HIV/AIDS-
The associated stigma affects access and utilization of health services.
Despite HIV/AIDS
The related stigma in health services was studied, and few work involved the relationship between professional development and stigma attitudes.
Therefore, in this study, we will expand early research by examining the relationship between the professional development phase and stigma attitudes towards HIV/AIDS patients.
A series of cross methods and analysis
Segment Design will be related to two-
Time point longitudinal design measures the stigma of health care students in undergraduate and postgraduate courses in Malaysia and Australia each year.
In the absence of appropriate measures, we will design a sequential hybrid method to develop such a tool.
Questionnaire data will be analyzed using a mixed-effect linear model to manage repeated measurements.
Ethics and communication we have received moral approval from the executive committee of Monash MBBS and the ethics committee for human studies at Monash University.
We will keep the data in a locked filing cabinet at Monash University (Sunway campus)
The premises for 5 years, after which the information will be crushed and placed in a safe bin according to the regulations of Monash University, and the digital recording will be deleted.
Only the chief investigator and researcher can enter the filing cabinet.
Our goal is to present and publish the results of this study in national and international conferences as well as in our peers
They are review journals respectively.
Introduction to HIV/AIDS
The associated stigma affects access and utilization of health services.
Despite HIV/AIDS
The related stigma in health services was studied, and few work involved the relationship between professional development and stigma attitudes.
Therefore, in this study, we will expand early research by examining the relationship between the professional development phase and stigma attitudes towards HIV/AIDS patients.
A series of cross methods and analysis
Segment Design will be related to two-
Time point longitudinal design measures the stigma of health care students in undergraduate and postgraduate courses in Malaysia and Australia each year.
In the absence of appropriate measures, we will design a sequential hybrid method to develop such a tool.
Questionnaire data will be analyzed using a mixed-effect linear model to manage repeated measurements.
Ethics and communication we have received moral approval from the executive committee of Monash MBBS and the ethics committee for human studies at Monash University.
We will keep the data in a locked filing cabinet at Monash University (Sunway campus)
The premises for 5 years, after which the information will be crushed and placed in a safe bin according to the regulations of Monash University, and the digital recording will be deleted.
Only the chief investigator and researcher can enter the filing cabinet.
Our goal is to present and publish the results of this study in national and international conferences as well as in our peers
They are review journals respectively.
The article focuses on the main purpose of this study is to study the relationship between the specialization and stigma attitudes of health care students towards people living with HIV/AIDS.
The second purpose of this study is to investigate the availability of appropriate measurement tools (s)—
Otherwise, create a measure of the transformation of HIV/AIDS --
Related Stigma in the working environment of health professionals.
Critical information-fair, responsive health systems require a healthcare workforce that is blind to "should not" and "moral condemnation;
Therefore, studying professional development related to the development of stigma attitudes is very important to address inequalities in the provision of care.
The main advantage of this protocol is its design, which will enable us to study professional development and possible changes (s)
Attitude in a period of time.
The limitations of this study are the uncertainty associated with the sample size calculation and the fact that we can measure
Rather than the actual attitude.
The sampling restrictions imposed by moral requirements also raise questions about the selection bias.
While the possibility of bias needs to be acknowledged, the nature of the research question may limit bias.
Brief introduction a health care worker who is responsive and fair to the treatment of patients is one of the core pillars of the modern health care system.
1 because of this, among other things, health care workers are bound by the code of ethics to treat patients according to their needs and not according to their gender, religious beliefs, sexual orientation, color or other social (de)
Value attribute.
2 when those otherwise ignorant social attributes may affect diagnosis, prognosis, or choose the most effective treatment, exceptions to this rule of social blindness may occur.
However, what should happen when the patient is considered a full reprobate
Is his existence challenging the moral foundation of a medical worker?
In theory, the answer is simple.
Treat patients in front of you according to their medical needs.
The challenge for the health system is that practice does not necessarily reflect professional intent, and personal bias and fear of infection can interfere with nursing decisions.
Examples of different patients are filled in the 3-5 literature (worse)
Treated for some obvious moral stains.
The prevalence of HIV provides a typical example.
Health care workers reportedly do not want to treat people with HIV/AIDS (PLWHA)
For a range of reasons, including: because the patient is not worth it, or because treating PLWHA devalues healthcare workers in other eyes.
In many cases, this situation creates a hierarchical health system in which "abandoned" patients are treated and "not abandoned" patients are not treated.
6 The severity of stigma and discrimination is associated with a decrease in access to treatment and care for those with poor traits.
8 in order to overcome the risk of discrimination associated with social evaluation of HIV/AIDS patients, many teaching programmes now contain clear or integrated learning objectives related to specialization.
The process of specialization promotes instilling acceptable practices of medical staff in accordance with social expectations, as well as social contracts between customers and medical staff.
10-12 in this case, improving the professional level of health care workers is as important as improving technical capabilities and is also related to practical ethics.
Therefore, increasing specialization is expected to reduce stigma and discrimination in the area of health care.
Whether specialization protects patients from stratified medical care is an empirical question, but there is reason to believe that specialization will work by reducing negative attitudes and discriminatory behaviour towards patients --
In particular, those from marginalized groups, such as those living with HIV/AIDS.
There is already some evidence in the literature to support this idea.
For example, it is well known that targeted learning focused on attitudes towards specific marginalized groups can lead to a positive attitude shift.
It is not so clear whether the general focus on specialization is sufficient to improve attitudes towards all socially marginalized groups, regardless of the attributes of social depreciation.
Two improvements are needed in the idea that specialization may reduce stigma attitudes.
