Browsing by Subject "ecological"

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    Interpretations of Communication Experiences of Pharmaceutical-Sponsored Clinical Educators
    (2020-08) Barshinger, Timothy Allen; Bute, Jennifer J.; Matthias, Marianne; Petronio, Sandra G.; Jones, Josette
    This qualitative study explored the communication experiences of clinical educators who provide patient education on behalf of pharmaceutical company sponsors. It investigated how these educators navigate a medical encounter within the domain of three regulatory drivers—on-label compliance, fair-balance presentation, and adverse event reporting. The study used the ecological model of communication in medical encounters and the theory of Communication Privacy Management (CPM) as the lenses for interpreting the data. The main data were telephonic interviews with twenty-six clinical educators who delivered education services for pharmaceutical companies. Member checking, in the form of three post-interview focus groups, was also used. Seven themes emerged: (a) political/legal contexts factors greatly influenced clinical educators’ communication with patients; (b) the influence of factors within this contexts would frequently force educators to experience ethical dilemmas; (c) a new context, the disease and treatment context, emerged from the interviews as having significant influence in the conversation dynamics; (d) educators employed communication strategies to better navigate within the political/legal and disease and treatment context ecological factors; (e) educators believed they needed to establish and maintain trust throughout the engagement process for them to successfully solicit meaningful patient disclosures; (f) educators managed the information disclosed to them by patients using routinized rules as well as changing rules; and (g) educators managed multiple types of confidant roles with patients including stakeholder, deliberate, and reluctant. A main implication for this study is that educators feel ethically and morally bound to do whatever was necessary to avoid breaching the trust they established with patients. For some, this attitude prevailed over their obligation to deliver a compliant educational engagement. Hence, pharmaceutical companies need to recognize that for many of their clinical educators, the question of whether to be compliant is not a legal or policy matter. It is a moral and ethical issue. That being said, educators were also skilled at using communication strategies to navigate through the compliance and disease and treatment barriers that functioned as self-management barriers. Many of those skills often served to influence the way educators created privacy rules and managed privacy decisions related to their patient engagements.
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    Sexually transmitted infections in association with area-level prostitution and drug-related arrests
    (Wolters Kluwer, 2020-12-15) Magee, Lauren A.; Fortenberry, J. Dennis; Nelson, Tammie; Roth, Alexis; Arno, Janet; Wiehe, Sarah E.; School of Public and Environmental Affairs
    Objectives: Examine the mediators and moderators of area-level prostitution arrests and sexually transmitted infections (STI) using population level data. Methods Using justice and public health STI/HIV data in Marion County (Indianapolis), Indiana, over an 18-year period, we assessed the overall association of area-level prostitution and drug-related arrests and STI /HIV, and mediators and moderators of the relationship. Point-level arrests were geocoded and aggregated by census block group. Results: Results indicate a positive relationship between numbers of prostitution arrests and area-level STI rates. There was a dose-response relationship between prostitution arrests and STI rates when accounting for drug-related arrests. The highest quintile block groups had significantly higher rates of reported chlamydia (IRR: 3.29, 95% CI: 2.82, 3.84), gonorrhea (IRR: 4.73, 95% CI: 3.90, 5.57), syphilis (IRR: 4.28, 95% CI: 3:47, 5.29), and HIV (IRR: 2.76, 95% CI: 2.24, 3.39) compared with the lowest quintile. When including drug arrests, the second (IRR: 1.19, 95% CI: 1.03, 1.38) and the third (IRR: 1.20, 95% CI: 1.02, 1.41) highest quintile block groups had lower IRR for reported rates of chlamydia, indicating that drug arrests mediated the prostitution arrest effect. Conclusions: These findings inform public health agencies and community-based organizations that conduct outreach in these areas to expand their efforts to include harm reduction and HIV/STI testing for both sex workers and individuals experiencing substance use disorder. Another implication of these data is the importance of greater collaboration in public health and policing efforts to address overlapping epidemics that engage both health and legal intervention.