Publications by authors named "Natalia Villegas"

34 Publications

Factors Associated With Psychosocial Illness Impact Among Black/African American and Hispanic Older Women Living With HIV.

J Am Psychiatr Nurses Assoc 2021 Nov 19:10783903211058786. Epub 2021 Nov 19.

Jose Guillermo Castro, MD, University of Miami Miller School of Medicine, Miami, FL, USA.

Background: In 2018, one in six newly diagnosed individuals with HIV in the United States were adults aged 50 years and older, 24% were women, and 60% were Black/African American and Hispanic (42% and 18%, respectively).

Objectives: This study aims to examine the factors associated with HIV psychosocial illness impact among Black/African American and Hispanic older women living with HIV.

Method: Guided by the socioecological model, a secondary data analysis design with cross-sectional data that included 138 Black/African American and Hispanic women aged 50 years and older was conducted.

Results: Higher levels of avoidant coping, depressive symptoms, negative self-perception of health, and decreased social support were significant factors associated with HIV psychosocial illness impact among this sample.

Conclusions: Findings from this study can contribute to identifying solutions to prevent and decrease these negative factors associated with HIV psychosocial illness impact among Black/African American and Hispanic older women.
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http://dx.doi.org/10.1177/10783903211058786DOI Listing
November 2021

Development and evaluation of a telehealth-based simulation to improve breastfeeding education and skills among nursing students.

Nurse Educ Pract 2021 Nov 2;57:103226. Epub 2021 Oct 2.

Palm Beach Atlantic University, 901 S Flagler Dr, West Palm Beach, FL 33401, USA. Electronic address:

Aim: The aim of this study was to evaluate undergraduate nursing students' perceptions of using telehealth-based simulations for practicing their breastfeeding education skills.

Background: Telehealth can help bridge the gap between the high need for healthcare services and the limited access to these services, such as breastfeeding mothers in rural settings. However current literature suggests that there is lack of telehealth education among healthcare providers, as well as, a shortage of adequately trained nurses on breastfeeding, making it difficult to provide new mothers with the support they need to successfully breastfeed. Telehealth simulation has shown to be acceptable and helpful in teaching clinical reasoning, increasing exposure to telehealth experiences, and preparing nursing students for real interaction experiences with patients.

Design: For this cross-sectional descriptive study, two breastfeeding telehealth simulation scenarios were developed and delivered through Zoom for Bachelor of Science in Nursing students in a high-level institution in Florida. Selected students interacted over Zoom as healthcare providers with a female simulated patient who played as a mother with a breastfeeding concern. Students in their role of healthcare providers assessed the breastfeeding needs of the mother and conducted breastfeeding education as appropriate. After debriefing, students received feedback from faculty and students who observed the simulation and completed an optional evaluation about their telehealth simulated experience.

Results: A total of 205 students completed the evaluation. Most students (n = 136, 66.3%) were not familiar with telehealth prior to the simulation. Most students (n = 199, 97.1%) also found the simulation helpful for supporting breastfeeding mothers and wanted more telehealth simulations in the future (n = 162, 79%). Feedback for improving the simulations included: improving the technical setup (n = 17, 8.3%), increasing the time that students interacted with the mother (n = 16, 7.8%), and observing the correct performance of the simulation after debriefing (n = 16, 7.8%).

Conclusion: Telehealth simulation is a promising modality for clinical competency assessment, thus it is essential to integrate telehealth education into nursing curriculum. It is evident that telehealth-based breastfeeding simulations can be used to address the exposure/knowledge gap among nursing students who are missing or have limited exposure to breastfeeding content and telehealth use in their nursing curriculum.
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http://dx.doi.org/10.1016/j.nepr.2021.103226DOI Listing
November 2021

Preferred HPV and HPV Vaccine Learning Methods to Guide Future HPV Prevention Interventions Among Rural Hispanics.

J Pediatr Nurs 2021 Sep-Oct;60:139-145. Epub 2021 May 4.

University of North Carolina at Chapel Hill School of Nursing, NC, USA. Electronic address:

Purpose: HPV vaccination among United States's rural Hispanic youth is suboptimal to the Healthy People 2030 goal. Rural Hispanic parents' HPV vaccine (HPVV) perceptions have influenced these low rates. Furthermore, few effective interventions for increasing HPV vaccination among rural Hispanic populations exist. This study aimed to determine rural Hispanic parent's preferred HPV and HPVV learning methods to guide future HPV prevention interventions.

Design And Methods: A descriptive qualitative design was used. A total of 23 rural Hispanic parents from South Florida participated in four focus groups. Conventional content analysis was used to analyze the transcripts.

