healt believe model

7/24/2019 healt believe model

1/11

1992; 1: 265-274

groups: a humanistic means of evaluating an HIV/AIDS

C A R O L E S C H R O E D E R RN,MS

Doctoral Candidate, Researeh Coordinator, Denver Nursing Project in Human Caring: Seni

Instruetor, University of Colorado Health Seienees Center

R U T H M . N E I L R N ,PhD

Project Director, Denver Nursing Project in Hum an Caring: Assistant P rofessor, University

of Colorado Health Seienees Center

Accepted for publication 3 May 1992 ' ..-.

S u m m a r y ' ' ' '

This qualitative study utilized focus group methodology to evaluate

strengths and weaknesses of a nurse-directed HIV/AIDS facility based on Je

Watson's theory of human caring (1985a,b, 1988, 1990).

The focus group method proved to be a humanistic means of evaluat

consumer satisfaction congruent with Watson's theory of human caring.

Different conce rns of research informants in different stages of th e H I V / A I

.,l,j,. f disease process were elicited; in addition, many of the informants elected to

their stories of living with HIV/AIDS. These stories were profoundly mov

and informative regarding the realities of l iving with HIV/AIDS in an und

prepared social an d health-care system.

A consistent theme emerging from the data was the high value the clie

placed on the caring behaviour shown by nursing staff.

This study was th e beginning of an empirical validation of the tenets

Watson's theory of human caring in nursing, and demonstrated the applicabi

of caritig theory in practice.

Keywords:

HIV, AIDS, qualitative research, focus groups, caring, consumeri

'' ^ ''

e (A ID S) have been recognized for over 10 years,

a vaccine or definitive cure continue to he

In a desire to offer innovative, health-orientated

an d services topeople l iving with HIV/AIDS, nurses

CaroleSchroeder, VAM C Building 5, 1055 Clermont

, Denver, CO 80220, USA

in a large western American city founded a nurse-manag

out-patient facility (Center) dedicated to this populati

The Center was initially supported by a co-operat

agreement between three local hospitals and a univers

school of nursing. In the Center's second yearof operati

th e US Department of Health and Human Servic

Division of Nursing, granted substantial funds to incre

client access to nursing services at the Center . The Cen

records 350-400 client visits per month; most ofthe clie

are homosexual men living with HIV/AIDS. Fewer th

5 % of theclientsutilizing the Center todate are female


2/11


3/11

Evaluating an HIV /AID S programme

patients '

ing (Larson , 1984, 1987; Johnso n Rie -

1986; Swa nson-K aufman , 1986; M ayer, 1987;Clay-

ernandez, 1991, among others). Other research

xplored how the bond s of caring relationship between

et al,

1991). Bottorff

to understand more fully

/AID S a t tendinganurse-managed ou t-patient centre.

In the initial design of this study, eliciting informants'

attempt to

categorized as 'caring

exception,

of the focus group sessions described caring

the aspect they most valued about the C enter. As a

theory. i

g r o u p m e t h o d o l o g y

groups are an inductive method of qualitative

used to obtain information from inform ants'

view. As

& Zellers (1989), focus groups

a process whereby groups can visualize and

Focus

are conducted in a natural environment in which

focuses discussion by listening, observ-

and collecting the information (Kreuger, 1988). '

Advantages of the method include low cost, social

dynamics of group interaction,

samplesize,and high facevalidity (Kreuger, 1988).

include convenience sampling, and because

validity of data generated, a tendency to

evaluating allsources of informa-

due to high face validity of informants' stories.

recommends that all data, whether from official

interviews, questionnaires, tests, and so forth,

care must be taken to evaluate all potential sources

information before implementing results.

TARGET POPULATION

The study population consisted of clients of the Cen

their families, friends and lovers, and professional staff

three hospital-based infectious disease (ID) clinics

referred clients to the Center. The total sample of

informants included three client groups (n=17),

group of family, friends and lovers of clients {n

=

4) ,

staffs of th e three infectious disease clinics of the th

hospitals which refer clien ts to the C ente r (n = 27).

staffs of the ID clinics were composed of nurses, p

icians,

social workers, administrators, nutritionists,

four graduate students in health-related professions.

addition, the Center nursing and administrative s

served as an initial pilot group in order to refine

methodology prior to implementing the research proje

Attetnpts to recruit a women's group were unsuccess

due to th e small numbers of women attending the Cen

The Center staff was particularly interested in eval

ing the ability of the Center to meet the needs of cli

experiencing different stages of HIV/AIDS disease p

cess. Increasing client satisfaction and access to the Ce

was another important objective of the research.

perceptions of family, friends and partners about

ability of the Center to meet their own and their signific

others' needs werealsostudied. Finally, the three refer

ID Clinic staffs were queried in relation to their perc

tions of strengths and weaknesses of the Center's ope

tions,and itsability to meet the needs of people living w

H I V / A I D S .

SAM PLIN G TECH NIQ UES . - - - - - -

Theoretical, nominated and convenience sampling te

niques were used to obtain informants. Criteria for cl

group parameters were developed from literature revi

regarding different stages of HIV/AIDS disease and d

ing meetings with Centerstaff. In group meetings, the s

of the Center discussed characteristics of potential cl

informants. In addition to similar stage ofdisease cha

teristics, group inclusion was based on perceived cl

willingness and health-related ability to participate in

focus groupprocess. The ID Clinic groups were compo

of all staff attending a regularly scheduled staff meeting

their respective hospitals.

After appropriate institutional review and appro

potential informants werecontacted by letter and/or ph


4/11

8 C.Schroeder and R .M . Neil

attheir

and each group had anaverageoffour or five

andlasted 1-2h. E ach session was co nducted

am asters ordoctorally prepared nurse mo derator and

to client informants, al-

to ID

Clinic groups.

No

or

videotaping

was

used. Instead,

the

assistant

and a gradua te research student both took

ofthe sessions.In

a flip chart towrite major

at the end of the sessionby

i

in the client groups were male. The sizeof

andeight inform-

while eachIDClinic group was composed of between

people. Client-informants were distributed into

the basis of stage of disease. Th ree client group s

theCenter), onefamily, friends and lovers group,and

aresumm arized inTables2an d3.

Professions ofthe clientinformants varied (inve stm ent

and so

forth),

but

most w ere retired and/o r

on

due to poor health. P ast health problem sand

in the

and acutely ill groups. A common

T a b l e 3 Dem ograph ics: acuteiy

newly diagnosed groups

1, long-term survivor, and

2 Gro up distribution

Inclusion criteria

Number

ill

persons

to

(3)

Living with AIDS >2

years, not acutely

ill at

present

Rect)vering from

an

opportunistic infectionor

evidencing progressive

disease

HIV

+

diagnosis

healt believe model

Documents