Publications by authors named "Rosina Cianelli"

65 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

Frailty in the Context of Older People Living With HIV: A Concept Analysis.

ANS Adv Nurs Sci 2021 Oct-Dec 01;44(4):340-356

School of Nursing and Health Studies, University of Miami, Coral Gables, Florida (Ms Iriarte and Drs Cianelli and De Santis); and School of Nursing, Pontificia Universidad Catolica de Chile, Santiago, Chile (Ms Iriarte and Dr Cianelli).

Despite advances in knowledge about older people living with HIV infection (PLWH), frailty remains a challenge to HIV care. Numerous studies have documented its impact; however, the concept remains unclear. Concept exploration of frailty in the context of older PLWH was conducted to provide a comprehensive understanding of the concept based on the Walker and Avant method. After the literature review, a concept analysis and a definition of frailty among older PLWH emerged. Implications for further practice, education, public policy, and research are presented to use the concept consistently, develop interventions to prevent frailty, and improve health outcomes.
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http://dx.doi.org/10.1097/ANS.0000000000000384DOI 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

Being Lost to Follow-Up to Healthcare Appointments: A Concept Analysis.

Nurs Sci Q 2021 10;34(4):430-439

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

The concept of being lost to follow-up is very common in healthcare. Though its meaning might seem literal, its use, particularly in healthcare, requires detailed analysis, to understand factors surrounding its incidence and ways of curtailing its detrimental consequences. Walker and Avant's eight-step concept analysis was used to identify the antecedents, attributes, empirical referents, and consequences of this concept. The attributes of the concept include a clinical starter event suffered by a patient that requires ongoing evaluation by an event tracker at a given location and frequency. However, despite a mutual agreement between the patient and the event tracker, the evaluation suffers a hiatus due to several modifiable and nonmodifiable risk factors (antecedents of the concept), consequences which might include morbidity and death. Early identification and intervention are critical to avoid the occurrence of being lost to follow-up, and nurses need to be cognizant of such knowledge.
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http://dx.doi.org/10.1177/08943184211031598DOI Listing
October 2021

The significance of breastfeeding practices on postpartum depression risk.

Public Health Nurs 2022 Jan 12;39(1):15-23. Epub 2021 Sep 12.

The University of British Columbia School of Nursing, BC, Canada.

Objective: Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD.

Design: A cross-sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model.

Results: Women currently breastfeeding (AOR = 0.87 CI: 0.79-0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates.

Conclusions: Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.
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http://dx.doi.org/10.1111/phn.12969DOI Listing
January 2022

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

Psychological Trauma in the Context of Intimate Partner Violence: A Concept Analysis.

Issues Ment Health Nurs 2021 Dec 7;42(12):1104-1113. Epub 2021 May 7.

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

A comprehensive understanding of psychological trauma in the context of intimate partner violence (IPV) is relevant for nurses and other healthcare providers to provide better care for individuals and families confronting this issue. A concept analysis based on Walker and Avant was conducted to fully understand this concept and its impact on physical and mental health. This concept analysis demonstrates that psychological trauma in the IPV context is an intricate multi-faceted concept that can have a significant long-term effect on individuals who have experienced IPV. The concept's attributes, antecedents, and consequences identified in this concept analysis will contribute to guiding practice, research, education, and policy development aimed to address the trauma affecting individuals and families in the context of IPV.
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http://dx.doi.org/10.1080/01612840.2021.1920651DOI Listing
December 2021

Social determinants of peripartum depressive symptoms among Black peripartum women living with HIV.

Arch Psychiatr Nurs 2021 02 23;35(1):102-110. Epub 2020 May 23.

University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, Miami 33143, United States of America. Electronic address:

HIV infection during pregnancy, may present risk of developing depression during pregnancy and postpartum. This psychiatric mood disorder, and many others such as anxiety and HIV-related post-traumatic stress disorder (PTSD) have been reported prevalent among pregnant and non-pregnant women living with HIV (WLWH). Multiple studies have found associations between social determinants of health and depressive symptoms in this population. However, despite deleterious effects on mother and child which may include suicidal ideations and infant death, only very few studies have examined this phenomenon for peripartum women, particularly Black women- a population prone to living in poor social and economic environments. Therefore, guided by the socio-ecologic model, this study examined predictors of peripartum depressive symptoms among Black peripartum WLWH. The study was a secondary data analysis of 143 Black women seen at special prenatal and women's health clinics in Miami, South Florida, USA. More than half of the women who experienced peripartum depressive symptoms (PDS) (n = 81, 57%) were of low socio-economic status. Low income was associated with increased odds of experiencing PDS. Women who endorsed intimate partner violence/abuse (IPV/A) were 6.5 times more likely to experience PDS; and compared to women with 1 or no childcare burden, women with 2 children-care burden were 4.6 times more likely to experience PDS. These findings demonstrate the negative impact of social factors on the psychological health of Black peripartum WLWH. Burdensome interpersonal relationships may have deleterious effects and trigger PDS among these women. Implications for nursing practice, education and research are also discussed.
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http://dx.doi.org/10.1016/j.apnu.2020.05.004DOI Listing
February 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