Results: Three overcharging themes were identified: 1) Learning method preferences for parents, 2) Learning method preferences for youth, and 3) Learning method preferences for families. Sub-themes included participants' preferences on their interest for an intervention, target audiences, teaching methods, availability of community members, intervention facilitators, and content.

Conclusions: Addressing HPV vaccination by developing culturally tailored programs for rural Hispanic parents is urgently needed to prevent HPV and HPV-related cancers among this disproportionately affected population. Findings highlight essential elements that should be considered when designing an intervention for increasing HPV vaccination among Hispanics in rural settings.

Practice Implications: Pediatric nurses must offer culturally appropriate HPVV education and literature and proactively recommend the HPVV at every opportunity. Pediatric nurses can administer the HPVV at schools and community health fairs while clinics can play educational clips in waiting and examination rooms.
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http://dx.doi.org/10.1016/j.pedn.2021.04.026DOI Listing
October 2021

Motivation for Critical Thinking in Nursing Students in Chile.

Hisp Health Care Int 2021 06 26;19(2):131-137. Epub 2020 Nov 26.

Escuela de Tecnología Médica, 28087Universidad Andres Bello, Viña del Mar, Chile.

Nursing education includes a constant challenge regarding the competencies that nurses must possess to provide high-quality nursing care. One of these competencies is critical thinking (CT), and motivation for critical thinking (MCT) has been identified as an element necessary to develop CT. Expectancy and value are important components of the MCT. This study aimed to analyze sociodemographic and academic factors related to MCT in Chilean nursing students. This study is an analytical-correlational, cross-sectional study conducted with 478 nursing students in Chile. The data were collected using an online questionnaire. The Critical Thinking Motivation Scale was used to measure MCT. Pearson's square, Chi-square, means comparison test, and binomial logistic regression were used to analyze the data. The expectancy component of the MCT had the lowest scores on the scale. Age was associated with the cost subcomponent ( < .03), and high school was associated with the interest subcomponent ( < .01). Academic factors contributing to MCT were problem-based learning, professor motivation, and the inclusion of MCT in nursing disciplinary subjects. Strategies that improve CT and MCT should be implemented and evaluated periodically from the beginning of a nursing career. Faculty should be trained to motivate students to think critically.
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http://dx.doi.org/10.1177/1540415320970110DOI Listing
June 2021

Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection.

Am J Hosp Palliat Care 2021 Jun 20;38(6):583-589. Epub 2020 Nov 20.

5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.

Background: Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions.

Objectives: To examine predictors of EOL discussions with significant others, family members, and friends.

Methods: Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV.

Results: Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM.

Discussion: Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .
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http://dx.doi.org/10.1177/1049909120971826DOI Listing
June 2021

Exploring Intimate Partner Relationships before and after HIV Diagnosis among Minority Older Women.

Clin Gerontol 2021 May-Jun;44(3):273-287. Epub 2020 Oct 30.

School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.

Objectives: Literature shows that sexual activity remains important at older age and is a valued part of life. However, little is known about the intimate partner relationships (IPR) among minority older women living with Human Immunodeficiency Virus (HIV). The purpose of this study is to explore the effect HIV diagnosis had on the intimate partner relationships (IPR) among minority older women living with HIV (MOWH).

Methods: Qualitative descriptive study. A total of 28 MOWH (Black and Latinas) aged 50 years and older participated in face to face semi-structured in-depth interviews. Interviews were analyzed using content analysis.

Results: Three themes emerged from the analysis: (a)" that revealed sexual practices increasing the risk for HIV in their intimate relationships; (b)" explored the consequences of HIV disclosure, and how disclosure determined the future of their intimate relationships; and (c) described the quality of intimate partner relationships and changes after HIV diagnosis.

Conclusions: Results from this study contribute to understanding and increasing awareness of the effect of HIV on the intimacy of MOWH.

Clinical Implications: Education provided by health care workers and interventions targeting MOWH should address the effect of HIV in IPR, address MOWH's concerns about it, and help them to improve their overall health.
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http://dx.doi.org/10.1080/07317115.2020.1838682DOI Listing
August 2021

Facilitators of Self-Initiated HIV Testing Among Youths: A Qualitative Study.

J Nurs Res 2020 Oct;28(5):e115

PhD, RN, IBCLC, Associate Professor, School of Nursing, University of North Carolina at Chapel Hill, USA.

Background: Youth experience disparities in HIV infection but have significantly low rates of HIV testing that lead to late diagnoses, increased transmission rates, and adverse health outcomes. There is limited knowledge regarding self-initiated HIV testing, which is a promising strategy for improving testing rates among youth.

Purpose: This study aimed to identify the facilitators of self-initiated HIV testing among youth.

