Established/built trust
Distributed flyers at key events
Engaged in cultural events
Face-to-face recruitment
Mailed recruitment flyers
Posted flyers at collaborating sites
Can you reach them?
If so, how?
Phase I Activities
8. Population Estimate
Community partners Number of transgender women living
with HIV served in the 12 months
prior to the pilot study
State health department 34*
County health department 32*
County infectious disease clinic 12
University hospital affiliated infectious disease clinic 10
Hospital affiliated infectious disease clinic ~5
AIDS service organization #1 17
AIDS service organization #2
Primarily serving black LGBT individuals
68**
9. If you answered yes to the questions above you may be able
to take part in a study about the experiences of seeking,
entering, and staying in HIV care. Information from this study
will increase knowledge and awareness of transgender
women’s HIV health needs and improve the HIV healthcare
experiences of transgender women.
Are you a transgender woman who is:
Living with HIV/AIDS and at least 18 years or older?
Please note that all eligible participants will be asked to take part in a one-on-one 60-90 minute
interview. Interviews will be held in private location. Your name and personal information are not
required to participate. A gift card will be given to all women who complete the interviews.
Call Dana H. RN, MSN
Indiana University School of Nursing
at (317) 759-3885 for more information
Originalstudyflyer
10. Phase I Outcomes
• Lasted three months (Aug-Nov 2012)
• Distributed 52 recruitment flyers
• 36 mailed from collaborating sites, the remainder via f2f events
• Progress slow Progress slow
• 3 participants over three months
11. Recruitment Modifications
• Established a CAB
• Revised recruitment flyers
• Broadened inclusion criteria:
• Changed criteria from diagnosed “with
HIV in last five years to “ever diagnosed
with HIV.”
• Changed from accessed in the last 12
months to “ever accessed care.”
• Increased incentive to $50
• Community engagement
12. Being there…
Indy Gay PRIDE
Indiana AIDS Walk
Talbott Street Night Club
Black PRIDE Festival
Brothers United
13. Giving back and investing time/resources
• DeCommunity input on interview guide questions
• Venue based recruitment informed by CAB
• Community input on design and distribution of research materials
(flyers, palm cards, etc.)
• Being consistent in showing my support*
• Reciprocal giving (pro-bono grant writing, QI/QA support)
• Emphasizing our shared identities
14. Board
Member
Race/Ethnicity Gender Sexual
Orientation
Affiliation/Representative
CAB
member 1
African
American
Transgender
woman
Heterosexual Program manager for AIDS service organization
Gatekeeper to transgender community
CAB
member 2
(and
outreach
worker)
African
American
Cisgender
woman
Not reported Community-based outreach worker for substance
abuse and commercial sex work
CAB
member 3
African
American
Cisgender man Gay Community-based outreach worker
House Ball Community
House Father
CAB
member 4
Black Hispanic Transgender
woman
Heterosexual Drag queen/performer
CAB
member 5
African
American
Transgender
woman
Not reported Commercial sex worker
Community Advisory Board
15. Would you like to help improve the healthcare experiences
of transgender women living with HIV?
Would you be willing to share your experiences
about accessing health care?
Would you like to help educate and inform
health care providers about transgender
women’s health needs?
Are you a transgender woman
living with HIV?
Are you willing to participate in
a 60-90 minute interview with a nurse
researcher?
You will receive a $50 gift card for your time.
If yes, then I would like to hear your story!!!
Dana, RN, MSN
Indiana University School of Nursing
I am a nurse researcher, advocate for transgender equality, and champion for quality
HIV care. Contact me at (317) 426-8102 for more information or to schedule an
interview.
Your name and personal information are not required to
participate.
Dana317-
426-8102
FlyerforHIVbasedclinicor
carecoordinationagencies
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
16. Would you like to help improve the healthcare experiences
of transgender women?
Would you be willing to share your experiences
about accessing health care?
Would you like to help educate and inform
health care providers about transgender
women’s health needs?
Are you a transgender woman ?
Are you willing to participate in
a 60-90 minute interview with a nurse
researcher?
You will receive a $50 gift card for your time.
If yes, then I would like to hear your story!!!
Dana, RN, MSN
Indiana University School of Nursing
I am a nurse researcher, advocate for transgender equality, and champion for quality
care. Contact me at (317) 426-8102 for more information or to schedule an interview.
Your name and personal information are not required to
participate.
