PurposeThe current study examined the relationships between health-related quality of life (HRQOL) and social determinants of health (SDH), which are the individual and structural factors that contribute to health outcomes.MethodA hierarchical general linear model was used to assess the sequential effect of the SDH on the scores of the Short Form-12 among people living with HIV.ResultsResults show that many psychosocial, medical, demographic, financial, and vocational factors are significant predictors of HRQOL.ConclusionsGaining a deeper understanding of the impact of SDH on HRQOL is critical for rehabilitation counselors to develop effective assessments and interventions.
(1) Background: Secure employment has been recognized as a social determinant of health for people living with HIV (PLHIV), but limited research has been conducted to understand the employment needs and vocational decision-making process of those who are employed. The purpose of this study is to examine the applicability of the client-focused considering-work model to assess the employment outcomes and employment decision-making phases of a sample of employed PLHIV. (2) Methods: This study analyzed data of 244 employed PLHIV who completed National Working Positive Coalition’s Employment Needs Survey which included a 20-item Considering Work Scale-Employed version (CWS-Employed) and a single-item Classification of Employment Status Scale (CESS). Factor analysis was used to evaluate the CWS-Employed. Chi-square tests of homogeneity of proportions were conducted to assess the domain-specific needs of individuals in each phase of employment decision-making. (3) Results: Our findings revealed high rates of insecure employment and diverse vocational service needs among research participants. Additionally, the CWS-Employed accurately predicted 71% of the self-reported classification of phases of employment decision-making. (4) Conclusions: When investigating the role of employment as a social determinant of health, more research is needed to better understand the vocational needs and outcomes of PLHIV who are working. Improving the measurement of the phases of employment decision-making is needed to better identify appropriate vocational interventions that can lead to improved employment and related health outcomes for this population.
Targeted work readiness training is an important approach to help people living with HIV (PLHIV) to overcome their unique barriers to work, while addressing social determinants of health needs. This study assesses the psychosocial impacts of a work readiness training and internship program among HIV peer workers in New York City. From 2014 through 2018, 137 PLHIV completed the training program, and 55 individuals completed both the training and the six-month peer internship. Depression, HIV internalized stigma, self-esteem, HIV medication adherence, patient self-advocacy, and safer sex communication apprehension were used as outcome measures. Paired t-tests were performed to determine if significant score changes occurred at the individual level before and after each training. Our results show that participating in the peer worker training program significantly decreased depression and internalized HIV stigma, and significantly increased self-esteem, medication adherence, and patient self-advocacy. The study underscores that peer worker training programs are important tools to improve not only the work readiness of PLHIV, but also psychosocial and health outcomes. Implications for HIV service providers and stakeholders are discussed.
PurposeThe role of rehabilitation counseling in addressing major public health issues is an emerging area in the field. Despite higher rates of disease burden among currently or formerly incarcerated people, the syndemic effects of incarceration has received little attention. This article outlines how to think of incarceration from a syndemic perspective.MethodThe authors of this article draw upon syndemic theory to 1) describe the social determinants of health that lead to a greater risk of incarceration of people with substance use disorders (SUD), mental illness (MI), and infectious diseases (ID), 2) describe the syndemic impact of incarceration leading to more significant levels of disability for these populations, and 3) discuss implications for rehabilitation counseling professionals.ResultsThis article highlights that incarceration may interact synergistically in various syndemics, having an exacerbated health and economic effects on individuals who are/were incarcerated, their families, and communities.ConclusionsBy employing stigma reduction strategies, advocating for prevention and treatment services, and addressing social determinants of health, rehabilitation counseling professionals have a substantial role to play in mitigating the syndemic impact of incarceration on people with SUD, MI, and ID.
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