Method: Thirty youths aged 18-24 years were recruited to participate in a qualitative descriptive study. Potential participants were recruited from a combination of HIV testing sites, including community testing events, a community-based organization, an adolescent health clinic, and a college campus. A demographic and sexual history questionnaire and audio-recorded interviews were used to collect data. Transcribed interviews were analyzed using qualitative content analysis.

Results: Salient themes and subthemes that explain the study findings are as follows: testing within the context of a sexual relationship (e.g., infidelity), support and influence from social relationships (e.g., family support), taking the initiative for health (e.g., signs and symptoms of infection), HIV testing preferences (e.g., free testing), and HIV testing experiences (e.g., provision of other health services).

Conclusions: The findings of this study advance scholarly understanding regarding the predictors of self-initiated testing and provide critical information necessary to further improve evidence-based nursing clinical practice and develop public health nursing interventions that target self-initiated HIV testing. Encouraging self-initiated HIV testing is an effective approach to increasing testing rates and, consequently, preventing new HIV transmissions in this vulnerable population.
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http://dx.doi.org/10.1097/JNR.0000000000000390DOI Listing
October 2020

Salient factors among Hispanic parents in South Florida rural communities for vaccinating their children against human papillomavirus.

J Pediatr Nurs 2020 Sep - Oct;54:24-33. Epub 2020 Jun 7.

University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA. Electronic address:

Purpose: Few studies have tried to understand the factors related to HPV vaccination among Hispanics living in rural communities in the United States (US). Nationally, HPV vaccination among Hispanics is suboptimal (26.1%) compared to the HealthyPeople 2020 goal of 80% and even more suboptimal in rural communties. This study aimed to determine the salient factors among Hispanic parents for vaccinating their children against HPV and for designing a future HPV prevention intervention for Hispanics.

Design And Methods: A descriptive qualitative design was used. Saturation was reached after conducting four focus groups with 23 Hispanic parents from rural communities in South Florida. Directed content analysis using the Theory of Planned Behavior (TPB) constructs was used to analyze the transcripts.

Results: All TPB constructs were identified as salient factors for HPV vaccination including background factors, attitudes towards the behavior, perceived norms, perceived behavioral control, actual control, intention, and behavior.

Conclusions: Addressing HPV vaccination by developing educational programs based on the TPB and tailored to meet the needs of Hispanic parents is urgently needed to prevent HPV among Hispanics in rural US communities. This approach can also serve as a directive to target HPV vaccination among Hispanics in other rural areas in the US.

Practice Implications: Pediatric nurses must proactively promote and recommend the HPV vaccine (HPVV), educate parents on having sex-related discussions with their children, include children in the HPVV education and decision, bundle the HPVV with other child vaccines, and utilize reminder systems to ensure completion of the vaccine series.
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http://dx.doi.org/10.1016/j.pedn.2020.05.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484143PMC
April 2021

Exploring the Psychosocial Impact of Living With HIV on Minority Older Women.

J Am Psychiatr Nurses Assoc 2020 May 29:1078390320927462. Epub 2020 May 29.

Heather Sanchez, RN, University of Miami, Coral Gables, FL, USA.

Among older adults, minority older women will account for 60% of the new HIV diagnoses. The psychosocial impact of living with HIV among this vulnerable population narrated by their own voices has been understudied. The purpose of this study was to explore the psychosocial impact of living with HIV on minority older women. In-depth interviews were conducted with 28 minority older women living with HIV at an Ambulatory Care Center HIV Clinic in South Florida. All interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to identify and define the major themes that emerged from the interviews. Questions included those concerning description of life after the HIV diagnosis, most challenging aspects of life after the diagnosis, and daily activities since the diagnosis. The analysis of the interview data led to five main themes: (I) Social Impact of HIV, (II) Threats to Health and Well-Being, (III) HIV as a Death Sentence, (IV) Spirituality, and (V) HIV Treatment Adherence. In their narratives, women described a myriad of psychosocial issues such as depressed mood, isolation, economic challenges, stigma, anhedonia of interest, fear of death, among others. There is a compelling empirical need for rapid implementation of a culturally tailored, holistic, low-cost, multistrategy intervention to early screen and reduce the psychosocial impact of HIV among minority older women.
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http://dx.doi.org/10.1177/1078390320927462DOI Listing
May 2020

Prevention of alcohol consumption and transmission of human immunodeficiency virus: randomized clinical trial.

Rev Lat Am Enfermagem 2020 11;28:e3262. Epub 2020 May 11.

Chapel Hill School of Nursing, University of North Carolina, Chapel Hill, North Carolina, United States of America.

Objective: to know the effects of a nursing intervention to reduce alcohol use and risk factors for transmission of human immunodeficiency virus (HIV).

Method: randomized single-blinded clinical trial performed by nurses with young women. The study included 66 participants in the intervention group and 66 participants in the control group. The instruments were the Alcohol Use Disorders Identification Test, the HIV Risk Behavior Knowledge and the Condom Use Self-efficacy Scale. Analysis of variance was used.

