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. 2023 Sep 13;57(10):801-816.
doi: 10.1093/abm/kaad022.

A Systematic Review of Intervention Studies That Address HIV-Related Stigmas Among US Healthcare Workers and Health Systems: Applying a Theory-Based Ontology to Link Intervention Types, Techniques, and Mechanisms of Action to Potential Effectiveness

Bryan A Kutner  1 , Michael P Vaughn  2 , Rebecca Giguere  2 , Cristina Rodriguez-Hart  3 , Karen McKinnon  2   4   5 , Farnaz Kaighobadi  6 , Bimbla Felix  7 , Attisso Akakpo  8 , Francine Cournos  5 , Matt Mikaelian  9 , Justin Knox  2   4   10 , Daria Boccher-Lattimore  5 , Kimbirly A Mack  3 , Marian LaForest  11 , Theodorus G M Sandfort  2   4   10 ; STAR (Stigma and Resilience) Coalition Compendium Team
Collaborators, Affiliations

A Systematic Review of Intervention Studies That Address HIV-Related Stigmas Among US Healthcare Workers and Health Systems: Applying a Theory-Based Ontology to Link Intervention Types, Techniques, and Mechanisms of Action to Potential Effectiveness

Bryan A Kutner et al. Ann Behav Med. .

Erratum in

Abstract

Background: To end the HIV epidemic, we need to better understand how to address HIV-related stigmas in healthcare settings, specifically the common theoretical bases across interventions so that we can generalize about their potential effectiveness.

Purpose: We describe theory-based components of stigma interventions by identifying their functions/types, techniques, and purported mechanisms of change.

Methods: This systematic review examined studies published by April 2021. We applied a transtheoretical ontology developed by the Human Behaviour Change Project, consisting of 9 intervention types (ITs), 93 behavior change techniques (BCTs), and 26 mechanisms of action (MOAs). We coded the frequency and calculated the potential effectiveness of each IT, BCT, and MOA. We evaluated study quality with a 10-item adapted tool.

Results: Among the nine highest quality studies, indicated by the use of an experimental design, the highest potentially effective IT was "Persuasion" (i.e. using communication to induce emotions and/or stimulate action; 66.7%, 4/6 studies). The highest potentially effective BCTs were "Behavioral practice/rehearsal" (i.e. to increase habit and skill) and "Salience of consequences" (i.e. to make consequences of behavior more memorable; each 100%, 3/3 studies). The highest potentially effective MOAs were "Knowledge" (i.e. awareness) and "Beliefs about capabilities" (i.e. self-efficacy; each 67%, 2/3 studies).

Conclusions: By applying a behavior change ontology across studies, we synthesized theory-based findings on stigma interventions. Interventions typically combined more than one IT, BCT, and MOA. Practitioners and researchers can use our findings to better understand and select theory-based components of interventions, including areas for further evaluation, to expedite ending the HIV epidemic.

Keywords: Behaviour change wheel; HIV/AIDS; Health services; Stigma; Systematic review.

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Figures

Fig. 1.
Fig. 1.
Model of the relationship between ITs, BCTs, and MOAs intended to reduce HIV-related stigmas among healthcare workers and improve health outcomes
Fig. 2.
Fig. 2.
PRISMA identification of eligible intervention studies of HIV-related stigma reduction among healthcare workers and systems in the USA[49, 50]
See this image and copyright information in PMC

References

    1. Rueda S, Mitra S, Chen S, et al. . Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. BMJ Open. 2016; 6(7):e011453. - PMC - PubMed
    1. Bayat A-H, Mohammadi R, Moradi-Joo M, et al. . HIV and drug related stigma and risk-taking behaviors among people who inject drugs: A systematic review and meta-analysis. J Addict Dis. 2020; 38: 711–783. - PubMed
    1. Katz IT, Ryu AE, Onuegbu AG, et al. . Impact of HIV‐related stigma on treatment adherence: Systematic review and meta‐synthesis. J Int Aids Soc. 2013; 16: 18640. - PMC - PubMed
    1. Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009; 21: 742–753. - PubMed
    1. The White House: National HIV/AIDS Strategy for the United States 2022–2025. Washington DC; 2021. https://www.whitehouse.gov/wp-content/uploads/2021/11/National-HIV-AIDS-...

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