Fully engaging LMIC nurses in health services research may yield pragmatic and evidence-informed service delivery and policy recommendations. Investments in supports for nursing research capacity may enrich global health policy effectiveness and improve quality of care.

The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level.

BackgroundThe enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low- and middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care.MethodsA prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test.ResultsResponse rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self—pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73–0.82), p = 0.002; workplace policies—pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance—pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising—pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002—and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation—pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). ...

The purpose of this article is to describe the results from an elicitation research study addressing the multisystem-level factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were determined from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from the current study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents.

Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decisionmakers from Canada and five low-and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled "Strengthening Nurses' Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean." The goal of the research program was to explore and promote nurses' involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.