Results: alcohol involvement decreased in the intervention group (F (1.119) = 50.28; p < 0.001; η2p = 0.297), while HIV knowledge (F (1.130) = 34.34; p < 0.001; η2p = 0.209) and condom use self-efficacy increased (F (1.129) = 27.20; p < 0.001; η2p = 0.174). In addition, less participants consumed alcohol in the past week compared to the control group (χ2 = 15.95; p < 0.001).

Conclusion: the nursing intervention had positive effects, which could help young women stay away from alcohol use and the risk of sexually transmitted infections. NCT: 02405481.
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http://dx.doi.org/10.1590/1518-8345.3393.3262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217628PMC
June 2020

Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children.

J Pediatr Nurs 2020 Jan - Feb;50:105-112. Epub 2019 Dec 3.

University of Massachusetts Memorial Medical Center, United States of America.

Preparation for surgery with the induction of general anesthesia is one of the most stressful events that a child can experience. It produces several threats to the child, including physical harm, parent separation, and fear of the unknown. Anesthesia providers utilize non-pharmacological and pharmacological interventions to decrease this preoperatively. However, little is known about the non-pharmacological interventions utilized by anesthesia providers in practice. The purpose of this study was to explore non-pharmacological interventions utilized by anesthesia providers before and during the induction of general anesthesia to reduce preoperative distress in children ages one to six years old. A qualitative descriptive approach was used in this study. Twenty anesthesia providers, fourteen registered nurse anesthetists and six anesthesiologists, participated in face to face, in-depth interviews in South Florida. Content analysis was used to identify and define the major themes that emerged from the interviews. A total of seven main themes were identified. Only the three themes directly related to parent-provider-child relationship are discussed in this paper: (I) Communication, (II) Observational Skills, and (III) Parental Presence. The anesthesia providers who participated in this study offered an opportunity to better understand the non-pharmacological interventions used to impact the management of preoperative distress among children. Study findings provide evidence about non-pharmacological anesthesia providers' clinical work not found elsewhere in the literature. Non-pharmacological interventions are effective in reducing preoperative distress in children.
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http://dx.doi.org/10.1016/j.pedn.2019.11.005DOI Listing
December 2020

Social Determinants of Depression Among Older Black Women Living With HIV.

J Am Psychiatr Nurses Assoc 2020 Nov/Dec;26(6):576-585. Epub 2019 Jun 28.

Sadandaula R. Muheriwa, MScMid, RNMe, University of Miami, Coral Gables, FL, USA.

The prevalence of depression spans age-groups, but it can be particularly destructive for older people with chronic illness. Among older Black women living with HIV (OBWLH), multiple social determinants have been associated with the prevalence and severity of depression. A greater understanding of the impact of the social determinants at the individual, interpersonal, and community levels is needed. To explore social determinants of depression among OBWLH at the intrapersonal, interpersonal, and community levels. Cross-sectional descriptive design. A total of 118 OBWLH were analyzed in the study. Depression was prevalent among the participants. Approximately 89.8% of the participants had moderate to severe depressive symptoms. Health status, exercise, and social support were significant predictors of depression in the sample. Social determinants at multiple levels play a significant role in the occurrence and management of depression among OBWLH. Implications for practice, education, and research can be drawn from these findings.
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http://dx.doi.org/10.1177/1078390319858415DOI Listing
June 2021

Assessment of Technology Use and Technology Preferences for HIV Prevention Among Hispanic Women.

Hisp Health Care Int 2018 12;16(4):197-203

1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.

Introduction: HIV transmission presents an ongoing risk to Hispanic women, and prevention efforts remain a priority. The use of technology to prevent HIV transmission among Hispanic women and those of lower socioeconomic status underscore the need for effective implementation of technology. The purpose of this study is to describe technology preferences and predictors of the use of the internet for HIV prevention among low-income Hispanic women.

Method: A secondary analysis was conducted using baseline data from an intervention to prevent HIV among 320 Hispanic women. The parent study was SEPA, Salud (health), Educación (education), Promoción (promotion), y [and] Autocuidado (self-care).

Results: Most participants reported using personal technology, such as smartphones (90.6%), the internet (78.1%), and personal email (67.5%), every day. Most (71.3%) participants were open to learning about HIV education via the internet. In the logistic regression analysis, education and time since the last visit to the health care provider were significant predictors of the use of the internet to learn about HIV prevention, after controlling for age, living with the partner, and years living in the United States.

Conclusion: Hispanic women demonstrated high levels of comfort with different forms of technology. These results indicated the potential to expand future HIV intervention efforts by implementing electronic dissemination of bilingual and culturally appropriate information for Hispanic women of diverse ages.
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http://dx.doi.org/10.1177/1540415318808828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6568264PMC
December 2018

HIV Testing Among Heterosexual Hispanic Women in South Florida.

