ABSTRACT
While current research on the factors affecting the HIV epidemic within the general population has considered the role of HIV case managers, much remains to be known about case management effectiveness and how it might be enhanced. This article presents the data from a statewide survey of case management professionals in Florida. The study focused on case managers' preparation for practice and barriers to successful practice. The study results reflect a very broad educational preparation in multiple disciplines with highly varied means of case manager training and orientation at entry to practice. Further, the results highlighted the existence of multiple barriers that challenge the ability of case managers to cope with the demands of case management practice in sites serving people living with HIV/AIDS who are socially and economically challenged. The article concludes with recommendations for changes in the system that would enhance the preparation of case management professionals for entry to practice.
Subject(s)
Case Management/standards , HIV Infections/therapy , Safety-net Providers/standards , Social Work/standards , Adult , Attitude of Health Personnel , Case Management/economics , Case Management/legislation & jurisprudence , Cultural Competency , Female , Financing, Government/legislation & jurisprudence , Florida , HIV Infections/economics , HIV Infections/psychology , Health Care Surveys , Health Personnel/education , Humans , Male , Patient-Centered Care/economics , Patient-Centered Care/legislation & jurisprudence , Patient-Centered Care/standards , Program Evaluation , Safety-net Providers/economics , Safety-net Providers/legislation & jurisprudence , Social Work/economics , Social Work/legislation & jurisprudence , United StatesABSTRACT
Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.