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

Chilean Health Care Providers' Perceived Comfort in Performing Oral Rapid Testing for HIV: A Cross-Sectional Study.

Hisp Health Care Int 2020 12 7;18(4):191-197. Epub 2020 Jan 7.

28033Pontifícia Universidad Católica de Chile, Santiago, Chile.

Objectives: To understand key factors influencing Chilean health care providers' perceived comfort performing oral rapid HIV testing.

Design: One hundred and fifty health care providers completed a self-administered questionnaire that included a five-item scale measuring self-perceived comfort in conducting HIV pretest counseling, oral rapid testing, finger-prick testing, and delivering test results.

Results: Most participants (60%) envisioned good overall comfort performing oral rapid HIV testing (mean score of 16.21; range 0-20), including doing at least four of the five steps. They perceived least comfort delivering HIV-positive test results during posttest counseling. HIV stigmatizing attitudes reduced self-perceived comfort.

Conclusions: Providing training to counter HIV stigmatization while increasing comfort in performing oral rapid testing would help facilitate its successful implementation.
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http://dx.doi.org/10.1177/1540415319896249DOI Listing
December 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

Health Literacy in Relation to Health Outcomes: A Concept Analysis.

Nurs Sci Q 2019 10;32(4):299-305

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

Health literacy is a concept discussed in the literature of many disciplines, but the definitions used are varied. Using the Walker and Avant method of concept analysis, the authors explore health literacy in relation to health outcomes-the defining attributes, antecedents, consequences, and empirical referents. In addition, cases are provided that illustrate health literacy in relation to health outcomes. This concept analysis allows for colleagues in nursing to have a better understanding of this concept and facilitates further development of tools to assess and improve health literacy and ultimately improve health outcomes overall.
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http://dx.doi.org/10.1177/0894318419864328DOI Listing
October 2019

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

Self-objectification in the context of breastfeeding: A concept analysis.

Public Health Nurs 2019 03 12;36(2):207-214. Epub 2018 Dec 12.

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

To increase the overall rate of breastfeeding initiation and duration, factors involved in a mother's decision to breastfeed must be identified. Self-objectification in the context of breastfeeding was a concept selected for exploring factors associated with negative views of breastfeeding. A concept analysis following the eight-step Walker & Avant method provides clarity and context to the concept of self-objectification in the context of breastfeeding. The antecedents of self-objectification in the context of breastfeeding include living in a culture of sexualization and objectification of women and the internalization of the values of objectification. Attributes of self-objectification in the context of breastfeeding are a prioritization of physical appearance attributes of the breast over the health benefits of breastfeeding and a preoccupation with physical appearance. Consequences include negative views toward breastfeeding initiation, duration, and public breastfeeding. A concept analysis on self-objectification in the context of breastfeeding will provide definition and clarity to this phenomenon, lend to theory and measurement, and add literature to the sociocultural factors impacting breastfeeding decisions.
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http://dx.doi.org/10.1111/phn.12570DOI Listing
March 2019

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

Cultural Integration Online: The Lived Experience of English-as-a-Second-Language RN-BSN Nursing Students Learning in an Online Environment.

Nurs Educ Perspect 2018 Jul/Aug;39(4):221-224

About the Authors Sonique Sailsman, PhD, RN, is Graduate Lead Faculty, Southern New Hampshire University Department of Nursing and Health Professions, Hooksett, New Hampshire. Marcella Rutherford, PhD, MBA, MSN, is dean, Nova Southeastern University College of Nursing, Davie, Florida. Melissa Tovin, PhD, PT, is associate professor, Physical Therapy Program, Nova Southeastern University. Rosina Cianelli, PhD, MPH, RN, IBCLC, FAAN, is associate professor, University of Miami School of Nursing and Health Studies, Miami, Florida. For more information, contact Dr. Sailsman at

Aim: The aim of this study was to explore the lived experience of RN-BSN English-as-a-second-language (ESL) nursing students who are engaged in learning online.

