HIV Disclosure - Salem State University

Research In Social Work
Practice
Salem State University
School of Social Work
Session Four
Jeff Driskell, MSW, PhD
Today’s class
• Check-in/Announcements
• Lecture
▫ Problem formulation/statements
▫ Theory in research
Theory and Research
What is a Theory?
“systematically organized knowledge applicable
in a relatively wide variety of circumstances
devised to analyze, predict, or otherwise
explain the nature or behavior of a specified set
of phenomena that could be used as the basis of
action” ( Van Ryn and Henry, 1992)
Theories
• Composed of concepts/constructs and
assumptions
• Not static- evolving and undergo modification
• A good theory- can be tested, is parsimonious,
generalizable and has a level of predictive power
• Helps frame interventions, programs and
evaluation design
• Cost effective – Theory can show us what works
Theories cont…
• Help identify which factors/variables/concepts
should be targeted a
• Assist in defining expected outcomes
• Basing programs on tested theory gives scientific
support
• Assist in developing useful implications for
practice, research and policy
Theory in a nut shell
• WHY people are making decisions that put their
health at risk
• WHAT you need to know before
developing/implementing a program
• HOW to shape program strategies to make an
impact on individuals, groups, communities
• WHAT should be monitored, measured, or
compared in program evaluation
Social Cognitive Theory
• Concepts associated with this theory?
• Has this theory evolved over time? That is where
did it originate?
Application Example- What
Theory?
• Pathways to Housing Program
Theory Application: Reading
Assignments
• Eyrich, K., Pollio, D. and C. North. (2003). An
exploration of alienation and replacement theories
of social support in homelessness. Social Work
Research. Volume 27: Issue 4.
• Kriz, K., Slayter E., Iannicelli, A. and J. Lourie
(2012). Fear management: How child protection
workers engage with non-citizen immigrant
families. Children and Youth Services Review.
34(1), 316-323.
Problem Focus
The Research Process
Choose
Topic/Prob.
Present
Findings
Research
Questions
Interpret
Data
Design
Study
Analyze
Data
Collect
Data
Introduction to Problem
Formulation
Social work research and evidence-based
practice follow a similar process.
Both:
▫ Begin with problem formulation
− Generate, explore, and select alternative strategies for
solving problems
− Implement a chosen approach
− Evaluate
− Disseminate findings
Think of the Process as a Funnel
Broad Problem Area
Narrowing
Steps
Hypotheses
Problem statement/Rationale
Communicates the following; (these will vary
from research to research)
• The focus & importance of the problem (purpose and
rational)
• Population under investigation
• The context & scope of the problem (statistics)
• Additional information
▫ The variables under investigation
▫ Research questions/hypotheses (sometimes stated)
▫ Supported research design
Problem Area- FOCUS
Identify
Refine
Evaluate
Identifying a Problem Area
• Consider the following for guidance:
▫ Personal experience
 Parental divorce
 Grief- Loss of a family member
▫ Professional experience
 Volunteering
 DCF, Hospice
▫ Research
 Discussion section- future research and limitations
Refining a Problem Area
• Identify a specific population
▫ Teenage Homeless mothers ages 15-19
▫ Men in recovery from crystal meth
▫ Elders living in retirement communities
• Limit the number of research questions you
want to explore
• Select a theory/theories or model to provide you
with a framework
▫ Stress and coping theory
▫ Health Belief Model
Evaluating a Problem Area
• Feasibility
▫ Time
▫ Access to a population
▫ Funding
• Social importance
▫ Are your study questions geared towards
improving the well-being of others?
Evaluating a Problem Area cont…
• Is the problem of current interest?
• Will more information about the problem have
practical application?
• Will more information about the problem have
theoretical importance?
• How large is the population affected by the
problem?
Evaluating a Problem Area cont…
• Would this study substantially revise or extend
existing knowledge?
• Would research findings lead to some useful
change in best practice?
• Is there evidence or authoritative opinion from
others to support the need for this research?
Feasibility
©2011, Brooks/ Cole
Publishing, A Division of
Cengage Learning, Inc.
 Refers to the extent to which a study may be done
practically and successfully
 Feasibility is not always synonymous with
methodological rigor or inferential capacity
 Researchers must consider:
− Scope
− Time
− Fiscal cost
− Ethical issues
− Cooperation with research partners
− Study participants
24
In a Nut Shell
• Research should build on
and move beyond existing
work – or ask unanswered
questions
• Think about:
• What you are passionate about
in your work
• What bothers, worries or
confuses you most?
• Particular populations you are
interested in
• Hot issues in your area
practice?
• Is there substantial literature on
your problem area?
• Is the problem timely?
Problems to Questions
Research Questions
• Research questions provide a framework/
navigational path for your research.
• Research questions are questions you seek to
answer through the collection of data.
• Research questions will guide which research
design you will use, i.e. qualitative or
quantitative
Techniques for Narrowing A
Problem into a Research Question
• Examine the literature
▫ What are the gaps in knowledge?
•
•
•
•
Talk over ideas with others
Apply to a specific context and/or population
Identify specific variables of interest
Define the aims of the study
Problem Focus Example- HIV
Disclosure
1. Broad Problem area: HIV/AIDS
2. HIV among MSM
3. HIV infected MSM (access)
4. Prevention of HIV infected among MSM
5. HIV Disclosure (via counseling with these men)
6. (Self-efficacy)
7. (HIV Disclosure self-efficacy)
8. Barriers and facilitators of HIV disclosure
Example- HIV Disclosure
• Overarching research question: What are
the characteristics associated with HIV disclosure and
TRB among HIV-infected MSM?
• Research Question (quantitative)
▫ What are the characteristics associated with HIV disclosure and
transmission risk among HIV-infected MSM?
