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Supporting Healthy Alternatives through Patient Education A program of El Rio Health Center/Special Immunology Associates Impact Consultants, Inc. Tucson, Arizona Grantee Meeting Washington, DC November 4-5, 2004 Supported by the U.S. Department of Health & Human Services Administration Special Projects of National Significance HIV/AIDS Bureau Grant #1 H97HA01111-0100

Special Thanks To the Center for AIDS Intervention Research (CAIR) Medical College of Wisconsin, AIDS Survival Project Atlanta and Seth C. Kalichman, Ph.D. for use of Healthy Relationships Intervention.

SHAPE Intervention Three Intervention Modules: MSM Women Men Video Discussion Intervention (VDI) Model Group level delivered by health education specialists. Each module consists of five two hour sessions delivered in a five week period.

SHAPE Intervention Study Protocol “Enhanced” intervention same as the standard with the addition of the 5 group sessions Patients assigned to the “enhanced” intervention must complete the 5 group sessions within 7 weeks Evaluations are completed at the end of each group session Follow up points: are at 3, 6, 9 and 12 months

SHAPE Intervention Protocol Assessments Patient evaluation of each session Facilitator evaluation of each session or series of sessions Manager evaluation of the facilitators Data Data from baseline assessment used in the intervention

Evaluator Assessment (partial) MSM Session One – Fidelity of the Intervention Date of session __  / __  / __ Number of attendees ___ Number expected ___ ___ Evaluator Name _____________      Session Facilitator Names_________________________ Evaluation of each component of the session: Session goals and introductions (5 minutes): Start Time: ___  : ___  AM/PM End Time: ___  : ___AM/PM Minutes ___ ___ Adherence to the manual: Excellent Good  Fair Poor Quality of the content: Excellent Good  Fair Poor Time Management: Excellent Good  Fair Poor Comments: __________________________________________________________________ ____________________________________________________________________________ Technical difficulties (DVD, temperature, lights, snacks, etc.):__________________________ ____________________________________________________________________________ Recommendations for changing the content of the session: _____________________________ ____________________________________________________________________________ Recommendations for the facilitators: ____________________________________________ ____________________________________________________________________________ Other: _______________________________________________________________________

Facilitator’s Evaluation SHAPE Session Evaluation “Lessons Learned” Today’s Date ___ ___ / ___ ___ / ___ ___ Session #: 1   2   3   4   5 We understand that some group sessions will run smooth and conform to the intervention manual, while other sessions (for whatever reason) will not.  We also understand that the intervention may need to be changed to reflect exercises or materials that might work better.  As the facilitator of the sessions you will have firsthand experience that is very valuable to document the fidelity of the intervention. Please use this form to document your thoughts and ideas about the SHAPE intervention, the intervention manual and the way in which you facilitate the group sessions.  Sharing your insights and techniques about what worked and what did not work during the session is very important.  By sharing your ideas with other program staff the SHAPE intervention, manual and the facilitation skills of the 3C staff will become better and more standardized.  Please document anything you would like to share to better the program. 1a) How well did this session conform to the manual? Completely Mostly Somewhat A little Not at all 5 4 3 2 1 1b) If this session did not completely conform to the manual, what changes were made, and why? 2) Did you have technical difficulties during this session (video, temperature, food, lights, etc)? 3) Should this session be changed?  Why? How? 4) Should the manual be changed?  Why? How? 5) What did you learn about facilitating this session that you would like other 3Cs to know? 6) Do you have any ideas that might be helpful for the other interventions (MSM, Heterosexual Men, Women)?