Background: Enrollment in RN-BSN degree completion programs has increased in the last several years, leading to a rise in program offerings online. There is limited research about the experiences of students who speak ESL.

Method: Ten individual interviews were conducted incorporating van Manen's methodological steps for exploring the lived experience.

Results: Through phenomenological reflection, five major themes emerged: understanding the online classroom, expressing culture online, alone but not lonely, writing as a surmountable barrier, and faculty role in the online journey.

Conclusion: RN-BSN ESL nursing students who pursue their degree online do so for convenience and flexibility. Exploring their lived experiences offered insight into their personal challenges and triumphs with integration, writing, and obtaining support for success.
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http://dx.doi.org/10.1097/01.NEP.0000000000000301DOI Listing
September 2019

Women's and Healthcare Workers' Beliefs and Experiences Surrounding Abortion: The Case of Haiti.

J Nurs Scholarsh 2017 03 1;49(2):170-176. Epub 2017 Feb 1.

Alpha Lambda & Beta Tau, Associate Professor, Pontifica Universidad, Catolica de Chile Escuela de Enfermeria, Macul, Santiago, Chile.

Purpose: Women in developing countries usually encounter serious inequities in terms of women's health. To date, there is limited understanding of abortion from the perspective of Haitian women. As a limited-resource country, Haiti faces complex social issues and healthcare challenges. With abortion being illegal, many adult and teenage women seek clandestine abortions. The aim of this study was to explore and gain a greater understanding of women's and healthcare workers' beliefs and experiences about abortion in Haiti.

Methods: Descriptive qualitative design was used to elicit information for the study. Eight focus groups were conducted with Haitian women and healthcare workers in five communities in the south of Haiti: Les Cayes, Aquin, St. Louis du Sud, Cavaillon, Maniche, and Ile a Vache. Participants were purposively selected and consented to participate and to be tape recorded. Content analysis followed using the verbatim transcripts, with triangulation of four researchers; saturation was reached with this number of focus groups.

Findings: The transcripts revealed six main themes regarding beliefs and experiences about abortion in Haiti: cultural aspects, consumers, perils of care, and legal concerns. Both women and healthcare workers discussed the repercussions of illegal abortion and the role of the government and hospitals. Participants identified similar perils and complications of unsafe abortions, such as postpartum hemorrhage and infection.

Conclusions: Results showed an urgent need to create a public health response that addresses different dimensions of abortion by engaging women and healthcare providers in rapid and concrete actions that promote access and safe care of women. It is imperative to conduct more research related to abortion in order to examine other associated factors to better understand the links between abortion and sexual health disparities among Haitian women. These results highlight the need for a rapid response to the need of this vulnerable group, who are experiencing high rates of mortality. This can also serve as a directive to approach this issue in other developing countries in the Caribbean region, particularly from its clinical relevance.

Clinical Relevance: Unsafe abortions are prevalent in developing countries; yet limited research exists on the topic. It is paramount to gain an understanding of the women's and healthcare workers' beliefs and experiences surrounding abortion, in order to develop interventions that prevent abortion complications in Haitian women.
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http://dx.doi.org/10.1111/jnu.12278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621786PMC
March 2017

Predictors of readiness for oral rapid HIV testing by Chilean health care providers.

Rev Panam Salud Publica 2016 Nov;40(5):363-370

Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Objective: This study identified the personal characteristics that affect Chilean health care providers' readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence-based practice (EBP).

Methods: Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test.

Results: Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean "readiness to implement ORT" score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT.

Conclusion: The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers' readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile's capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.
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November 2016

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

Social Determinants of Depression Among Hispanic Women.

J Am Psychiatr Nurses Assoc 2017 Jan/Feb;23(1):28-36. Epub 2016 Sep 19.

5 Nilda Peragallo, DrPH, University of Miami, Coral Gables, FL, USA.

Background: Depression is the number one cause of disability in the world. Hispanic women are at a higher risk for depression than Caucasian and African American women. This is in part due to multiple social determinants of health that affect the individual, family, aggregates, and community.

Objective: To investigate the social determinants of depression among Hispanic women in South Florida.

Design: This is a secondary cross-sectional data analysis. A total of 280 Hispanic women from South Florida between 18 and 50 years of age were analyzed.

Results: Depression is prevalent among Hispanic women in South Florida (37.5%). Education, health status, and living with partner were significant predictors of depression in the sample.

Conclusion: Development of a culturally tailored risk assessment tool that highlights the social determinants of depression in Hispanic women is essential, as it could be used as a standard practice in primary care and other appropriate settings.
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http://dx.doi.org/10.1177/1078390316669230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621785PMC
February 2018

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
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