Article Critique 1

Laura Rebolledo

California State University, San Bernardino

HSCI 6260

Dr. Mshigeni

March 12, 2022

Introduction

Published articles regarding HIV/AIDS have failed to discuss cultural relevance in

intervention programs, deciding to concentrate on the outcomes instead. With HIV/AIDS being a

significant health impact to African Americans in the United States, interventions concentrating

on peer-oriented strategies and social networks have been implemented. These interventions

place special emphasis on social relationships, identity, and direct peer-to-peer outreach. They

have shown to decrease risk behaviors among these populations, however process evaluation of

the majority of these studies lack publishing. In result, a process evaluation using ethnographic

methods was conducted on an HIV prevention program to address these knowledge gaps.

Methodology

The STEP into Action intervention program concentrated on social influence among

injection drug users (IDUs) and sexual networks by promoting HIV preventative behaviors. The

acronym STEP is defined by the following: S stands for “stand up and be positive'', T stands for

“talk with respect”, E stands for “evaluate the situation”, and P stands for “put a plan into action”

(Hong et al. 2005). The intervention was conducted over six sessions and four group sessions

where focus was placed on peer relationships and communication. Participants were given an

individual session as well as a dyad session where focus was placed on their relationship with

their sex or drug partner. The STEP program was revised as needed and approved by the John

Hopkins University School of Public Health’s IRB, as well as pilot tested from July 2003

through January 2004.

The program was implemented in Baltimore, Maryland and criteria for participants

included being “at least 18 years of age, recruitment of at least one drug or sex risk network

member, and self-reported IDU within the last three months” (Hong et al. 2005).
Results

The intervention program focused on harm reduction, however after observing the

participants, a program misconception was discovered. To clarify, the participants believed the

intervention was a treatment for them to “get clean”, and in result, they believed most of their

problems would be solved. Program language had to be modified to emphasize how harm

reduction could aid in getting clean and then eventually to other life benefits. This was done to

not discourage participants from practicing harm reduction.

Another miscommunication that was discovered was the meaning of “partners” when

referring to sexual or drug partners. It was found that the participants thought anyone they knew

were part of their social network and practiced outreach with people who did not necessarily

need the mentorship. On the other hand, the program meant for participants to communicate with

the partners whom they engaged in risky behavior with. The word “partner” was discarded from

the program and focus was placed on teaching communication skills within their social networks

through examples instead.

This seemed to be a similar trend with other key terms within the participants and

communication. This occurred with the phrase “staying positive” where participants could not

relate to that phrase. This led to the letter S’s definition in the program title to be updated to

“stand up and be positive” to take into consideration the participants’ feelings and experiences in

their communities. Focus on communication was also updated to reflect the behaviors within

social networks and an emphasis of speaking with respect versus active listening was

implemented. Lastly, the method in which risk factors were explained to the participants was

modified as well. This was done to consider the actual experience IDUs went through when
participating in risk behaviors. Instead of shaping the participants to the program, the program

was shaped to fit the participants in order to effectively reduce harm reduction.

Process Evaluation

Process evaluation was conducted using ethnographic methods and data collection. The

participants, presentations, sessions, and the actual interactions in the community were subtly

observed by ethnographers. Communication and feedback were also collected directly from the

participants after a few intervention sessions. Most importantly, ethnographers followed and

observed participants, with their consent, and examined them practice risk reduction skills with

their partners. Data was collected through detailed notes, recordings, and audiotape and then later

analyzed to detect any program problems. This process allowed problem identification and

modification within the training and session materials.

Positive Points

The content of the article was well-organized and allowed the readers to follow closely.

For instance, the Findings section was divided well and clearly communicated each aspect by

using titles. Another positive note was the transparency expressed in the Strengths and

Limitations section regarding data collection. Overall, the article was very detailed and allowed

readers that are new to the topic to easily understand the program evaluation that was conducted.

Constructive Points

Although the article was very detailed, some sections under the Findings could have been

combined to condense similar information. Slight modifications, such as bold or underlined text,

to the title fonts would have made it easier to differentiate from sections as well. Lastly, the

article used many words that had specific definitions pertaining to the intervention program and a

short glossary would have been a good reference to add.

 References

Hong, Y., Mitchell, S. G., Peterson, J. A., Latkin, C. A., Tobin, K., & Gann, D. (2005).

Ethnographic Process Evaluation: Piloting an HIV Prevention Intervention Program

among Injection Drug Users. International Journal of Qualitative Methods, 1–12.

https://doi.org/10.1177/160940690500400101