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HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil’s Unified Health System

Author

Listed:
  • Rahbel Rahman

    (Department of Social Work, Community of College and Public Affairs, Binghamton University, 67 Washington St, Binghamton, NY 13902, USA)

  • Rogério M. Pinto

    (School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI 48109, USA)

  • Melanie M. Wall

    (Department of Biostatistics, Columbia University, 722 West 168th St. New York, NY 10032, USA)

Abstract
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.

Suggested Citation

  • Rahbel Rahman & Rogério M. Pinto & Melanie M. Wall, 2017. "HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil’s Unified Health System," IJERPH, MDPI, vol. 14(3), pages 1-15, March.
    • Handle: RePEc:gam:jijerp:v:14:y:2017:i:3:p:294-:d:93047
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    References listed on IDEAS

    as
    1. Pinto, R.M. & Wall, M. & Yu, G. & Penido, C. & Schmidt, C., 2012. "Primary care and public health services integration in Brazil's unified health system," American Journal of Public Health, American Public Health Association, vol. 102(11), pages 69-76.
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    Cited by:

    1. Rong Liu & Ling Huang & Qing Yang & Qiang Hu & Qing Huang & Xiaoqing Jiang & Hui Zhu & Fei Xie & Xiaotong Wen & Xiaojun Liu & Zhaokang Yuan & Yuanan Lu, 2018. "Investigation on Task Shifting of HIV/AIDS Follow-Up Management Workers in New Launched Areas, China," IJERPH, MDPI, vol. 15(10), pages 1-9, September.
    2. Rahman, Rahbel & Ross, Abigail M. & Spector, Anya Y. & Huang, Debbie & Chesna, Sharon & Patel, Rupal, 2023. "Predictors of service integration by community based providers in New York State offering maternal and infant services," Children and Youth Services Review, Elsevier, vol. 153(C).

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