Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA; HIV Prevention Project, Aasaman Nepal, Lalitpur, Nepal.
Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Farmington, CT, USA.
Front Public Health. 2016 Mar 31;4:61. doi: 10.3389/fpubh.2016.00061. eCollection 2016.
Historically, HIV prevention efforts in Nepal have primarily focused on heterosexual transmission, particularly, among female sex workers and their male clients, with little acknowledgment of the contribution of migrant workers to the epidemic. The very few HIV prevention efforts that have been attempted with migrants have been unsuccessful primarily due to stigma, discrimination, and insufficient availability of culturally relevant evidence-based interventions (EBIs). As an initial step toward addressing this unmet need, we conducted formative research aimed at adapting an evidence-based HIV risk-reduction intervention for implementation among migrants in Nepal.
Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews with members of the target population and key stakeholders. Between July and August, 2014, we conducted structured one-on-one interview with migrants (n = 5) and key stakeholder (e.g., counselors, field workers, and project coordinator; n = 5), which focused on the HIV risk profiles of the migrants and on ways to optimize intervention content, delivery, and placement within the community-based settings. Data analysis followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis, cross-case analysis, and analytical coding of textual data.
Based on formative research, we adapted the Holistic Health Recovery Program, an EBI, to consist of four 30-min sessions that cover a range of topics relevant to migrants in Nepal. The intervention was adapted with flexibility, so that it could be provided in an individual format, implemented within or outside the community-based organization, and it can be delivered in either consecutive or weekly sessions based on time constraints.
This paper provides a detailed description of the formative research process in preparation for the adaptation of an EBI - taking into account both empirical evidence and input from target population and key stakeholders - for use with migrants in Nepal. We hope that this study will help to inform similar work in the future as a growing number of EBIs have become widely available, but may not yet be in optimal form for implementation in real-world community-based settings.
历史上，尼泊尔的艾滋病毒预防工作主要集中在异性传播上，特别是在性工作者及其男性顾客中，而对移民工人对艾滋病的贡献则认识不足。为数不多的针对移民工人的艾滋病毒预防工作之所以没有成功，主要是因为耻辱、歧视以及缺乏文化相关的循证干预措施（EBIs）。作为解决这一未满足需求的初步步骤，我们进行了形成性研究，旨在为尼泊尔的移民实施基于证据的艾滋病毒减少风险干预措施。
我们的形成性工作包括对既定的 EBIs 进行批判性审查，并结合通过对目标人群和关键利益攸关方成员进行结构化访谈获得的数据，对相关出版物进行补充。2014 年 7 月至 8 月，我们对移民（n=5）和关键利益攸关方（如顾问、实地工作者和项目协调员；n=5）进行了结构化的一对一访谈，重点关注移民的艾滋病毒风险概况以及优化干预内容、交付和在社区环境中的安置方式。数据分析采用了多种定性数据分析技术，包括归纳分析、跨案例分析和文本数据的分析编码，遵循主题分析方法。
基于形成性研究，我们改编了 Holistic Health Recovery Program，这是一种 EBI，由四个 30 分钟的单元组成，涵盖了与尼泊尔移民相关的一系列主题。该干预措施具有灵活性，可以以个人形式提供，在社区组织内外实施，也可以根据时间限制以连续或每周的形式进行。
本文详细描述了形成性研究过程，为在尼泊尔移民中使用 EBI 做准备，同时考虑到实证证据和目标人群和关键利益攸关方的意见。我们希望本研究将有助于为未来的类似工作提供信息，因为越来越多的 EBIs 已经广泛可用，但在实际的社区环境中实施时可能还不是最佳形式。
