How can male rates of HIV testing be increased? Recommendations from a mixed methods study in southern Malawi.

Background: In southern Malawi, 12.8% of adults are HIV positive. Men are less likely to have been tested than women. We investigated men's HIV knowledge and the attitudes, influencers, facilitators and barriers affecting HIV testing. Methods: We conducted an explanatory mixed-methods study with analysis of secondary quantitative data from 425 rural men collected in January 2014 (time 1) and April 2015 (time 2) and qualitative interviews with 50 men in September 2015. All respondents lived in villages receiving HIV education and testing. Results: Quantitative data revealed that comprehensive HIV knowledge increased and was associated with having been tested by time 2. Educational level was positively associated with having been tested. Men's reasons for not getting tested were fear of learning their HIV status, fear of rejection by partners and wives and fear of discrimination. Wives influenced men's opinions about healthcare. The qualitative results demonstrated that men feared being seen at test sites and feared discrimination. Wives had the greatest reported influence on male testing. Men perceived services as female-oriented and stigmatizing. They preferred door-to-door testing. Conclusions: Providers can improve uptake by increasing men's HIV knowledge, leveraging the influence of spouses and offering door-to-door testing with male health workers.

"Getting into the skin": empathy and role taking in certified nursing assistants' care of dying residents.

Twenty-four percent of Americans die in nursing homes, and 80% to 95% of nursing home care is delivered by certified nursing assistants (CNAs). Interview data were collected from 27 CNAs at three facilities. Data were coded and analyzed for recurrent themes using the concepts of empathy and role taking. The results revealed that CNAs used role taking to guide their caregiving actions and to understand the emotional experience of residents. Compassionate detachment, a hallmark of empathy, was evident in effective care, but problems with the ability to detach were also revealed. Organizational factors that supported empathy and those that undermined empathy were also examined. Recommendations for improving care are discussed in this article.