▫ What is the relationship between HIV disclosure and
transmission risk in high-risk HIV-infected MSM?
▫ How does HIV disclosure among HIV-infected MSM vary by
demographics, health characteristics, psychosocial factors and
sex partner characteristics?
Example cont…
• Research Question (qualitative)
▫ How do HIV infected MSM make decisions about
HIV disclosure to their sex partners?
▫ What are the barriers to HIV disclosure?
▫ What are the facilitators of HIV disclosure?
Study AIMS
• To examine the relationship between HIV disclosure and
transmission risk among HIV-infected MSM.
• To examine the relationship between participant demographics,
health characteristics, psychosocial factors and sexual partner
characteristics upon HIV disclosure.
• To examine the relationship between participant demographics,
health characteristics, psychosocial factors, and sexual partner
characteristics upon transmission risk.
Variables
Types of Variables
• Variable- A characteristic or property that can
vary.
▫ Independent (IV)- a variable that is
hypothesized to cause or lead a variation in
another variable.
▫ Dependent (DV)- a variable that is hypothesized
to vary depending on or under the influence of
another variable.
Types of Independent and
Dependent Variables
IV and DV
VARIABLES
Discrete
Continuous
Identifying Variables
Variables tend to be based on:
•
•
•
•
•
Knowledge
Opinions, feelings, attitudes
Behaviors
Demographics
Others?
Activity- Variable Application
Scenario: You are crafting a survey tool that can
be administered to individuals who are
participating in a study on substance use.
▫ First, identify at least 3 variables you would want
to assess as part of the survey tool.
▫ Second, develop 3 questions you might ask on the
survey that assesses those variables.
Mediating and Moderating
Variables
 A mediating variable is the mechanism
by which an independent variable affects a
dependent variable
Mediating Variable Diagram
Mediator Variable Example
Disclosure Selfefficacy
HIV Disclosure
HIV
transmission
Risk Behavior
Hypotheses
Definition of Hypothesis
Hypothesis- testable statements of presumed
relationships between two or more variables.
Types of relationships
Positive
Negative/Inverse
Curvilinear
Types of Relationships between Variables
Null Hypothesis…Huh?
“Postulates that the relationship being tested is
explained by chance…it does not actually exist in a
population or in a theoretical sense. Thus, when
our findings are show to be statistically
significant, we then reject the null hypothesis
because the probability that it is true…that our
results were caused by chance is less than our
level of significance”. (pp 578-579.)
Hypotheses in Action
Example 1- Wilkinson et al., (2008)
Hypotheses in Action
cont…
Example 2- Driskell, (2007)
Hypothesis:
Among HIV infected MSM HIV disclosure selfefficacy will be significantly and positively
related to HIV disclosure. HIV infected MSM
who have a stronger sense of HIV disclosure
self-efficacy will be more likely to disclose to
their sex partners.
Your Turn….
Example 3- As the number of stressors increase,
the number of depressive symptoms increases.
Example 4- As social support increases,
caregiver stress decreases.
Example 5- As years of education decreases,
income decreases.
Other Approaches to Hypothesis
Testing
• In stating hypotheses, you will not always be
required to indicate direction. For example:
▫ There will be a relationship between exam scores
and student anxiety.
Reading Reflection
• Meadows, L. A., Kaslow, J. J., Thompson, M. P.
& Jurkovic, G.J. (2005). Protective factors
against suicide attempt risk among African
American women experiencing intimate partner
violence. American Journal of Community
Psychology, 36(1/2), 109-121
Meadows et al., (2005)
An Example: Study aims,
research questions, and
hypotheses:
Study AIMS
• To examine the relationship between HIV disclosure and
transmission risk among HIV-infected MSM.
• To examine the relationship between participant demographics,
health characteristics, psychosocial factors and sexual partner
characteristics upon HIV disclosure.
• To examine the relationship between participant demographics,
health characteristics, psychosocial factors, and sexual partner
characteristics upon transmission risk.
Primary Hypotheses
• Primary Hypotheses
• H1. Among HIV-infected MSM disclosure of HIV status to sex
partners will be significantly and negatively related to HIV
transmission risk behavior. Such that, HIV-infected MSM who
disclose their HIV status to sex partners will be related to less
transmission risk behavior.
• H2. Among HIV-infected MSM HIV disclosure self-efficacy will be
significantly and positively related to HIV disclosure. HIV infected
MSM who have a stronger sense of HIV disclosure self-efficacy are
more likely to disclose to sex partners.
Exploratory Hypotheses
• Exploratory Hypotheses
• H3. Among HIV-infected MSM, HIV disclosure will be significantly
and positively related to age, education level and income. Such that,
those who are older, have more education and higher income will be
related to greater HIV disclosure to sex partners.
• H4. Among HIV-infected MSM, HIV disclosure will be significantly
related to indices of disease progression and antiretroviral
treatment. It is hypothesized that those with more advanced disease
(i.e., lower CD4, higher viral load, and longer time since diagnosis)
and not receiving ART will have significantly lower rates of HIV
disclosure.
Exploratory hypotheses cont…
• H5. Among HIV-infected MSM, age, education and substance use
will be significantly and negatively related to transmission risk
behaviors. Such that, those who report substance use, are younger,
are less educated will be associated with an increase in transmission
risk.
• H6. Among HIV-infected MSM, viral load and HAART will be
significantly and positively related to transmission risk. Such that
those with an undetectable viral load and on HAART will be
associated with an increase in transmission risk behaviors.
• H7: Men of color will report higher rates of transmission risk
behaviors compared to Caucasian men.
• H8: HIV-infected MSM who are single will be less likely to disclose
to their sex partners than HIV-infected MSM who are partnered.