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Background <p>Psychological trauma is a highly prevalent driver of poor health among people with HIV in the Southern United States. Trauma-informed care (TIC) has potential to advance national Ending the HIV Epidemic goals, but formative research is needed to tailor TIC implementation to complex and interdependent HIV networks.</p> Methods <p>We applied a community-based participatory research approach to iteratively engage personnel from high-volume HIV care institutions in Nashville, Tennessee. Current practices and potential implementation determinants were identified through participatory process mapping and key informant interviews. The Consolidated Framework for Implementation Research was applied to deductively code interview data. Personnel attending a dissemination summit developed a network-wide implementation plan.</p> Results <p>Data were collected with personnel from five institutions (e.g., community-based organizations, primary care clinics, public health department), via process mapping (<i>n</i> = 48), interviews (<i>n</i> = 35) and a summit (<i>n</i> = 17). Results suggest there are limited trauma screenings, assessments, and services across the network. Relevant <i>Characteristics of Individuals</i> included a trauma-sensitive workforce committed to continuous learning and TIC adoption. Relevant <i>Inner Setting Factors</i> were networks and communications, with strong tension for change, high compatibility with TIC, and need for advancing cultural responsiveness. Relevant <i>Outer Setting Factors</i> included patient needs and resources and cosmopolitanism, with need for better leveraged mental health services. Relevant <i>Process</i> domains were champions and leadership, with need to diversify championship among leaders. Relevant <i>Intervention Characteristics</i> included relative advantage and complexity, with need for personnel wellness initiatives and increased engagement with the community as service designers. Four recommendations included development of shared communication systems, personnel wellness campaigns, routine evaluations to inform practices, and culturally responsive care initiatives.</p> Conclusion <p>Modifiable TIC determinants were identified, and a community-created implementation plan was developed to guide adoption. Future research should focus on city-wide implementation and strengthening pre-implementation research in other settings. </p>

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Community-based participatory research to guide adoption of culturally responsive trauma-informed HIV care throughout Nashville, Tennessee

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月25日

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  • L. Lauren Brown,
  • Jessica M. Perkins,
  • A. Jessica Acuña,
  • Julie Thacker,
  • Clare Bolds,
  • Mary Hawkins,
  • Jamie L. Stewart,
  • Julie Barroso,
  • Sadie B. Sommer,
  • Joshua Van der Eerden,
  • Bryan W. Heckman,
  • Amna Osman,
  • Tarik Smith,
  • LaToya Alexander,
  • Allie Denton,
  • Tiye Link,
  • Anita Crawley,
  • Rosemary Nabaweesi,
  • Maria Aboubaker,
  • Joanna Shaw-KaiKai,
  • Norman Foster,
  • Beverly Glaze-Johnson,
  • Jessica Hoke,
  • Carolyn M. Audet,
  • Jessica M. Sales,
  • April C. Pettit

摘要

Background

Psychological trauma is a highly prevalent driver of poor health among people with HIV in the Southern United States. Trauma-informed care (TIC) has potential to advance national Ending the HIV Epidemic goals, but formative research is needed to tailor TIC implementation to complex and interdependent HIV networks.

Methods

We applied a community-based participatory research approach to iteratively engage personnel from high-volume HIV care institutions in Nashville, Tennessee. Current practices and potential implementation determinants were identified through participatory process mapping and key informant interviews. The Consolidated Framework for Implementation Research was applied to deductively code interview data. Personnel attending a dissemination summit developed a network-wide implementation plan.

Results

Data were collected with personnel from five institutions (e.g., community-based organizations, primary care clinics, public health department), via process mapping (n = 48), interviews (n = 35) and a summit (n = 17). Results suggest there are limited trauma screenings, assessments, and services across the network. Relevant Characteristics of Individuals included a trauma-sensitive workforce committed to continuous learning and TIC adoption. Relevant Inner Setting Factors were networks and communications, with strong tension for change, high compatibility with TIC, and need for advancing cultural responsiveness. Relevant Outer Setting Factors included patient needs and resources and cosmopolitanism, with need for better leveraged mental health services. Relevant Process domains were champions and leadership, with need to diversify championship among leaders. Relevant Intervention Characteristics included relative advantage and complexity, with need for personnel wellness initiatives and increased engagement with the community as service designers. Four recommendations included development of shared communication systems, personnel wellness campaigns, routine evaluations to inform practices, and culturally responsive care initiatives.

Conclusion

Modifiable TIC determinants were identified, and a community-created implementation plan was developed to guide adoption. Future research should focus on city-wide implementation and strengthening pre-implementation research in other settings.