Participant Evaluation SHAPE Session Evaluation Today’s Date ___ ___ / ___ ___ / ___ ___ Session #: 1  2  3  4  5 1) Please rate the following aspects of the session by circling the appropriate rating:  a) Overall session Excellent Good Fair Poor  b) Usefulness of the videos for discussion Excellent Good Fair Poor  c) Usefulness of the materials given to you Excellent Good Fair Poor  d) Usefulness of the exercises Excellent Good Fair Poor  e) Session leader’s overall performance Excellent Good Fair Poor Please circle the rating that best describes how you feel about the following aspects of the session: I learned something in this session Strongly Agree     Agree     Disagree       Strongly Disagree The session dealt with things that are real for me Strongly Agree     Agree     Disagree       Strongly Disagree The videos were good for discussion Strongly Agree     Agree     Disagree       Strongly Disagree The materials were helpful for me Strongly Agree     Agree     Disagree       Strongly Disagree The exercises were helpful for me Strongly Agree     Agree     Disagree       Strongly Disagree I learned practical information in this session Strongly Agree     Agree     Disagree       Strongly Disagree I participated in this session Strongly Agree     Agree     Disagree       Strongly Disagree I feel comfortable in this group Strongly Agree     Agree     Disagree       Strongly Disagree Is there content you thought that should have been covered better?    Please specify what you think should be covered better: Is there anything else you’d like us to know regarding the session? Yes No Please tell us what you think: THANK YOU VERY MUCH!!

Feedback Form SHAPE Project Personalized Feedback I During the survey and interview you completed before attending the groups, you answered several questions regarding your experiences and your feelings. Below is a list of things that were stated as most stressful. Going on disability Major loss of income Telling family member Death of friend Telling a friend Telling a partner Starting a relationship Ending a relationship Discrimination Unsafe sex Accessing  treatment Waiting for test results Starting new treatment Being hospitalized Increase in CD4 Increase in viral load Decrease in CD4 Decrease in viral load Changing my doctor About disclosing your status... Below is a summary of your responses to some of the survey and interview questions. You said you have disclosed your status to ___family members and __ friends. You said that you have told __ people your status in the past 3-months, and that of those experiences ___ were supportive when you told. You said that there are __people in your life that you have not told your status to, but would like to.

SHAPE Intervention – Session 1 MSM Module Session 1 Stressors – Non-HIV and HIV related    Disease Milestones    Sexual orientation Disclosure to family and friends regarding sexual orientation Video clips

SHAPE Intervention – Session 2 Session 2 Active listening and assertive communication Identifying Triggers and barriers Problem Solving skills 5 steps to problem solving Effective decision making decision making grid Disclosing HIV status to family and friends Video clips

SHAPE Intervention – Session 3 Session 3 Difference of disclosing HIV status to a partner rather than to family and friends Apply decision making skills and decision making grid Video clips Introduce the issues of disclosing HIV status to prospective sexual partners

SHAPE Intervention – Session 4 Session 4 Disclosing to a sexual partner positive partner vs. negative partner Video clips Introduce safer sex/risk reduction Introduce concept of “healthy relationship”

SHAPE Intervention – Session 5 Session 5 Review the previous sessions and concepts Review condom negotiation skills Review concept of “healthy relationships” Family Friends Partner Video clips

Session Feedback - Evaluator Minor changes to the order of topics and manual Work on co-facilitation skills Incorporate medications and disease progression and impact on relationships – session 4 Discuss disease acceptance – session 2 or 5 Shame and guild from gay community – session 2 or 5 Elicit participant experiences in disclosure more Change session 5 “what I feel” versus “what I know” – session 5 Characteristics of facilitators and differences in style

Session Feedback - Facilitator Lessons learned… Fun Openness of the group Improve with practice (preparation, summarize previous session) Engage quieter participants Time constraints differ with size of group Timing, props, order of topics Re-write session 5

Session Feedback - Participants Components of the sessions rated quite high (3.5 - 4.0) on 1-4 scale Facilitators were rated highly (3.75+) Participants agreed that they learned from the session, the videos were excellent for discussion, and that the issues were real for them (3.4 – 4.0) on a 1-4 scale

Session Feedback - Participants “It touched upon things that really hit home.  I held my tears back several times because there are sensitive issues that touch me still.  One is the lack of understanding among the non-HIV population.” “This session initiated self introspection. I enjoyed the interaction of the group and leader. It was a great experience.” “It was a very comfortable environment to be open and honest.” “Great opportunity to bring about more awareness and conscious thought about HIV status with peers and family.  A small forum where we can be more open and let our hair down.” “This was a great session. [It] seemed to be under control and a lot of material was covered.  A super group for communication.” “It was great but 2 hours goes by so fast.  This group likes to talk (that is a good thing!)” “I like to say thank you all.”