J Nurs Scholarsh 2019 Jul 19;51(4):427-437. Epub 2019 Mar 19.

Alpha Alpha, Dean and Professor, University of North Carolina School of Nursing, Chapel Hill, NC, USA.

Purpose: The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women.

Design: This study utilizes a cross-sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. The Social Cognitive Model (SCM) guided this study.

Methods: Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression.

Findings: The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it.

Conclusions: Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women.

Clinical Relevance: Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.
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http://dx.doi.org/10.1111/jnu.12470DOI Listing
July 2019

Image quality assessment of pre-processed and post-processed digital panoramic radiographs in paediatric patients with mixed dentition.

Imaging Sci Dent 2018 Dec 20;48(4):261-268. Epub 2018 Dec 20.

OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.

Purpose: To determine the impact of an image processing technique on diagnostic accuracy of digital panoramic radiographs for the assessment of anatomical structures in paediatric patients with mixed dentition.

Materials And Methods: The study consisted of 50 digital panoramic radiographs of children aged from 6 to 12 years, which were later on processed using a dedicated image processing method. A modified clinical image quality evaluation chart was used to evaluate the diagnostic accuracy of anatomical structures in maxillary and mandibular anterior and maxillary premolar region of processed images.

Results: A statistically significant difference was observed between pre and post-processed evaluation of anatomical structures (<0.05) in the maxillary and mandibular anterior region. The anterior region was found to be more accurate in post-processed images. No significant difference was observed in the maxillary premolar region (>0.05). The Inter-observer and intra-observer reliability of both pre and post processed images were excellent (>0.82) for anterior region and good (>0.63) for premolar region.

Conclusion: The application of image processing technique in digital panoramic radiography can be considered a reliable method for improving the quality of anatomical structures in paediatric patients with mixed dentition.
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http://dx.doi.org/10.5624/isd.2018.48.4.261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305780PMC
December 2018

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Hispanic Women Delivered in a Real-World Setting by Community Agency Personnel.

Am J Health Promot 2019 05 24;33(4):566-575. Epub 2018 Oct 24.

2 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.

Purpose: To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting.

Design: Randomized controlled trial.

Setting: Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami.

Participants: Three hundred twenty Hispanic women.

Intervention: The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology.

Measures: Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use.

Analysis: Differences at baseline by group were assessed using Wilcoxon rank sum test, χ, and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables.

Results: Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%).

Conclusion: The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.
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http://dx.doi.org/10.1177/0890117118807716DOI Listing
May 2019

EXPLORING SELF-EFFICACY AND PERCEIVED HIV RISK AMONG SOCIOECONOMICALLY DISADVANTAGED HISPANIC MEN.

Horiz Enferm 2017 ;28(1):42-50

School of Nursing, University of North Carolina Chapel Hill.

The prevalence of HIV in Chile predominately affects the male population with the primary mode of transmission (99%) through sexual contact. In order to engage in safe sexual practices, men must have high sexual self-efficacy and perceived risk of infection, however, little research examines these variables with respect to HIV prevention. The purpose of this article is to review existing literature on self-efficacy and its connection with perceived HIV risk among Hispanic men, in order to direct future HIV prevention interventions among Chilean men. A literature search was conducted to identify studies for this review using three databases. A combination of keywords was used to conduct the search and a total of 34 articles were analyzed. All of the articles reviewed examined the Hispanic male population with respect to either self-efficacy or perceived risk, or a combination of the two. Major themes emerging from the review include: substance use, condom use, cultural norms, relationship communication, negotiation, and homonegativity. The existing studies provide evidence for preventing future HIV infection among low socioeconomic status Chilean males and begin to establish a positive relationship between self-efficacy and perceived HIV risk. While additional studies are needed to provide further support, self-efficacy and perceived risk should be integral aspects of future prevention interventions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136432PMC
January 2017

Development and psychometric evaluation of a condom use self-efficacy measure in Spanish and English.

HIV Clin Trials 2016 09 5;17(5):212-7. Epub 2016 Aug 5.

a School of Nursing and Health Studies , University of Miami , Coral Gables , FL , USA.

Background: Condom self-efficacy is an important construct for HIV/STI prevention and intervention. A psychometrically sound measure of the self-efficacy for using condoms that has been designed for Hispanic women to respond in Spanish or English is needed.

Objectives: The goal of this study was to develop and evaluate a brief self-report measure of condom use self-efficacy.

Methods: We developed a 15-item measure of condom use self-efficacy based on expert knowledge of measurement and HIV/STI prevention with Hispanic women using a translation-back translation approach. Participants were 320 Hispanic women from the Southeastern US.

