HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System.
Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil's Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs-confidence, perseverance, knowledge, and skills.
Department of Social Work, Community of College and Public Affairs, Binghamton University, 67 Washington St, Binghamton, NY 13902, USA. rrahman@binghamton.edu.
Rahbel
R
Rahman
School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI 48109, USA. ropinto@umich.edu.
Rogério M
RM
Pinto
Department of Biostatistics, Columbia University, 722 West 168th St. New York, NY 10032, USA. mmw2177@cumc.columbia.edu.
Melanie M
MM
Wall
D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy; D001938:Brazil; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006078:Government Programs / Q000458:organization & administration*; D015658:HIV Infections / Q000628:therapy*; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D011320:Primary Health Care / Q000458:organization & administration*; D012946:Social Welfare
HIV/AIDS; interprofessional collaboration; service integration; social services