No abstract

Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.

No abstract

Purpose: Rates of sexually transmitted infections among adolescents remain high in the United States and Botswana. Mobile phone density rates in Botswana exceed those of the United States. Yet, in both countries, safer sex information continues to be delivered primarily via face-to-face curricula such as Becoming a Responsible Teen and Living as a Safe Teen . While social media shows promise as a medium for delivering risk-reduction information to youth, few studies have been conducted in either country to assess its effectiveness. This study examines adolescents in both countries, their mobile phone and social media usage, and their perceptions of safer sex interventions delivered via social media. Design and methods: Three focus groups were conducted with 28 adolescents 13–18 years of age who lived in the United States (n=14) and Botswana (n=14). Data analysis was ongoing, which informed the data collection process. After the first group, no additional revisions were made to the focus group protocol. An abridged method of analyzing the data was employed. Results: Adolescents in all groups discussed peer pressure and connectedness with mobile phones and social media and had general knowledge of STIs and HIV. The adolescents agreed that adaptation of risk reduction interventions for mobile phone and social media delivery was warranted, and they shared ideas for adaptation. Practice implications: Our findings provide a starting point for researchers interested in developing a social media intervention with global implications for sexual health promotion.

No abstract

Botswana has the third highest rate of HIV infection, as well as one of the highest mobile phone density rates in the world. The rate of mobile cell phone adoption has increased three-fold over the past 10 years. Due to HIV infection rates, youth and young adults are the primary target for prevention efforts. One way to improve prevention efforts is to examine how risk reduction messages are disseminated on social media platforms such as Twitter. Thus, to identify key words related to safer sex practices and HIV prevention, we examined three months of Twitter data in Botswana. 1 December 2015, was our kick off date, and we ended data collection on 29 February 2016. To gather the tweets, we searched for HIV-related terms in English and in Setswana. From the 140,240 tweets collected from 251 unique users, 576 contained HIV-related terms. A representative sample of 25 active Twitter users comprised individuals, one government site and 2 organizations. Data revealed that tweets related to HIV prevention and AIDS did not occur more frequently during the month of December when compared to January and February (t = 3.62, p > 0.05). There was no significant difference between the numbers of HIV related tweets that occurred from 1 December 2015 to 29 February 2016 (F = 32.1, p > 0.05). The tweets occurred primarily during the morning and evening hours and on Tuesdays followed by Thursdays and Fridays. The least number of tweets occurred on Sunday. The highest number of followers was associated with the Botswana government Twitter site. Twitter analytics was found to be useful in providing insight into information being tweeted regarding risky sexual behaviors.

No abstract

No abstract