This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.1.
Specific Aims A strong primary care system has been recognized as a requirement for the achievement of effectiveness and equity in a health service system. In the clinical management of AIDS, previous studies show that the presence of a primary source of ambulatory care increases the likelihood of receiving antiretroviral therapy decreasing mortality rates. Primary care has been defined as that level of a health service system that provides entry into the system for all new needs and problems, provides person-focused rather than disease-oriented care over time, provides care for the most common problems in the community by providing preventive, curative, and rehabilitative services to maximize health and well-being, and coordinates or integrates care provided elsewhere or by others. The Primary Care Assessment Tools (PCAT) has been widely used as a measure to assess the health services delivery system according to the characteristics of their approach to providing primary care. We propose to translate into Spanish these instruments using the methods developed by Mat as-Carrelo and colleagues (2003) that aim to achieve a valid and generalizable instrument. We specifically aim to: a. To translate and culturally adapt the Primary Care Assessment Tools (PCAT) to Spanish for use with Puerto Ricans with HIV/AIDS. 2. Brief Project Description For the first step of the translation, a professional translator certified by the American Translation Association will translate the instruments from English to Spanish. Once the translation is done a committee of experts in the area who are fluent in both English and Spanish will review the Spanish instrument. The members of this committee must be fluent in both Spanish and English, must be familiar with the primary care services for people with HIV/AIDS in Puerto Rico, and knowledgeable about the constructs that the instruments assess. The experts committee would assess the content and technical equivalence. The recommendations of the expert committee will be incorporated to the instruments and presented to an additional review by providers and consumers of HIV/AIDS primary care services. Three different types of focus groups will be conducted, one will include HIV/ AIDS patients care providers, the second will include adult HIV/ AIDS patients consumers of primary care and the third will consist of administrators of primary care facilities. Participants for the focus groups will be recruited from immunology clinics. A convenience sample of 30 participants is expected, approximately 10 for each focus group.The focus groups aim to discuss the constructs under study and to assess the tools items comprehensibility, appropriateness, and relevance. To guide the discussion a series of open-ended questions will be developed to elicit participants point of view regarding the meaning of the constructs. Each item and the instructions in the instruments will also be reviewed individually. The next step will be to submit for a second review the recommendations from the focus groups to the experts committee. The committee will consider these recommendations and will provide a final version of the instruments. This process is done to assure that the language will be appropriate to the level of the cognitive, cultural and language development of the persons to be interviewed. This final version will be given to a professional translator certified by the American Translation Association and who is not familiar with the original version for back-translation, that is, to translate the final version to English. Finally, there will be a final review by the same committee of experts to compare both versions of the English instrument. This final step is essential to assure that the Spanish-version include items similar in meaning to those of the English language instrument. 3. Significance of the Study Primary care physicians can play an important role in helping patients to the management the progress of their conditions. Taking charge by making improvements in these areas can enhance patients feelings of well-being and mastery of their lives. Primary care providers can encourage and advocate for these positive behaviors with their patients in a supportive way. According to the Ryan White 2004 Report, more than two thirds of CARE Act funds were used for primary care and treatment in 2002. Almost one third of the recipients were 45 years or older; about 46 percent of recipients were black and about 20 percent were Hispanic; more than 31 percent of HIV-positive recipients were female; and 2 percent of recipients were children 12 years or younger.The current model of HIV/AIDS care often lacks a periodic, comprehensive physical examination and the routine laboratory and radiographic studies that are recommended as part of primary- and secondary-disease prevention for all adults. In addition to routine 'HIV-directed' physical examinations every 3 to 4 months, patients over the age of 40 should undergo a yearly comprehensive physical examination and a detailed review of systems. Patients should be evaluated both for evidence of the complications of HIV infection and the normal health problems that affect adults. It may be necessary to schedule dedicated health-maintenance visits or collaborate closely with a primary care provider to address patients' health maintenance needs (Reiter, 2000). Several studies indicate that greater experience in HIV care leads to improved patient outcomes. The relation between outcomes and type of training (sub-specialist or generalist) is less clear, and studies have not distinguished between type of training and experience. Less experienced physicians may be able to provide high-quality care if appropriate consultation from expert physicians is available. Components of primary care, including accessibility, continuity, coordination, and comprehensiveness, are associated with better patient outcomes. Optimal care of HIV infection requires a combination of disease-specific expertise and primary care skills and organization (Hecht et al, 1999). In light of these results from previous studies, it is imperative to have available valid and reliable methodologies to provide evidence of the effectiveness of the primary care system providing services to HIV/AIDS patients. The Spanish-translation, and cultural adaptation test of the PCAT will make available a valid and reliable method of assessing the quality of the primary care system providing services for the HIV/AIDS patients that may be easily adapted to the general population including Puerto Ricans in mainland US, an ethnic group that represents a rising segment of the diverse US Latino population. The resulting instruments must be written in a grammatically correct and simple language, they would be comprehensible to the Spanish-speaking Puerto Rican population regardless of their educational level.4. Preliminary resultsAs proposed for the first step of the translation, a professional translator certified by the American Translation Association translated the instruments from English to Spanish. Once the translation was done a committee of experts in the area who are fluent in both English and Spanish reviewed the Spanish instrument. The members of this committee are fluent in both Spanish and English, are familiar with the primary care services in Puerto Rico, and knowledgeable about the constructs that the instruments assess. Since primary care for the population with HIV in Puerto Rico is provided by the same providers that offer care to the general population we added a step and included in the committee three primary care physicians, two community representatives (consumer perspective, adult and childs caregiver), two primary care facility administrators, a policy expert, an organizational psychologist with experience in instrument development and psychometrics (M. Rodr guez) and a health services researcher and program evaluator (R. Rios). The experts committee assessed the content and technical equivalence. The recommendations of the expert committee are in the process of being incorporated to the instruments. Their main concern was that the providers tool should be more specific in terms of identifying which setting is evaluating. Providers in Puerto Rico may serve in different administrative settings and could evaluate each setting in a different way. The research team is taking these concerns into account and is developing a set of questions that will be integrated to the main instrument. We hope to explore these concerns further with the providers focus groups. This initial committee considers that the HIV population in Puerto Rico is the one that receives the best primary care because of the efforts of the case managers. They identified the case managers as the one fostering specifically, coordination of services. As our third step, experts in HIV care have been already contacted to review and adapt the tools for HIV-primary care, before submitting the instruments to the focus groups. IRB authorizations have been approved.
Showing the most recent 10 out of 20 publications
