The purpose of this study was to examine the effect of perceived discrimination on Samoan health. This study employed purposive data collection and was conducted quantitatively using a questionnaire format, which measured everyday perceived discrimination, depression, and physical health.

Certain individual and institutional factors such as knowledge about stigma and discrimination, fear of infection, social judgement, legal and policy environment act as actionable drivers and facilitators of HIV-related stigma and discrimination. These factors may hinder the utilisation and quality of care provided to people living with HIV. Purpose: The purpose of the study was to establish the actionable drivers and facilitators that determine the different forms of HIV-related stigma and discrimination among healthcare professionals at a district hospital in Malawi. Methods: The study used a descriptive correlational study. Data was collected through self-administered questionnaire. Data were analysed using SPPS and STATA 12. Fisher's Exact Test was used to conclude the association and binary logistic regression was used to model the degree of the statistical relationships. Results: The results showed statistically significant relationship between knowledge of stigma and discrimination, social judgement and awareness of workplace policy and HIV-related stigma and discrimination. Recommendations: Interventions aimed at increasing knowledge about HIV-related stigma, reducing social judgement, reinforcing HIV-related workplace policies are needed to reduce HIV-related stigma and discrimination in healthcare settings. / Health Studies / M. Ph. (Health Studies)

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA / Health Studies / D.Litt. et Phil. (Health Studies)

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA / Health Studies / D.Litt. et Phil. (Health Studies)

