Formative and process evaluations of a cognitive-behavioral therapy and mindfulness intervention for people with epilepsy and depression.

People with chronic diseases are at high risk for depression, resulting in a need for effective and accessible treatment options. Project UPLIFT is a program based on cognitive-behavioral therapy and mindfulness that is aimed at reducing depressive symptoms among people with epilepsy. It is designed to be delivered to small groups of people over the phone or Internet. This study describes the formative and process evaluations of Project UPLIFT; the purpose of these evaluations was to assess the acceptability and feasibility of the program, looking at both the program components and delivery methods. The formative evaluation, conducted prior to program implementation, included nine participants in three focus groups. The process evaluation included qualitative comments and responses to the Client Satisfaction Questionnaire from 38 Project UPLIFT pilot study participants. Overall, the results from both evaluations indicate that participants felt that Project UPLIFT was acceptable and perceived to be beneficial.

HIV testing preferences among young men of color who have sex with men.

OBJECTIVES: We assessed awareness of and preferences for rapid HIV testing among young, urban men of color who have sex with men and are engaged in high-risk behaviors for HIV. METHODS: A cross-sectional survey was conducted in New York City among 177 young men who have sex with men (MSM). RESULTS: Among the 85% of the participants who had previously undergone HIV testing, 43% reported rapid testing at their most recent test. In terms of future tests, 64% would seek rapid testing, as compared with 36% who preferred traditional testing. Those who preferred rapid testing were significantly more likely to have attended at least some college, to have discussed HIV testing with a sexual partner, to be aware of rapid testing, and to have had a previous HIV test. CONCLUSIONS: In general, young MSM of color seem aware of rapid testing. However, our results indicate the need to carefully consider the unique needs of those who are particularly disenfranchised or engaged in high-risk behaviors and who may need concerted efforts around HIV counseling and testing. Likewise, our findings point to a need for more effective education and social marketing strategies.

Feasibility of using computer-assisted interviewing to enhance HIV test counseling in community settings.

OBJECTIVES: Significant advances in the treatment of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) place a premium on early detection and linkage to care. Recognizing the need to efficiently yet comprehensively provide HIV counseling, we assessed the feasibility of using audio computer-assisted self-inventory (A-CASI) in a community-based HIV counseling and testing facility. METHODS: A convenience sample of 50 adults presenting for HIV testing was recruited to complete an 85-item computerized HIV Assessment of Risk Inventory (HARI) containing domains of demographics, sexual behaviors, alcohol and substance use, emotional well-being, past experiences with HIV testing, and attitudes about taking HARI. RESULTS: Client acceptance rate was limited by the completion time outlined during the intake process. However, the majority of respondents who completed HARI felt that it took only a short to moderate time to complete and was easy to understand. A majority also reported a preference for using a computerized format in the future. Further, HARI identified a number of risk-taking behaviors, including unprotected anal sex and substance use prior to past sexual encounters. Additionally, more than half of the sample reported moderate to severe depressive symptoms. CONCLUSIONS: Those respondents who had time to complete the survey accepted the A-CASI interview, and it was successful at identifying a substantial level of risk-taking behaviors. A-CASI has the potential to guide HIV counselors in providing risk-reduction counseling and referral activities. However, results suggested the need to shorten the instrument, and further studies are needed to determine applicability in other HIV testing sites.

Overheard in the halls: what adolescents are saying, and what teachers are hearing, about health issues.

BACKGROUND: Schools have long been recognized as an excellent place to offer health education and supportive services. Teachers are among the most important influences in the lives of school-aged children and can provide valuable insight into the health issues important to adolescents. The purpose of this study was to examine the potential role general academic teachers may play in facilitating adolescent health promotion efforts. METHODS: To determine what teachers think about the role of health promotion in schools and what tools and topics they would find most helpful as critical advisers to students, we administered a 28-question survey at staff development meetings in 4 New York City schools. RESULTS: Teachers agreed that schools were an important venue for discussing and providing health messages. More than half of those surveyed reported having overheard student discussions about health once a week or more, and 70% stated that they had been actively approached by students 1-3 or more times per semester with reports of personal problems or health issues. Teachers expressed concern about their ability to handle student mental, behavioral, and reproductive health problems and desired additional staff development workshops to address these needs. CONCLUSIONS: Teachers felt that schools were important places to promote dialogue about health and accept the importance of playing a broader role in the lives of youth beyond education. To enhance the prospect of health-promoting interactions between teachers and students, attention must be paid to developing the overall skill and comfort level of teachers with respect to adolescent health concerns.

An online audio computer-assisted self-interview for pre-screening prior to rapid HIV testing in a vulnerable population.

ACASI (Audio Computer-Assisted Self-Interview) has been demonstrated to be more effective than face to face interviews in eliciting truthful responses on sensitive subjects such as substance abuse and sexual behavior (1, 2). Thus, ACASI has the potential to streamline and standardize HIV counseling and testing by providing a comprehensive overview of each patients behavior while highlighting areas that may merit further exploration.

Parents of urban adolescents in Harlem, New York, and the Internet: a cross-sectional survey on preferred resources for health information.

BACKGROUND: Vulnerable populations suffer disproportionately from a variety of health conditions. Access to health information is an important component of health promotion. Reports suggest that while health providers and print media are traditional sources of information, the Internet may be becoming an increasingly important resource for consumers. Particularly, for parents of urban adolescents of color, the Internet could prove to be a valuable asset in helping them understand adolescent health and behavioral issues. OBJECTIVE: To determine the types of adolescent health and behavioral issues of concern to parents of color and to assess their preference for sources of health information, including the Internet. METHODS: A confidential, self-administered survey was administered to parents (largely of African American and Hispanic descent) of 9th-grade students over a 2-year period during 2001-2002 in Harlem, NY. The instrument assessed health and behavioral topics of concern, preferred resources for information, ownership and utilization patterns of computers and the Internet, and interest in obtaining additional computer/Internet training. RESULTS: A total of 419 surveys were completed; 165 in 2001 (67% response rate) and 254 in 2002 (no response rate available). Analysis of responses indicated a substantial degree of interest in obtaining information about a variety of adolescent health issues, including: HIV, sexually transmitted infections, , mental health concerns and relationships with family and peers. While home ownership of computers (84%) and access to the Internet were reasonably high (74%), use of the Internet for health information was low (14%). However, 62% of parents indicated a strong desire to have more instruction on computers and the Internet. CONCLUSIONS: Compared to other sources of health information, the Internet is underutilized by urban parents of color. Additional research is needed to identify strategies to improve utilization and assess subsequent impact on parenting activities.