Flyerforgeneral
recruitmentvenues
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
Dana317-
426-8102
17. Recruitment Flyer
Palm Cards
Front of card Back of card
Want to share your story about
accessing health care?
Want to help improve care for other
transgender women?
Flip me over to find out how!!!
How: Participate in a 60-90 minute interview. $50
gift card for your time.
When/where: A time and place of your choice.
With: Dana, a nurse researcher at IUPUI. Call
(317) 426-8102 for more info or to schedule your
interview.
Palmcardstobeused
onlybyCABmembers
18. Phase II Outcomes/Results
• Focused heavily on community involvement and engagement
• Lasted 18 months (Jan 2013-July 2014)
• Recruited 15 trans women
19. Participant Demographics
• N=18
• 10=AA/Black
• 4= White
• 1= Hispanic/Latina
• 1=Native American
• 1= Native American/Pacific
Islander
• Most (n=12) diagnosed with HIV
within 5 years prior to the study
• n=3 living with HIV 20+ years
• Most between the ages of 20-29
(n=8) and 18-19 (n=5) at the
time of their initial diagnosis
20. Participants by Recruitment Site/Approach
Site/Approach
Recruitment/Collaborating Site 7 (39%)
• Recruitment site 1 (largest CC agency in the state) • 4 (57%)
• Recruitment site 2 (hospital-affiliated medical home) • 2
• Recruitment site 3 (public hospital affiliated medical home) • 1
CAB member 7 (39%)
Recruitment flyer from a friend 4 (22%)
21. Participants by Race and Recruitment Site/Approach
Site/Approach Race Number
• Recruitment site 1 (largest CC
agency in the state)
2=White
1=Hawaiian/Pacific Islander
1=Multi-racial
• 4 (57%)
• Recruitment site 2 (hospital-
affiliated medical home)
1=AA
1-White
• 2
• Recruitment site 3 (public
hospital affiliated medical
home)
1=AA • 1
Recruitment flyer from a friend 2=AA
1=white
1=Multi-racial
4 (22%)
22. Participants by Race and CAB Member
CAB
Member
Occupation Gender Race/Ethnicity No.
Participants
Participant Race/Ethnicity
1 Program
manager at
CBO
Trans
woman
AA n=2 1=AA
1=HL
2 Outreach for
sex workers
Cisgender
woman
AA N=4 AA
3 Staff CBO Gay man AA n=1 AA
4 Performer Trans
woman
AA 0
5 Sex worker Trans
woman
AA 0
23. Key Finding #1
• Community-engaged recruitment strategies take time
• 21 months, two phases
Is this feasible???
• No. participants recruited per month
• No. participants retained in study
24. Comparison to other published GT studies
Study Timeline No. participants recruited
Keeping hope possible: A grounded theory study of
the hope and experience of parental caregivers who
have children in treatment for cancer (Bally, et al
2014).
13 months 16
I am normal: Claiming normalcy in Christian-
identified HIV-infected adolescent and emerging
adult males (Smith, et al. 2016).
16 months 21
Origins of the desire for euthanasia and assisted
suicide in people with HIV-1 or AIDS: A qualitative
study (Lavery, et al. 2001).
19 months 32
Current study 21 months 18
25. Key Finding #2
• Majority of participants referred to study from recruitment sites and
by CAB members
• Fewer learned about study from a recruitment flyer
• These findings underscore the importance of partnering with
community-based agencies and clinics that serve trans women and
engaging community gatekeepers and community leaders in the
recruitment process
26. Consistency with existing research
• “Giving back”
• Effective strategy in overcoming recruitment barriers (Ammerman, et al.,
2002).
• Trusted health care providers
• TW more likely to participate in HIV vaccine trials when recommended by a
trusted HCP (Andrasik et al., 2014).
• Advisory Boards
• Effective in recruiting trans participants for the Adolescent Trials Network
(Siskind, et al. 2016)
• Representative research team
• Health research among trans participants increase when trans people or trans
friendly research staff were involved in data collection and recruitment
(Owen-Smith, et al. 2016).
27. Key Finding #3
• Most AA participants were referred by CAB members (n=6, 60%)
• Fewer by friend or recruitment site (n=2)
• Findings suggest that AA trans women may be more likely to engage in health
research suggested by a community leader than friend or staff member at
recruitment site
• Most White participants (3 out of 4) were referred by staff at a
recruitment site.
