1. Participatory Formative Research in Development of Trigger Videos on Stigma and Discrimination in Health Care Settings in the Caribbean Presentation to 2007 HIV/AIDS Implementers’ Meeting Kigali, Rwanda - June 16-19, 2007 Elaine Douglas, Caribbean Regional Director

2. Background I-TECH supports the development of human and institutional capacity for improving the care and treatment of people living with HIV/AIDS Established by HRSA, in collaboration with CDC. Additional funds from USAID for work in the Caribbean In the Caribbean, I-TECH supports the Caribbean HIV/AIDS Regional Training Network (CHART) CHART = 6 National Training Centers & a Coordinating Unit

3. Context S&D are significant obstacles to providing Quality HIV and AIDS services in the Caribbean  PLWHAs reluctant to access care  Health workers reluctant to treat people with HIV and AIDS Reducing S&D is essential to increasing effectiveness of services

4. Method Requires tapping into the affective domain of learners Tool needed to help trainers & clinicians address S&D in all training and follow-up activities Had used Trigger Tapes successfully in PMTCT training in region Short video scenarios and facilitator’s guide to trigger discussion on relevant issues

5. Clip from scenario ONE here

6. Approach = Participatory Formative Research To validate and strengthen product Ensure Cultural Appropriateness Ensure that Intended Message is Communicated Ensure that Tool can be Used Easily Ensure that Resources are Used Efficiently

7. 1.Understand Issue/Reality (Interviews) 2.Validate Scripts (Focus Groups) 3.Feedback on Scenarios and Facilitators Guide (Pre Test) Phases

8. Key Findings Script Revision Was Essential to Enhance Cultural Appropriateness and Prevent Untended Consequences Feedback from the first round of focus groups was key to developing the Facilitator’s Guide Focus Groups highlighted the need to increase the focus on affective topics such as:  “How does this relate to me”  Developing action steps for addressing issues within the health care workers particular settings

9. Clip from scenario FIVE here

10. Surprises The range of interpretation of even straightforward issues and messages was broader than we expected Even small changes resulted in different perceptions

11. Would Not Do Again Include health workers from one hospital in a focus group - more reluctant to talk, seemed less frank Limit number of focus groups/cadres included

12. Would Do Again Formative Research Use this methodology -- test scripts, pretest video Include PLWHAs in first round

13. Recommendations Formative research is critical for ensuring that training tools on affective topics are effective Members of the target audience are the best sources

14. Thank you! Contact: edouglas@u.washington.edu For more information: www.go2itech.org