Organizational learning and the development of global health educational capabilities: critical reflections on a decade of practice.

This paper describes the process of organizational global health capability development at the University of Maryland Baltimore over the past decade. Theories of organizational learning and of organizational capabilities are applied in this retrospective analysis of organizational innovations in global health education within UMB as well as in the University of Maryland School of Nursing.

Evaluation of three adolescent sexual health programs in ha noi and khanh hoa province, Vietnam.

With an increase in sexual activity among young adults in Vietnam and associated risks, there is a need for evidence-based sexual health interventions. This evaluation of three sexual health programs based on the Protection Motivation Theory (PMT) was conducted in 12 communes in Ha Noi, Nha Trang City, and Ninh Hoa District. Inclusion criteria included unmarried youth 15-20 years residing in selected communes. Communes were randomly allocated to an intervention, and participants were randomly selected within each commune. The intervention programs included Vietnamese Focus on Kids (VFOK), the gender-based program Exploring the World of Adolescents (EWA), and EWA plus parental and health provider education (EWA+). Programs were delivered over a ten-week period in the communities by locally trained facilitators. The gender-based EWA program with parental involvement (EWA+) compared to VFOK showed significantly greater increase in knowledge. EWA+ in comparison to VFOK also showed significant decrease at immediate postintervention for intention to have sex. Sustained changes are observed in all three interventions for self-efficacy condom use, self-efficacy abstinence, response efficacy for condoms, extrinsic rewards, and perceived vulnerability for HIV. These findings suggest that theory-based community programs contribute to sustained changes in knowledge and attitudes regarding sexual risk among Vietnamese adolescents.

Gender, Alcohol Consumption Patterns, and Engagement in Sexually Intimate Behaviors Among Adolescents and Young Adults in Nha Trang, Viet Nam.

A randomly selected cross-sectional survey was conducted with 880 youth (16 to 24 years) in Nha Trang City to assess relationships between alcohol consumption and sexual behaviors. A timeline followback method was employed. Chi-square, generalized logit modeling and logistic regression analyses were performed. Of the sample, 78.2% male and 56.1% female respondents ever consumed alcohol. Males reporting sexual behaviors (vaginal, anal, oral sex) had a significantly higher calculated peak BAC of 0.151 compared to 0.082 for males reporting no sexual intimacy (p < .0001). Females reporting sexual behaviors had a peak BAC of 0.072 compared to 0.027 for those reporting no sexual intimacy (p = .016). Fifty percent of (33/66) males and 30.4% (7/23) females report event specific drinking and engagement in sexual behaviors. Males reporting 11+ drinks in 30 days had more sexual partners than those reporting 1 to 10 drinks (p = .037). Data suggest different physical and psychosocial mediators between alcohol consumption and sexual behaviors by gender.

Parent-youth communication and concordance between parents and adolescents on reported engagement in social relationships and sexually intimate behaviors in Hanoi and Khanh Hoa Province, Vietnam.

PURPOSE: Parent-child communication is associated with positive outcomes for youths' engagement in sexual behaviors. Limited data are available regarding parent-child communication in transitional countries. We present data from Vietnamese parent-youth dyads on parent reproductive health (RH) knowledge, comfort of communication, frequency of talk, and discordancy between youths' reported and parents' perceptions for engagement in relationships and sexually intimate behaviors. METHODS: The cohort included 185 randomly selected parent-youth dyads in four communes in Hanoi and Khanh Hoa Province. Descriptive and comparative analysis included chi-squared tests, independent samples t-tests, and ANOVA. Linear regression analysis was used to assess relationships between parental knowledge, level of comfort, frequency of talk, and discordancy. RESULTS: Seventy-six percent of parents and 44% of youth were female. The mean age of youth was 17.2 years. The mean score for parental "RH knowledge" was 24.74 (SD, 3.84; range, 15-34). Lower parental RH knowledge was positively associated with lower levels of education (F = 2.983; df, 184; p = .014). Data indicate a linear model in which knowledge is related to "comfort" (ß = .17; p = .048), and "comfort" to frequency of "talk" (ß = .6; p < .0001). Frequency of "talk" is not related to parents' discordant perceptions regarding their child's reported involvement in relationships (ß = .002; p = .79) or sexual touching (ß = .57; p = .60). CONCLUSIONS: Parent and youth in Vietnam are engaged in limited communication about RH. There is a need for more data to assess the effect of these communication patterns on youths' engagement in sexual behaviors and for development of family-centered interventions to increase parental knowledge and skills for positive communication.

Vaccine desirability during an effectiveness trial of the typhoid fever polysaccharide Vi vaccine in Kolkata India.