Abstracts in English and Zulu / Immunisation is a cost-effective public health intervention that contributes to the attainment of the Sustainable Development Goals (SDGs). About 40% of children under the age of five years die from vaccine-preventable diseases in Nigeria. Routine immunisation has been quite low in Nigeria, where national coverage is estimated to be 33%, according to a 2016–2017 survey. This empirical research was aimed at determining the key socio-economic and gender determinants of immunisation in the Federal Capital Territory (FCT), identifying gaps and proffering solutions. Mixed methods of data collection and analysis were used. Data were gathered from several secondary sources and from 11 key informants using semi-structured interviews and 501 household and 26 health-facility surveys using questionnaires mounted on Open Data Kit. Lot quality assurance sampling and probability to population size methodology were used to size the samples and identify survey locations. Odds ratio analysis and logistic regression analysis were conducted to gauge the statistical association between the determinants and the coverage of immunisation. The main finding that was reached on the basis of the documents reviewed and the feedback received from the key informants was that they were gender blind at worst and gender neural at best. Most of the current strategies give little attention to socio-economic and gender barriers. Over 40 immunisation variables were identified. The analysis, particularly using the 2x2 odds ratio, yielded mixed results. The majority of the variables exhibited a close statistical association as far as immunisation indices were concerned. These variables included urban residency, married couples, literacy, birth at a health facility, antenatal care experience, vaccination card possession, immunisation knowledge, child health information, non-farming earnings, socio-economic status and tolerance of spouse beating. On the other hand, variables that were found to have no statistical significance included sex, marital status, marriage type, age, religion, tetanus toxoid (TT) vaccination and adequacy of income. Immunisation and gender are intertwined, particularly because of mothers’ biological and social attachment to their children. At the same time, conducting vaccination avails the opportunity to access almost all households. Moreover, it is important to recognise that socio-economic and gender determinants are not totally in control of one ministry. Single agenda interventions will not produce the desired result. A paradigm shift and the concerted effort of various sectors and partners are required. Therefore, the Nigerian government should galvanise the relevant stakeholders to bring gender and socio-economic variables into the mainstream throughout the immunisation ecosystem and to implement integrated development initiatives by prioritising vulnerable communities. / Ugonyo yindlela engcono yokungenela kwezempilo yabantu engathela esivivaneni ekufinyeleleni izinhloso zentuthuko eqhubekela phambili ezaziwa ngelokuthi yi- Sustainable Development Goals (SDGs). Cishe izingane ezifinyelela ku 40% ezingaphansi kweminyaka emihlanu zibulawa yizifo ezivimbelekayo ngomgcabo emitholampilo eNigeria. Ukugonya njalo kusezingeni eliphansi eNigeria, laphokhona ukwengamela kuzwelonke kulinganiselwa ku 33%, ngokuya kocwaningo olwenziwe phakathi kuka 2016-2017. Ucwaningo lokuthola ubufakazi lwalunenhloso yokubona imithelela yezesimo sabantu nomnotho (socio-economic) kanye nobulili ngokugonya kwi-Federal Capital Territory (FCT) ukubona amagebe kanye nokutholakala kwezixazululo. Amamethodi axubene okuqokelela ulwazi kanye nohlaziyo kwasetshenziswa. Ulwazi lwaqokelelwa ngokufunda imithombo yemibhalo (secondary sources) kanye nakubantu ababalulekile abanolwazi (key informants) abangu 11 ngokusebenzisa ama-semi-structured interview kanye nemizi engu 501 kanye namasurvey amafasilithi ezempilo angu 26 ngokusebenzisa uhla lwemibuzo yamaquestionnaire ebifakelwe kwi-Open Data Kit. Kwasetshenziswa nemethodi ye-Lot quality assurance sampling ne-probability, ngemethodoloji yobuningi babantu, ukwenza usayizi wamasampuli kanye nokubona izindawo okumele kwenziwe kuzo ama-survey. Kwenziwa nohlaziyo lwe-Odds ratio analysis kanye ne-logisic regression analysis ukubona ukuhambelana kwamastatistiki phakathi kwezinto eziwumthelela kanye nokunaba kongamelo lokwenziwa kogonyo. Okukhulu okutholakele ngokulandela amadokhumende okufundwe kuwo, kanye nezimpendulo ezivela kulabo abanolwazi ababalulekile (key informants) kube wukuthi bekungaboneleli ubulili (gender blind) kanti futhi bekungachemile ngokulandela ubulili (gender neutral) ngezinga elibi nangokungcono kakhulu. Amasu amaningi amanje awanakekeli kakhulu izihibe ezimayelana nabantu nezomnotho kanye nezobulili. Kwaphawulwa cishe izinto ezehlukene zama-variable ezingu 40 mayelana nogonyo. Uhlaziyo, ikakhulukazi ngokusebenzisa i 2x2 odds ratio, lwaveza imiphumela exubene. Ezinto zama-variable ehlukene eziningi zikhombise ukuhlobana phakathi kwamastatistiki mayelana namaindices ogonyo. Lama variable, abandakanye ukuhlala emadolobheni, abantu abashadile, ikhono lokubhala nokufunda, ukuzalwa kwezingane kumafasilithi ezempilo, izipiliyoni zonakekelo lwengane ngaphambi kokuzalwa, ukuba nekhadi lomgcabo ix wasemitholampilo, ulwazi ngogonyo, ulwazi ngempilo yengane, ukuthola imali ngemisebenzi engeyona eyokulima, isimo sabantu mayelana nezomnotho, kanye nokuqinisela ukuhlukunyezwa ngokushaywa kwabesimame. Kanti ngakolunye uhlangothi, ama-variable atholakale engenakho ukubaluleka ngokwamastatistiki, abandakanya ubulili, isimo ngokomendo, inhlobo yomendo, iminyaka yobudala, inkolo, umgcabo we-tetanus toxoid (TT), kanye nokwenela kwengeniso lemali. Ugonyo kanye nobulili kuyangenelana nokuhambelana, ikakhulukazi ngenxa yokusondelana komama kanye nezingane zabo. Ngaso leso sikhathi, ukwenziwa kogonyo kuhlinzeka ngethuba lokufinyelela cishe kuwo yonke imizi eminingi. Nangaphezu kwalokho, kubalulekile ukwamukela ukuthi isimo sabantu mayelana nezomnotho kanye nobulili kuyizinto ezinomthelela, azinalo ulawulo oluphelele kumnyango kangqongqoshe owodwa. Ungenelo ngento eyodwa ngeke kwaveza imiphumela efiswayo. Ukugudluka ngokomqondo (paradigm shift), kanye nemizamo eqhubekela phambili yemikhakha ehlukene kanye nabasebenzisani kuyadingeka. Ngakho-ke uhulumeni waseNigeria, kumele agqugquzele ababambiqhaza abafanele ukuhlanganisa nokufaka emkhakheni ofanele izinto ezimayelana nabantu nomnotho kanye nobulili, kuyo yonke inqubo yokusebenzisana kwemikhakha okumele isebenzisane nehlangene ukusebenza ngokulandela inqubo yentuthuko ehlangane ngokubonelela imiphakathi ekwizimo ezibucayi / Development Studies / D. Phil. (Development Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / A significant body of literature has accumulated in the last decade that provides evidence of the growing health care disparities among racial and ethnic groups in the United States. The literature suggests that Black adults share a disproportionate burden in death, disability, and disease. In 2002, the Institute of Medicine report, Unequal Treatment, showed that racial-ethnic disparities in health cannot be entirely attributed to problems of health care access, clinical performance, or patients’ personal characteristics. Many studies have shown that institutional and individual level discrimination that Blacks face in the health care system impacts their health status. This study used secondary data analysis to examine how primary care experience impacts self-reported health status and health care utilization among Black adults. Data were from the Medical Expenditure Panel Survey (MEPS) implemented by the Agency for Healthcare Research and Quality (AHRQ). Specifically, MEPS Panel 10 (2005-2006) and Panel 11 (2006-2007) data were used in the analyses. The final sample comprised of N=15,295 respondents ages 18 and over. Logistic regression analyses were carried out using Stata Statistical Software, version 11. The study results reflect the disparities among Blacks and Whites on self-reported health and health care utilization. Blacks were 15% less likely to report good health status compared to Whites and had 0.11 less expected office-based doctor visits. Respondents who had better primary care experience had 0.05 times higher expected office-based doctor visits than respondents who did not have good primary care experience. Health care Social Workers should advocate for structural changes in health policy that will take into account the historical marginalization and contemporary inequities that continue to encompass the lives of many Black Americans.

Indiana University-Purdue University Indianapolis (IUPUI) / While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.