• Findings suggest that White trans women may be more inclined to participate
in research studies when suggested by a member of their care team
29. Closing Quotes-Benefits to Community
“You’ve been very instrumental in paying attention to the needs of
transgender people, not scared to ask questions, and not scared to
embrace us. As an RN, you could be doing your doctorate work on
anything in the whole wide world but you have chosen to do your
doctorate study on transgender issues, and that means a great deal to
me.”
30. Closing Quotes-Benefits to Community
“It’s an honor for someone to take time out of their life and schedule, to
include us into your life, because at the end of the day, we all have our
own agenda, we all have our own life, but we’re all connected. When
my buddy told me that you were doing a study and you get something
from it, like you probably never noticed this but we actually just killed
two birds with one stone. Like you get something out of it, I get
something out of it.”
31. Closing Quotes-Benefits to Community
“It feels good to talk to you. Something like this should be done a more
often, a regular basis, because I think that a lot of us have a lot to talk
about and a lot of us have a lot to deal with. A lot of us keep it bottled
up. And being able to express it and get it out there in the open, it says
a lot for maybe society is starting to recognize that we’re just as human
as they are. You don’t have to shun us away with like we’ve got leprosy.
This work will help and it should be done more often.”
32. Conclusions
• Recruiting traditionally hard to reach populations for health research
requires an investment of time and commitment to the community
• Giving back is the first step towards building a “Deep fund of good will”
(Passmore, et al., 2016).
• Reciprocal giving facilitates recruitment efforts and sustains
partnerships
• Community-engagement plays a key role in connecting researchers to
key communities
33. References
• Pescosolido BA. Beyond rational choice: The social dynamics of how people seek help. Am. J. Sociol.
1992:1096-1138.
• Siskind RL, Andrasik M, Karuna ST, et al. Engaging Transgender People in NIH-Funded HIV/AIDS Clinical Trials
Research. JAIDS. 2016;72(Suppl 3):S243.
• Andrasik MP, Yoon R, Mooney J, et al. Exploring barriers and facilitators to participation of male-to-female
transgender persons in preventive HIV vaccine clinical trials. Prev Sci. 2014;15(3):268-276.
• Owen-Smith AA, Woodyatt C, Sineath RC, et al. Perceptions of Barriers to and Facilitators of Participation in
Health Research Among Transgender People. Trans Health. 2016;1(1):187-196.
• Passmore SR, Fryer CS, Butler III J, Garza MA, Thomas SB, Quinn SC. Building a" Deep Fund of Good Will":
Reframing Research Engagement. JHCPU. 2016;27(2):722-740.
• Bally JM, Duggleby W, Holtslander L, et al. Keeping hope possible: A grounded theory study of the hope
experience of parental caregivers who have children in treatment for cancer. Cancer Nurs. 2014;37(5):363-
372.
• Smith ST, Dawson-Rose C, Blanchard J, Kools S, Butler D. “I Am Normal”: Claiming Normalcy in Christian-
Identified HIV-Infected Adolescent and Emerging Adult Males. JANAC. 2016;27(6):835-848.
• Lavery JV, Boyle J, Dickens BM, Maclean H, Singer PA. Origins of the desire for euthanasia and assisted
suicide in people with HIV-1 or AIDS: a qualitative study. Lancet. 2001;358(9279):362-367.
34. Contact Information
Dana D. Hines, PhD, RN
Assistant Professor of Nursing
George Washington University
Dana_Hines2@gwu.edu
1919 Pennsylvania NW
Suite 500
Washington, DC 20006
Editor's Notes
Aims of the study were to describe the social patterns and pathways of HIV care among transgender women living with HIV. The study was guided by grounded theory methods, which are used to describe a shared social process among a group of people.
Assertions of the NEM that were central to the study
The Power of One Person and the
In conducting my dissertation study,Social Patterns and Pathways of HIV Care among HIV-Positive Transgender Women it was my ambition to shed light on a
population of women who are often overlooked, ridiculed, and misunderstood. I made it my personal mission to give voice to these women who were essentially voiceless and hidden, and to educate my peers and colleagues about the need to include them in research, and to treat them as human beings.
