Division of Health Science, Florida A&M University, 334 Palmer Avenue, Tallahassee, FL, 32307, USA.
Dept of Communication Studies, University of Miami, 5100 Brunson Dr, Coral Gables, FL, 33146, USA.
Soc Sci Med. 2023 Jun;327:115945. doi: 10.1016/j.socscimed.2023.115945. Epub 2023 May 12.
Black women in the Southern U.S. account for 67% of all new HIV diagnoses across women of all races and ethnicities. In comparison to women of other racial and ethnic identities, Black women disproportionately experience internalized stigma, lower levels of disclosure self-efficacy, and lower rates of medical adherence. The disclosure processes model hypothesizes that persons living with HIV can be disclosure avoidance oriented or disclosure approach oriented. Disclosure avoidance is facilitated by various forms of stigma and negative outcome expectations. While disclosure approach orientation is facilitated by factors such as positive disclosure attitudes and disclosure self-efficacy. Despite the important role of disclosure in ending the HIV epidemic, extant interventions are limited. Recent research suggests entertainment-education (EE) may be an effective intervention for HIV status disclosure. Entertainment-education is a persuasive strategy that consists of intentionally embedding health and social messages into entertaining content.
The present study evaluated the comparative efficacy of the 90 DAYS film for improving internalized HIV stigma, disclosure beliefs, positive disclosure attitudes, disclosure self-efficacy, HIV disclosure intentions, and medical adherence intentions. A randomized controlled trial was employed consisting of 130 Black women living with HIV in the Southern U.S. Participants were recruited primarily via a Qualtrics panel and randomly assigned to either view the 90 DAYS film or a standard of care brochure.
Results indicated the EE condition significantly outperformed the brochure condition on the following outcomes: disclosure beliefs (p = .046), positive disclosure attitudes (p = .008), disclosure self-efficacy (p = .007), and intentions to disclose to an intimate partner (p = .038). Statistically significant differences were not observed for internalized stigma or medical adherence intentions.
Findings suggest that EE is an effective strategy for improving psychosocial influences of disclosure and disclosure intentions. Theoretical and practical implications of this work are discussed.
在美国南部，黑人女性占所有种族和族裔女性新 HIV 诊断病例的 67%。与其他种族和族裔身份的女性相比，黑人女性不成比例地经历内在污名、较低的披露自我效能感和较低的医疗依从率。披露过程模型假设，艾滋病毒感染者可以是披露回避取向或披露接近取向。披露回避通过各种形式的污名和负面结果预期来促进。而披露接近取向则由积极的披露态度和披露自我效能感等因素来促进。尽管披露在结束艾滋病毒流行中起着重要作用，但现有的干预措施有限。最近的研究表明，娱乐教育（EE）可能是 HIV 状况披露的有效干预措施。娱乐教育是一种有说服力的策略，它将健康和社会信息有意地嵌入到娱乐内容中。
本研究评估了 90 天电影在改善内在 HIV 耻辱感、披露信念、积极披露态度、披露自我效能感、HIV 披露意向和医疗依从意向方面的比较效果。采用随机对照试验，包括美国南部 130 名感染艾滋病毒的黑人女性。参与者主要通过 Qualtrics 小组招募，并随机分配观看 90 天电影或标准护理手册。
结果表明，在以下结果方面，EE 组明显优于手册组：披露信念（p=0.046）、积极的披露态度（p=0.008）、披露自我效能感（p=0.007）和向亲密伴侣披露的意向（p=0.038）。内在污名或医疗依从意向没有观察到统计学上的显著差异。
研究结果表明，EE 是改善披露的社会心理影响和披露意向的有效策略。讨论了这项工作的理论和实践意义。
