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Developing a culturally safe and appropriate mobile health program with and for Indigenous people living with HIV : community collaboration and questionnaire validation

University of British Columbia

Introduction: In Canada, HIV disproportionately affects Indigenous persons and culturally safe combined antiretroviral therapy (cART) adherence programs are needed. WelTel is a bidirectional text-messaging program that improves cART adherence in persons living with HIV (PLWH). However, WelTel benefits individuals able to engage with the program most, and no demographic factors predict whom. Health psychology literature suggests understanding personal dispositions to assess behaviours impacting health. Measuring disposition is simple/rapid, and could personalize adherence supports. There is minimal research on associations between disposition and health among Indigenous communities. Furthermore, Indigenous knowledge has not been intertwined in WelTel. We sought to receive input on WelTel from Indigenous PLWH, and determine whether dispositional variables are valid and hold similar associations with health and wellbeing among Indigenous and low socioeconomic status (SES) communities in Vancouver, British Columbia. Methods: An integrated knowledge exchange process was employed. Indigenous Elders and community collaborated in every study facet to ensure cultural safety. Sharing Circles were held to gain feedback on WelTel program and questionnaire design from Indigenous PLWH (women’s circle, n=8; men’s circle, n=10). We recruited 300 participants (149 Indigenous, 151 non-Indigenous) from various clinics/centres to complete measures of purpose, the Big Five personalities, health, and wellbeing. Factor and reliability analyses determined validation of measures. Correlational analyses determined associations with health. Results: Indigenous PLWH expressed value in WelTel, suggesting it is accessible, empowers autonomy in healthcare, improves adherence, and may assist in strengthening community. They made recommendations to improve cultural safety. The majority of questionnaire participants (mean age 49 y, 58% male) had an income ≤$15,000/y and educational attainment <high school. Measures of personal disposition were reliable in Indigenous and low SES groups. Correlations were similar between Indigenous and non-Indigenous groups. Purpose was positively associated with health and wellbeing (all p<0.01); of the Big Five, conscientiousness was positively and neuroticism was negatively significantly associated with most health factors. Conclusion: Community collaboration provided cultural safety improvements for WelTel for Indigenous PLWH. Similar to other populations, disposition is worth considering when understanding the health and wellbeing of Indigenous and low SES communities, and could be used to personalize HIV adherence supports.

Thesis/Dissertation

eng

Vancouver : University of British Columbia Library

10.14288/1.0390009

Master of Science - MSc

Medicine, Faculty of; Experimental Medicine, Division of; Medicine, Department of

2020-05

Graduate

DSpace