Results: Internal consistency of the full measure was 92. A short form of the instrument with a subset of five items also had acceptable internal consistency, alpha = .80, and was significantly correlated with the full scale, rs = .93, p < .001. A single latent factor explained 9-48% of the variation in these items. Evidence of construct validity of the short form was provided by correlations of the scale with two self-report measures of condom use: rs = .34** with condom use, rs = .37** with condom use during vaginal sex.

Conclusions: Either the full measure or the five-item measure could be used in studies where condom use is an important behavioral outcome, such as evaluating prevention interventions, with Hispanic women. Future studies should examine the performance of this measure with other groups, including Hispanic men and members of other ethnic and language groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062954PMC
http://dx.doi.org/10.1080/15284336.2016.1213487DOI Listing
September 2016

Self-efficacy for HIV Prevention Among Refugee Hispanic Women in South Florida.

J Immigr Minor Health 2017 08;19(4):905-912

School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr., Miami, FL, 33146, USA.

The number of refugees increased in recent years due to factors worldwide, including violence, wars, political strife, and natural disasters. Refugees who are Hispanic women (RHW) in South Florida are a vulnerable population at risk of acquiring HIV infection. Although studies have shown a relationship between self-efficacy for HIV prevention and behavior changes, none have studied RHW. The purpose of this study was to assess whether predictors suggested by the literature were related to self-efficacy for HIV prevention in a sample of RHW. The study is a secondary analysis that uses baseline data from a randomized controlled experimental study, SEPA. A total of 99 refugee Hispanic women from South Florida, 18-50 years of age, participated in the study. There were two predictors of self-efficacy. HIV knowledge was positively related to self-efficacy, and living with a partner was inversely related to self-efficacy for HIV prevention. Culturally competent sexual health education interventions in this population may impact self-efficacy for HIV prevention.
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http://dx.doi.org/10.1007/s10903-016-0462-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659853PMC
August 2017

Mujeres que Consumen Sustancias y su Vulnerabilidad frente al VIH en Santiago de Chile (Women Who Consume Substances and Their Vulnerability to HIV in Santiago of Chile).

Hisp Health Care Int 2016 06 10;14(2):89-93. Epub 2016 May 10.

Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.

Introduction: Women represent 15% of the people living with HIV in Chile. Risk behaviors for HIV are: multiple partners, unsafe sex, and exchange of sex for drugs/money.

Methodology: A correlational design was used. A sample of 203 women who were sexually active and consumed substances within the last 3-months were selected for this study.

Results: The average age of the participants was 32.4 years (SD = 9.2) and 68.1% were housewives. The substance most commonly used was alcohol (95.1%) and marijuana (49.8%); 23.7% of the women were drunk or drugged before having sex; 74.4% had multiple sexual partners and 95.6% had unprotected sex. There is a significant correlation (p < 0.05) between substance abuse and HIV risk behaviors.

Conclusion: It is necessary to develop more research to understand in depth the relationship between substance use and HIV risk among Chilean women. It is important to consider the use of substances to develop and implement HIV prevention programs in the Chilean community.
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http://dx.doi.org/10.1177/1540415316647978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715660PMC
June 2016

Factores que Influencian la Adquisición de Infecciones de Transmisión Sexual y VIH en Mujeres Jóvenes Chilenas que Participaron en la Intervención Online I-STIPI (Factors That Influence the Acquisition of Sexually Transmitted Infections and HIV in Chilean Young Women Who Participated in the Online Intervention I-STIPI).

Hisp Health Care Int 2016 03;14(1):47-56

School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.

The aim of this descriptive cross-sectional study was to investigate the following factors associated with sexually transmitted infections and human immunodeficiency virus prevention: (a) knowledge, (b) attitudes, (c) self-efficacy, (d) vulnerability, (e) risky behaviors, (f) preventive behaviors, and (g) internet use among 40 Chilean women between 18 and 24 years who participated in the pilot of an Internet based STI/HIV prevention intervention (I-STIPI). A structured questionnaire available in a secure website was used for data collection and it included questions related to STI and HIV prevention. The results of the study indicated that young women are at risk of acquiring STIs and HIV and have special needs for prevention. Familiarity and frequency of use of internet in this population can be used for STIs and HIV prevention.
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http://dx.doi.org/10.1177/1540415316629682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715657PMC
March 2016

Exploring the Masculine Identity in the Context of HIV Prevention in Chile.

J Nurs Scholarsh 2016 Mar;48(2):128-38

Beta Tau, Dean and Professor, School of Nursing and Health Studies, University of Miami, FL, USA.

Purpose: This study aims to describe human immunodeficiency virus (HIV)-related knowledge and beliefs, as well as understanding attitudes towards masculinity in the context of HIV prevention, held among Chilean men.

