Timely linkage to HIV care and treatment has led to improved individual and population benefits; however, 25%-31% of people diagnosed with HIV do not engage in care. Most linkage to care research has focused on larger metropolitan areas, but smaller metropolitan and rural areas encounter unique challenges to linkage to care. Our purpose was to examine factors influencing the decision to seek care by 27 people infected with HIV living in smaller metropolitan and rural areas of Florida. We used grounded theory methods to develop a theoretical model describing the decision-making process and participant recommendations within the context of stigma. Participants described support, defining care, activating care, conflicting messages of care, and pivotal events influencing the care decision. Findings highlight the complexities of HIV care and suggest a client-centered approach to address the multifaceted social and structural challenges people with HIV face in the journey from infection to care.
Introduction: Research on the physical, psychosocial, and economic effects and coping mechanisms used by Black men from the time of prostate cancer (CaP) diagnosis to survivorship is limited. The result of the limited research on CaP care and survivorship (CaPCaS) is lack of tailored behavioral intervention programs focused on assisting Black men through the CaPCaS process. Using the principles of community engagement research, we (1) employed a Grounded Theory study design to develop a CaPCaS model for Black men and (2) developed and tested the efficacy of CaPCaS video documentary designed to assist newly diagnosed Black men in coping with their diagnosis and transitioning effectively through the CaPCaS process. Methodology: Black CaP survivors were identified through the Florida Cancer Data System. For aim 1, semistructured interviews were conducted to collect data from participants using audio, video, and Photovoice recordings on participants’ experiences on CaP prevention, detection, diagnosis, treatment, survivorship, and advocacy. Using an iterative process, we developed the CaPCaS model for Black men. For aim 2, we developed the CaPCaS video documentary based on the ethnographic data collected from aim 1. Subsequently, we tested the efficacy of the CaPCaS video documentary among Black men relative to assisting them across the CaPCaS process. Results: The study comprised 10,818 Black men diagnosed with CaP. Of the 10,818 participants, the birthplaces of 4,117 Black men were identified, which allowed us to classify them into three ethnic groups: US-born (63.5%), African-born (0.9%), and Caribbean-born (35.6%). We found significant differences among these men relative to smoking status, age at CaP diagnosis, and first-course therapy for CaP. To develop the CaPCaS model, we reached data saturation with 32 participants for the Grounded Theory study. The CaPCaS model that was developed represented the trajectory of CaP prevention, screening, diagnosis, treatment, survivorship, and advocacy. An unexpected unique theme that emerged is the Point of Prostate Cancer Diagnosis (PPCD) Model. The PPCD interpretative framework provides information that can be used by physicians to prepare for their PPCD consultation with Black men as well as develop a support system for Black men at the PPCD. We also developed CaPCaS video documentary for each of the CaP care continuum phases (see: https://www.dropbox.com/sh/c4g49x47n9jx2fp/AACHF8vnI_5H6MB00U3mN9rIa?dl=0 ). The videos were tested among 17 Black men. Satisfaction and quality were rated high for all 6 videos. In addition, there was improvement in the attitude, beliefs, perceived behavioral control, and knowledge of participants after the CaPCaS videos’ intervention. Conclusion: Through the Florida CaPCaS project, we have developed 6 video interventions based on the CaP experiences of ethnically-diverse Black men. The videos provide Black men the ability to connect with and learn from survivors who have gone through CaP diagnosis. This abstract is also being presented as Poster B013. Note: This abstract was not presented at the conference. Citation Format: Folakemi Odedina, MaryEllen Young, Getachew Dagne, Jennifer Nguyen, Ernest Kaninjing, Nissa Askins. Development of a prostate cancer care and survivorship intervention trial for ethnically diverse Black men [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr PR11.
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