This paper describes the process of organizational global health capability development at the University of Maryland Baltimore over the past decade. Theories of organizational learning and of ...organizational capabilities are applied in this retrospective analysis of organizational innovations in global health education within UMB as well as in the University of Maryland School of Nursing.
Abstract Background Globally, nursing is the largest health profession. Nurses provide crucially important health services in both acute and primary health-care settings around the world. Building ...the capacity of nurses to address global health challenges—particularly in resource-constrained settings—is a key element of health systems strengthening. North–South global partnerships between sister schools of nursing can contribute to building the capacity of nurses on both sides of the partnership. We developed a strategy to build institutional capacity for global health at the University of Maryland School of Nursing (UMSON) and aimed to identify key elements of success. Methods We used a case study approach to identify and analyse the key elements in the successful implementation of UMSON's 6-year global health strategic plan to build institutional capacity for programmatic partnerships with nursing schools in Nigeria, Liberia, Rwanda, and Haiti, and faculty and student exchange programmes with schools of nursing in Africa, Asia, and the Middle East. Findings Four crucial elements were identified in successful programme implementation: (1) strong advocacy for global health by student and faculty organisations within UMSON and the University of Maryland Baltimore; (2) integration of global health into the School of Nursing's overall strategic plan; (3) establishment of the Office of Global Health to provide core institutional agency to leverage resources; and (4) development of strong partnerships with nursing schools in Africa, the Caribbean, Asia, and the Middle East, which includes faculty and student exchange programmes and long-term programmatic collaborations that focus on nursing capacity development. Interpretation The implementation of UMSON's strategic plan for global health has provided a sustainable institutional framework that supports the development of partnerships with other schools of nursing in several countries worldwide. These partnerships have provided mutually beneficial educational experiences for nursing students and faculty from both UMSON and our sister schools of nursing. These partnerships have also contributed to continuing changes in nursing education and practice at home and abroad. Funding None.
Abstract Purpose Parent–child communication is associated with positive outcomes for youths' engagement in sexual behaviors. Limited data are available regarding parent–child communication in ...transitional countries. We present data from Vietnamese parent–youth dyads on parent reproductive health (RH) knowledge, comfort of communication, frequency of talk, and discordancy between youths' reported and parents' perceptions for engagement in relationships and sexually intimate behaviors. Methods The cohort included 185 randomly selected parent–youth dyads in four communes in Hanoi and Khanh Hoa Province. Descriptive and comparative analysis included chi-squared tests, independent samples t -tests, and ANOVA. Linear regression analysis was used to assess relationships between parental knowledge, level of comfort, frequency of talk, and discordancy. Results Seventy-six percent of parents and 44% of youth were female. The mean age of youth was 17.2 years. The mean score for parental “RH knowledge” was 24.74 (SD, 3.84; range, 15–34). Lower parental RH knowledge was positively associated with lower levels of education ( F = 2.983; df , 184; p = .014). Data indicate a linear model in which knowledge is related to “comfort” (β = .17; p = .048), and “comfort” to frequency of “talk” (β = .6; p < .0001). Frequency of “talk” is not related to parents' discordant perceptions regarding their child's reported involvement in relationships (β = .002; p = .79) or sexual touching (β = .57; p = .60). Conclusions Parent and youth in Vietnam are engaged in limited communication about RH. There is a need for more data to assess the effect of these communication patterns on youths' engagement in sexual behaviors and for development of family-centered interventions to increase parental knowledge and skills for positive communication.
