DePaul University Via Sapientiae College of Science and Health Theses and Dissertations College of Science and Health Spring 6-12-2015 Providers' Socioecological Perspectives on the Supports for and Challenges to Engagement in Care for Latino Youth Living with HIV: A Qualitative Study Diana Lemos DePaul University, [email protected] Follow this and additional works at: https://via.library.depaul.edu/csh_etd Part of the Psychology Commons Recommended Citation Lemos, Diana, "Providers' Socioecological Perspectives on the Supports for and Challenges to Engagement in Care for Latino Youth Living with HIV: A Qualitative Study" (2015). College of Science and Health Theses and Dissertations. 109. https://via.library.depaul.edu/csh_etd/109 This Dissertation is brought to you for free and open access by the College of Science and Health at Via Sapientiae. It has been accepted for inclusion in College of Science and Health Theses and Dissertations by an authorized administrator of Via Sapientiae. For more information, please contact [email protected]. PROVIDERS’ SOCIOECOLOGICAL PERSPECTIVES ON THE SUPPORTS FOR AND CHALLENGES TO ENGAGEMENT IN CARE FOR LATINO YOUTH LIVING WITH HIV: A QUALITATIVE STUDY A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy to BY DIANA LEMOS June, 2015 Department of Psychology College of Science and Health DePaul University Chicago, IL ii THESIS COMMITTEE Gary W. Harper, Ph.D., M.P.H. Chairperson Bernadette Sanchez, Ph.D. Departmental Reader Leonard A. Jason, Ph.D. Departmental Reader John Mazzeo, Ph.D. Outside Reader Fernando DeMaio, Ph.D. Outside Reader Sybil G. Hosek, Ph.D. Outside Reader iii ACKNOWLEDGMENTS Many people made this dissertation project possible and provided much support and guidance throughout my years at DePaul. First and foremost, I would like to thank Dr. Gary Harper for not only believing in me when I decided first to apply to Stroger Hospital of Cook County and second, to DePaul University, but also for his patience and support through the difficult adjustment period of trying to find my way as a graduate student, project director, and colleague. He has provided me with an incredible amount of wisdom, and with lots of humor, not just in an academic and research sense, but most importantly, in life. I will forever remember the pottery analogy when approaching writing edits. His exemplary pursuit of giving voice to those most marginalized has been the inspiration for my work in this dissertation, and for my work as a community psychologist. I would like to express heartfelt appreciation to Dr. Bernadette Sanchez, who has served as a mentor to me throughout graduate school, and who stepped in as chairperson of my committee when Gary could no longer serve, due to a change in the university. I am forever grateful to my mentor and supervisor, Dr. Sybil Hosek, with whom I have worked closely with for the past 10 years, who has offered unconditional support and guidance throughout my professional development. Her encouragement and genuine belief in others’ abilities and capabilities to reach their fullest potential is a source of inspiration that I hope to be able to pay forward to others. I am also grateful to the other dissertation iv committee members, Dr. Jason, Dr. DeMaio, and Dr. Mazzeo, who were patient in this dissertation‘s completion, and in providing insightful feedback that resulted in making the document stronger. I also would like to thank my mother, Maria P. Fraire, and my father, Arturo Lemos, for their support throughout my graduate school experience, and in being supportive of me completing the project. Throughout my life, they have taught me the importance of hard work, self-education, gratitude, perseverance and selflessness through their actions. I would also like to thank all my family members who have been there throughout this process, which includes my siblings, my nephews and niece, my grandmother, Balvina Fraire, and my dearest friends and colleagues, especially Jennifer Brothers. I would also like to thank my fellow Harper Research and Graduate student team members with whom I have closely bonded and on whom I leaned for support. Finally and most importantly, I am thankful to the providers who were participants in this study, who volunteered their time and effort to share their experiences working with Latino youth living with HIV. All of these people, in more ways than one, have contributed emotionally, spiritually, and physically toward the completion of this dissertation and thus, thank you! v VITA The author was born in Chicago, Illinois on June 9, 1981. She graduated from Wells Community Academy High School, received her Bachelor of Arts Degree in Psychology from the University of Illinois at Chicago in 2003, and a Master of Public Health degree in Health Education and Health Promotion from the University of Texas Health Science Center at Houston School of Public Health in 2005. vi TABLE OF CONTENTS Thesis Committee ................................................................................................... ii Acknowledgments.................................................................................................. iii Vita ...........................................................................................................................v Table Of Contents .................................................................................................. vi list of tables ............................................................................................................ xi List Of Figures ...................................................................................................... xii Overview .............................................................................................................. xiii Chapter I Introduction ..............................................................................................1 Overview of the HIV Epidemic in the United States ...................................2 Overview of the Latino Population ..............................................................6 Socioecological Factors Impacting HIV Risk and Resilience .....................8 Individual-Level Factors Influencing the HIV Epidemic ................9 Interpersonal-Level Factors Influencing the HIV Epidemic .........11 Community-Level Factors Influencing the HIV Epidemic ...........12 Structural-Level Factors Influencing the HIV Epidemic ...............13 Cultural Factors That Impact the HIV Epidemic ...........................20 Socioecological Influences on Continuum of Care for LYLWH ..............25 Factors Influencing HIV Testing ...................................................28 Factors Influencing HIV Linkage to Care .....................................29 Factors Influencing HIV Engagement in Care ...............................31 vii Factors Influencing Medication Adherence ...................................33 Factors Influencing Retention in Care ...........................................34 HIV-Related Interventions for Latinos and Latino Youth .........................35 Rationale ....................................................................................................46 Focus on Theoretical Foundation...............................................................49 Research Questions ....................................................................................52 Chapter II Method ..................................................................................................55 Participants .................................................................................................55 Sample-Size Justification ...............................................................56 Recruitment Procedures .................................................................59 Obtaining Consent .........................................................................61 Data Collection ..........................................................................................63 Quality Assurance ..........................................................................63 Ethical Considerations ...................................................................65 Measures ........................................................................................66 Chapter III Analysis And Results ..........................................................................69 Analysis......................................................................................................71 Bracketing of Experiences .............................................................72 Coding ............................................................................................76 Reviewing Interviews ....................................................................76 Content Analysis ............................................................................77 Thematic Analysis .........................................................................77 Coding Refinement ........................................................................77 viii Data Comparison ...........................................................................78 Data Verification ............................................................................78 Results ........................................................................................................80 Case Summaries of Individual Participants ...............................................80