BACKGROUND: High rates of typhoid fever and the emergence of multi-drug resistant strains create a need for prevention efforts including vaccines. Socio-behavioral research can provide important data for participation in future trials and public health vaccination campaigns. DESIGN: A 3b phase clinical trial in Kolkata India including pre- and post-vaccination socio-behavioral surveys. RESULTS: 47.9% of respondents were male. Ward 29 respondents included 32.4% Hindu and Ward 30 respondents were 99.0% Hindu. Lower rates of participation were found among Muslim respondents and those with post high school education. Lack of information and negative information affected participation. Joint decision-making within households increased participation rates. METHODS: seven hundred households were randomly selected 503 respondents (71.85%) completed both the pre- and post-closed-ended surveys. Data analysis included descriptive statistics, Pearson's chi-square tests, independent t-tests, and stepwise logistic regression analysis. Four open-ended questions were included in the survey. These qualitative data were coded and reviewed for common themes and patterns. CONCLUSIONS: Individuals' decisions to participate or not participate in a vaccine trial entail a balance between individual beliefs, household dynamics and socio-political influences. Efforts prior to vaccination trials need to develop strategies which address potential underlying mediators for belief systems as well as structural factors which may reinforce individuals' beliefs and perceptions about vaccination trials.

Strategies for developing gender-specific HIV prevention for adolescents in Vietnam.

In Vietnam, between 2000 and 2006, HIV rates among 15- to 49-year-olds in the general population have increased from 27% to 53%. The HIV epidemic is occuring in a context of rapid socioeconomic changes, which have brought about conflicting ideals and norms between "traditional" and "modern" gender roles. We discuss the processes for developing the Exploring the World of Adolescents gender-specific HIV prevention curricula for 15- to 21-year-old adolescents living in both rural and urban Vietnam. The curricula are modeled after an existing HIV prevention program previously adapted and evaluated in Vietnam (Vietnamese Focus on Kids) and based in social learning theory (prevention motivation theory) contextualized within socioeconomic changes. The overall capacity building and participatory strategies for program development included (a) review of the HIV/AIDS and socioeconomic conditions in Vietnam, (b) review of the Vietnamese Focus on Kids curriculum themes and the theoretical constructs from the protection motivation theory, () analysis of qualitative and quantitative needs assessment data to incorporate culturally significant issues of gender and sexuality, and (d) a review of themes and activities from existing evidence-based adolescent reproductive health curricula.

Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy.

As rates of HIV increase in Vietnam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic changes. The authors report results from qualitative interviews with 159 Vietnamese adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. In the qualitative interviews, youths report a strong adherence to ideals and values regarding abstinence outside of marriage. Youths reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%; p = .000). A total of 15 of 32 (46.9%) sexually active youths reported rarely or never using condoms. Females had significantly higher scores for perceived sexual stigma than males (t = -10.22 [95% confidence interval (CI); -3.72 to -2.52; p = .000) whereas males scored significantly lower than females on a scale of perceived self-efficacy for abstinence (t = 5.31 [95% CI; .27 to .59]; p = .000). The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence; however, these same values decrease adolescents' ability to obtain accurate information about sexuality and HIV and sexually transmitted infections and engage in safer sex.

Effectiveness of a theory-based risk reduction HIV prevention program for rural Vietnamese adolescents.

As of April 2003, 64,801 HIV cases have been documented in Vietnam (Policy Project 2003), 53.9 % of which are among individuals 20-29 years of age. Although HIV education efforts have increased, there remains a need for proven effective programs. We present findings from a randomized-controlled effectiveness trial of an HIV prevention program for adolescents 15-20 years. Four hundred eighty adolescents were randomized into control and intervention groups. Evaluation data were collected using the Vietnamese Youth Health Risk Behavior Instrument, including scales based on the protection motivation theory (PMT). Findings presented show significant differences in knowledge of severity and vulnerability of HIV/AIDS ( p < .05), perceptions of self-efficacy ( p < .001), and response efficacy for condom use ( p < .05) between control and intervention youth at immediate and 6-month postintervention. A significant difference was also found for response cost of condom use ( p < .05) at immediate postintervention. No significant difference was found for the construct of response cost at 6 months, and there were no significant differences for the constructs external and internal rewards. Reported engagement in vaginal sex (1.7%), or anal and/or oral sex (3.1%) was extremely low, and therefore changes in actual behaviors could not be accurately measured. However, intention to use condoms in possible future sexual encounters increased significantly ( p < .05) for the intervention youth compared to control youth between baseline (74/240, 30.8%) and both immediate postintervention (132/230, 57.4%), and six month follow-up (123/228: 53.9%). These data suggest the potential applicability of the PMT for HIV program development with non-Western adolescents but also point to the need for further studies on how constructs within behavioral theories might need to be modified in different sociocultural settings.