With an increase in sexual activity among young adults in Vietnam and associated risks, there is a need for evidence-based sexual health interventions. This evaluation of three sexual health programs ...based on the Protection Motivation Theory (PMT) was conducted in 12 communes in Ha Noi, Nha Trang City, and Ninh Hoa District. Inclusion criteria included unmarried youth 15–20 years residing in selected communes. Communes were randomly allocated to an intervention, and participants were randomly selected within each commune. The intervention programs included Vietnamese Focus on Kids (VFOK), the gender-based program Exploring the World of Adolescents (EWA), and EWA plus parental and health provider education (EWA+). Programs were delivered over a ten-week period in the communities by locally trained facilitators. The gender-based EWA program with parental involvement (EWA+) compared to VFOK showed significantly greater increase in knowledge. EWA+ in comparison to VFOK also showed significant decrease at immediate postintervention for intention to have sex. Sustained changes are observed in all three interventions for self-efficacy condom use, self-efficacy abstinence, response efficacy for condoms, extrinsic rewards, and perceived vulnerability for HIV. These findings suggest that theory-based community programs contribute to sustained changes in knowledge and attitudes regarding sexual risk among Vietnamese adolescents.
As rates of HIV increase in Vietnam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic ...changes. The authors report results from qualitative interviews with 159 Vietnamese adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. In the qualitative interviews, youths report a strong adherence to ideals and values regarding abstinence outside of marriage. Youths reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%; p = .000). A total of 15 of 32 (46.9%) sexually active youths reported rarely or never using condoms. Females had significantly higher scores for perceived sexual stigma than males (t = -10.22 95% confidence interval (CI); -3.72 to -2.52; p = .000) whereas males scored significantly lower than females on a scale of perceived self-efficacy for abstinence (t = 5.31 95% CI; .27 to .59; p = .000). The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence; however, these same values decrease adolescents' ability to obtain accurate information about sexuality and HIV and sexually transmitted infections and engage in safer sex.
As of April 2003, 64,801 HIV cases have been documented in Vietnam (Policy Project 2003), 53.9% of which are among individuals 20-29 years of age. Although HIV education efforts have increased, there ...remains a need for proven effective programs. We present findings from a randomized-controlled effectiveness trial of an HIV prevention program for adolescents 15-20 years. Four hundred eighty adolescents were randomized into control and intervention groups. Evaluation data were collected using the Vietnamese Youth Health Risk Behavior Instrument, including scales based on the protection motivation theory (PMT). Findings presented show significant differences in knowledge of severity and vulnerability of HIV/AIDS (p less than 0.05), perceptions of self-efficacy (p less than 0.001), and response efficacy for condom use (p less than 0.05) between control and intervention youth at immediate and 6-month postintervention. A significant difference was also found for response cost of condom use (p less than 0.05) at immediate postintervention. No significant difference was found for the construct of response cost at 6 months, and there were no significant differences for the constructs external and internal rewards. Reported engagement in vaginal sex (1.7%), or anal and/or oral sex (3.1%) was extremely low, and therefore changes in actual behaviors could not be accurately measured. However, intention to use condoms in possible future sexual encounters increased significantly (p less than 0.05) for the intervention youth compared to control youth between baseline (74/240, 30.8%) and both immediate postintervention (132/230, 57.4%), and six month follow-up (123/228: 53.9%). These data suggest the potential applicability of the PMT for HIV program development with non-Western adolescents but also point to the need for further studies on how constructs within behavioral theories might need to be modified in different sociocultural settings.
In Vietnam, between 2000 and 2006, HIV rates among 15- to 49-year-olds in the general population have increased from 27% to 53%. The HIV epidemic is occurring in a context of rapid socioeconomic ...changes, which have brought about conflicting ideals and norms between "traditional" and "modern" gender roles. We discuss the processes for developing the Exploring the World of Adolescents gender-specific HIV prevention curricula for 15- to 21-year-old adolescents living in both rural and urban Vietnam. The curricula are modeled after an existing HIV prevention program previously adapted and evaluated in Vietnam (Vietnamese Focus on Kids) and based in social learning theory (prevention motivation theory) contextualized within socioeconomic changes. The overall capacity building and participatory strategies for program development included (a) review of the HIV/AIDS and socioeconomic conditions in Vietnam, (b) review of the Vietnamese Focus on Kids curriculum themes and the theoretical constructs from the protection motivation theory, (c) analysis of qualitative and quantitative needs assessment data to incorporate culturally significant issues of gender and sexuality, and (d) a review of themes and activities from existing evidence-based adolescent reproductive health curricula.
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