Design: This study reports the qualitative findings of a sequential qualitative-quantitative mixed methodology study: Bringing men into HIV Prevention in Chile, NIH R01 TW007674-03.

Methods: Twenty in-depth interviews using a qualitative, descriptive approach to elicit information for the study were conducted among men residing in two communities of low socio-economic status in Santiago, Chile.

Findings: Content analysis of interviews revealed three main themes regarding machismo and how it relates to HIV: sexuality and machismo, the changing nature of machismo, and violence against women.

Conclusions: Addressing HIV and intimate partner violence through developing education programs tailored to meet the needs of Chilean men are needed to include men in HIV prevention efforts.

Clinical Relevance: Specifically, incorporating ideas of what men consider healthy masculinity and working to destigmatize men who have sex with men are important steps in addressing the negative aspects of machismo.
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http://dx.doi.org/10.1111/jnu.12190DOI Listing
March 2016

Mothers in Substance Abuse Recovery: Perspectives on Motivators, Challenges and Family Involvement.

Int J High Risk Behav Addict 2016 Mar 17;6(1). Epub 2016 Feb 17.

School of Nursing and Health Studies, University of Miami, Miami, USA.

Background: Most women in substance abuse treatment are of childbearing age, and many of them have children who both are affected by and influence the mother's substance abuse and treatment behaviors.

Objectives: This qualitative study (n = 13) was conducted in two drug treatment centers in southern Florida and explored the perspectives of mothers currently or recently in substance abuse treatment regarding their recovery motivators and challenges, as well as their attitudes and preferences regarding family involvement in their treatment.

Patients And Methods: We used a qualitative descriptive approach. In-depth interviews were conducted with the participants and centered on 3 major themes: (a) motivators for recovery, (b) challenges for recovery, and (c) attitudes and preferences for family involvement in recovery.

Results: Findings revealed that family plays an important role in the recovery of these mothers, and that mothers are willing to incorporate their families in their recovery process. Women expressed a positive attitude towards family therapy, and they believed that it could benefit their recovery, and their relationship with their children and families.

Conclusions: The findings of this study can contribute to the development of a family-based substance abuse treatment aftercare intervention that might benefit women in substance abuse treatment.
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http://dx.doi.org/10.5812/ijhrba.32558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412135PMC
March 2016

Developing and testing an online breastfeeding training among undergraduate nursing students.

Clin Nurs Stud 2015 1;3(1):82-88. Epub 2014 Dec 1.

School of Nursing and Health Studies, University of Miami, Coral Gables, USA.

The benefits of breastfeeding for mothers and babies have been well documented in the scientific literature, with new evidence about the benefits continuing to emerge. The Surgeon General's call to action to support breastfeeding recommends mandatory breastfeeding education and training for all healthcare providers that deliver care to mothers and babies. The purpose of this study is to analyze the development of an online computer based breastfeeding training (BT) and the preliminary outcomes of this training. The development of this training included consultation with content and technology experts. The collection of preliminary outcomes related to breastfeeding knowledge data and evaluation of the online BT was pre and posttest study. Eighty six undergraduate nursing students completed the online BT using Blackboard Learn. The online component of the BT consisted of five modules with a combined length of approximately 16 hours. After the completion of the modules, the students increased their levels of knowledge related to breastfeeding and the majority believed that they were fully able to perform skills to support breastfeeding. The results of this study indicate that a successful BT for nursing students can be effectively designed, which can in the future be disseminated to other healthcare providers and students. In addition, this online BT was cost-efficient and effective in improving students' knowledge and skills to support breastfeeding.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069066PMC
http://dx.doi.org/10.5430/cns.v3n1p82DOI Listing
December 2014

Pilot testing an internet-based STI and HIV prevention intervention with Chilean women.

J Nurs Scholarsh 2015 Mar 19;47(2):106-16. Epub 2014 Nov 19.

Beta Tau, Assistant Professor of Clinical, School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.

Purpose: The incidence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is high among young Chilean women, and there are no STI or HIV prevention interventions available to them that incorporate technology. The purpose of this study was to investigate the preliminary efficacy of an Internet-based STI and HIV prevention intervention (I-STIPI) for Chilean young women on measures of STI- and HIV-related information, motivation, behavioral skills, and preventive behaviors.

Design: This is a pretest-posttest study. Forty young Chilean women between 18 and 24 years of age participated in an investigation of the I-STIPI's preliminary efficacy on STI and HIV prevention-related outcomes between baseline and a postintervention assessment. The intervention consisted of four online modules. Data collection was conducted in Santiago, Chile. Paired-samples t test analysis was used to determine whether there were significant differences in each of the outcome variables.