Back in 2010 when I presented my idea for this study to the faculty in my research training program at Indiana University I was met with some resistance and encouraged to pursue a different topic. The concerns of the faculty were valid in that I could not answer the basic questions of, “How many people are
transgender?” and “How many transgender people have HIV? All that I had to go on at the time were estimates from surveys that had been conducted in large metropolitan areas and a small, but slowly growing body of literature that suggested it was time to pay attention to the transgender population, and the words, wisdom, and passionate please of a talented woman and fierce advocate for the transgender community-Ms. Marissa Miller. I first met Marissa when I was working for a Ryan White HIV/AIDS Services Program in Indianapolis. At the time our paths crossed I was very early in my doctoral studies and trying to carve out my niche (nitch) in the research world. Marissa a long-time advocate for the trans community frequently attended our Ryan White Planning Council meetings and often challenged us about our lack of reporting data specific to the transgender community. Her words were loud and clear. She said, You all come here each month and you talk about what’s happening with the epidemic among MSM, men and women; but you all never talk about the transgender community. It’s like we don’t exist. Her words really resonated with me and the more I listened the more convinced I was that we were doing a disservice to the trans community. I started meeting with Marissa for lunch, coffee, talking to her more about her concerns. Over our period of interactions we developed a friendship and a sisterhood. This was my entre into transgender health research.
Unfortunately-the anecdotal information that I had gathered throughout the course of interacting with Marissa and eventually other women in the trans community, was not quite enough to convince my then committee chairs that my proposed study concept was feasible or fundable. In addition, it wasn’t enough to say, “Well, we need to do this study because so little is known about this population.”
But soon after, something major happened. In the spring of 2011, the Institute of Medicine released its groundbreaking report: The Health of
Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. One charge issued by this community was that we needed to do more to support and fund research that explicitly focuses on the transgender community. I vividly remember the day that this report was released
because I received an email from Dr. Susan Rawl with a link to the IOM report that read, “What an awesome argument you are making for the need for population.
Over the next few slides I will discuss some of my research projects and then highlighte strategies used to engage the community
I eventually went on to write my dissertation proposal and am happy to say that it was funded on the first submission by the National Institute of Nursing Research.
This particular city has the highest rates of HIV incidence and prevalence in Indiana and is served by several major Ryan White-funded HIV clinics and care coordination centers.
While gaining greater visibility, the trans population is still fairly hidden and at the time this study (2011-2012) was conducted, trans health research was just beginning to emerge
Black pride, gay pride, ball room competitions
3 flyers returned d/t incorrect address; number likely much higher given the transient nature of the population
Did not aggressively recruit so as not to exhaust the estimated small sample in the community
Community Enagement:
How did I get here?
I’ve already talked about the power of one, but the context of where I was professional at the time is also important
Engaged in the community through work at the local health department
Many connections with infectious disease clinics, care coordination sites, attended community events such as gay Pride and black pride, which eventually became Indiana Pride of Color.
I had a strong presence in the HIV community already because of my profession. But that alone wasn’t enough to gain entre’ into the trans community.
I knew that community engagement was the key. So I began attending other events such as Ball competitions, volunteering at LGBT agencies, offering pro bono grant writing, and other professional services.
I also formed a community advisory board-naming Marissa as the lead of that group. This one community leader led me to other CAB members and helped me successfully recruit 18 transgender women living with HIV in Indiana
Recall that the NEM served as an organizing lens for this study. Two assertions of this model were evident in our recruitment outcomes:
Individuals socialize/connect with those who are most like them
Social networks are the primary source for health information
Two criteria commonly used to evaluate feasibility of recruitment methods is number of participants recruited per month and number of participants retained in the study
Challenge with evaluating number of participants recruited through GT and other studies is that the timeframe is often not reported
Although we used a variety of recruitment approaches, ____ was most successful
While we made no attempt to recruit equal numbers of TW by race/ethnicity, the majority of our participants were AA
Greater representation could be due to the racial composition of the research team and CAB or could have been reflective of the disproportionate impact of HIV on AA in Indiana
Given that we were able to recruit a diverse sample, we suspect relationship building and giving back was helpful in reaching TW from other racial/ethnic groups
May not be generalizable beyond central Indiana where trans visibility is still relatively low in comparison to larger metro areas such as San Fran, NY, Miami, Chicago, DC. Therefore time needed to locate and identify these populations may be longer
May not be practical for studies using other research designs
Doctoral scholars may have fewer time constraints than academic researchers
Focused solely on experiences of TW living with HIV and strategies may not work for recruiting HIV –negative TW
Opt in only may yield a healthier, more homogenous sample
Sometimes requiring us to invest beyond our personal research agenda/goals