Findings: After receiving I-STIPI, women reported a significant increase in levels of STI- and HIV-related knowledge, attitudes toward the use of condoms and perceived self-efficacy, and a reduction of risky sexual behaviors with uncommitted partners.

Conclusions: The I-STIPI showed promise as an Internet-based intervention that can reduce barriers to accessing preventive interventions and increase STI and HIV preventive behaviors in young Chilean women.

Clinical Relevance: The study provided important information about the ability of an Internet-based intervention to reduce young women's risk factors and to provide positive preliminary efficacy on STI- and HIV-related outcomes. Internet-based interventions can eliminate many barriers to receiving prevention interventions and may prove to be cost effective.
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http://dx.doi.org/10.1111/jnu.12114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535713PMC
March 2015

Relevance of biofilms in the pathogenesis of Shiga-toxin-producing Escherichia coli infection.

ScientificWorldJournal 2013 12;2013:607258. Epub 2013 Nov 12.

IMBIV, CONICET y Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, 5000 Córdoba, Argentina.

The present study was designed to determine the relationships among biofilm formation, cellular stress and release of Shiga toxin (Stx) by three different clinical Shiga toxin-producing Escherichia coli (STEC) strains. The biofilm formation was determined using crystal violet stain in tryptic soy broth or thioglycollate medium with the addition of sugars (glucose or mannose) or hydrogen peroxide. The reactive oxygen species (ROSs) were detected by the reduction of nitro blue tetrazolium and reactive nitrogen intermediates (RNI) determined by the Griess assay. In addition, the activities of two antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT), were studied. For the cytotoxicity studies, Vero cells were cultured with Stx released of STEC biofilms. The addition of sugars in both culture mediums resulted in an increase in biofilm biomass, with a decrease in ROS and RNI production, low levels of SOD and CAT activity, and minimal cytotoxic effects. However, under stressful conditions, an important increase in the antioxidant enzyme activity and high level of Stx production were observed. The disturbance in the prooxidant-antioxidant balance and its effect on the production and release of Stx evaluated under different conditions of biofilm formation may contribute to a better understanding of the relevance of biofilms in the pathogenesis of STEC infection.
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http://dx.doi.org/10.1155/2013/607258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845835PMC
June 2014

Unique factors that place older Hispanic women at risk for HIV: intimate partner violence, machismo, and marianismo.

J Assoc Nurses AIDS Care 2013 Jul-Aug;24(4):341-54

School of Nursing and Health Studies, University of Miami, Florida, USA.

Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal-postmenopausal-related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention.
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http://dx.doi.org/10.1016/j.jana.2013.01.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870152PMC
October 2013

Hemolysin from Escherichia coli induces oxidative stress in blood.

Toxicon 2013 Aug 6;70:15-20. Epub 2013 Apr 6.

Department of Pharmacy, IMBIV-CONICET, Faculty of Chemical Sciences, National University of Córdoba, Haya de la Torre y Medina Allende, University Campus, 5000 Córdoba, Argentina.

Hemolysin (HlyA) produced by some stains of Escherichia coli is considered to be an important virulence factor of those bacteria. On the other hand, reactive oxygen species (ROS) have been reported to be involved in the pathogenesis of different diseases via oxidative stress generation. The purpose of this study was to analyze the capacity of HlyA to induce oxidative stress in whole blood cultures (WBCs). To this end, ROS production, the damage induced in lipids and proteins, and the antioxidant defense system was evaluated in blood cultures exposed to low concentrations of HlyA. We found that HlyA increased the level of free radicals detected by chemiluminescence assay. Moreover, lipid peroxidation and protein damage was significantly increased in cultures treated with HlyA in comparation with those found in control cultures. On the other hand, a decrease in total antioxidant capacity of plasma and in the activity of superoxide dismutase (SOD) was observed in plasma from blood treated with HlyA. Collectively, our data demonstrate that low concentrations of E. coli hemolysin induced oxidative stress in WBCs with the induction of different oxidative damage biomarkers.
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http://dx.doi.org/10.1016/j.toxicon.2013.03.014DOI Listing
August 2013

Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions.

Rev Lat Am Enfermagem 2012 May-Jun;20(3):612-8

Escuela de Enfermería, Pontificia Universidad Católica de Chile, Chile.

The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV. Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria. Research suggests that AAT/A is effective for different patient profiles, particularly children. Interaction with dogs has been found to increase positive behaviors, such as sensitivity and focus, in children with social disabilities. Decreased levels of pain have also been reported among child patients as a result of AAT/A. More research should be done in the area of children living with chronic diseases that require strict adherence to treatment, such as HIV, and on AAT/A's prospective use as an educational tool to teach children about the importance of self-care for their medical conditions.
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http://dx.doi.org/10.1590/s0104-11692012000300025DOI Listing
March 2013
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