The first is the distinction between general specialization and targeted learning, as it is at the heart of ensuring a responsive and equitable health system.
For example, in targeted learning, if there is a need to develop programs to address the stigma attitude of health care workers towards each marginalized group or disease, the cost is too high, and the education process is always passive.
In contrast, the general professional healthcare workforce that understands and follows the holistic approach to ethical code of conduct is a more flexible workforce and is unlikely to create a tiered healthcare system.
The second improvement is to distinguish between individuals and private, non-health care professionals
Professional field.
There is no reason to think that the calm of the professional sphere for socially marginalized people will translate into the private life of health professionals.
In addition, there is no overwhelming reason to believe that professional attitudes are always consistent with private attitudes, as well as early on (future)
Healthcare professionals have clearly described the inharmonious attitude of individuals and professional areas. For example, I may be "blind" to the fact that a person is a pedophile in treating myocardial infarction, but if there are signs that they have joined my social circle, my vision may be restored.
Therefore, it may be expected that as the degree of specialization increases, there will be some degree of disagreement among health care workers about the social attitudes of marginalized people.
Specifically, while in order to provide treatment and care, negative attitudes towards social marginalisation may decrease as the degree of specialization increases, and social marginalisation in the field of individuals, the same attitude change may not be observed.
Despite HIV/AIDS-
The related stigma in health services was studied, and few work involved the relationship between professional development and change in stigma attitudes.
In fact, most studies rely on cross-cutting
Segmented data to assess the level of general stigma, 18-28 years old, but did not attempt to understand how attitudes may evolve and change over time, or pollution related to the field of professional and private life
This issue is particularly important in providing health services, as there is a hypothetical link between the trajectory of stigma attitudes and the trajectory of professional development.
The main purpose of this study was to investigate the relationship between the professional development stage of health students and the stigma attitude towards PLWHA.
More specifically, our goal is to measure students' attitudes towards PLWHA to assess (1)
The degree of stigma attitude ,(2)
Differences in attitudes in the professional and private sectors and (3)
As students become more specialized, differences in attitudes in the professional and private areas have changed.
While there are many stigma metrics, there are very few separate measures of stigma attitudes in the professional and private areas, and none of them have been validated in our research environment
Therefore, the conditional secondary goal is to develop a suitable tool to measure the stigma attitude in the professional and private fields.
However, this time the target is described in less detail, and the agreement assumes that this measure is identifiable.
Despite HIV/AIDS-
The related stigma in health services was studied, and few work involved the relationship between professional development and change in stigma attitudes.
In fact, most studies rely on cross-cutting
Segmented data to assess the level of general stigma, 18-28 years old, but did not attempt to understand how attitudes may evolve and change over time, or pollution related to the field of professional and private life
This issue is particularly important in providing health services, as there is a hypothetical link between the trajectory of stigma attitudes and the trajectory of professional development.
The main purpose of this study was to investigate the relationship between the professional development stage of health students and the stigma attitude towards PLWHA.
More specifically, our goal is to measure students' attitudes towards PLWHA to assess (1)
The degree of stigma attitude ,(2)
Differences in attitudes in the professional and private sectors and (3)
As students become more specialized, differences in attitudes in the professional and private areas have changed.
While there are many stigma metrics, there are very few separate measures of stigma attitudes in the professional and private areas, and none of them have been validated in our research environment
Therefore, the conditional secondary goal is to develop a suitable tool to measure the stigma attitude in the professional and private fields.
However, this time the target is described in less detail, and the agreement assumes that this measure is identifiable.
Methods and analysis design the ideal design of this study is 4-year to 5-
Annual longitudinal study on the change of attitude of medical and health students in measuring professional courses;
However, an alternative approach was proposed to limit the expenditure on resources while demonstrating the merits of this idea well.
Instead of vertical design, serial crossover
Segment Design (
In different study years, check the difference between the queues)
Will merge with the two
Longitudinal design of time points (
Examine the differences between the beginning and end of a single annual study; figure 1).
The stigma level will be measured once at the beginning of a single annual study and once at the end of the same year, which will be carried out throughout the year.
Download the figure open in the research design of the new tabDownload powerpoint figure 1 MBBS project.
Monash University is an Australian university with campuses in Australia, Malaysia and South Africa.
In this study, we will recruit health care students from Monash University from three campuses (
Two campuses in Australia, one in Malaysia).
Students over the age of 17, Study 4-
Professional, health care qualifications, degree courses will be eligible.
Students with health care qualifications will be excluded;
For example, a nurse returns to college to pursue medicine.
In addition, students under the age of 17 will be excluded.
There are no other exclusion criteria.
Sample size calculation is usually the number of predictive variables, variability of result variables, correlation between repeated measurements, planned statistical test types used to calculate the minimum number of respondents required to obtain significant results with known probabilities.
29 The variability of the results measurements is unknown, and the correlation between personal stigma and professional stigma repeated measurements is also unknown, which makes realistic sample size calculations almost impossible.
However, recent research on HIV knowledge and stigma among health care population in Malaysia provides a rough guide.
31 in studies without repeated measurements, a sample size of 340 was calculated.
Exaggerate this estimate to consider repeated measurements, which is equivalent to the conservative Design Effect of 2.
5, resulting in an estimated sample size of 850.
However, the ethical mechanisms that operate within the university for students as participants prevent random sampling and, in fact, people have to try to contact all students.
If the data analysis plan is assumed, we expect to use a mixed-effect linear model to examine the difference in stigma attitudes between different years
Group, control appropriate covariates such as age, gender, ethnographic background, and curriculum.
The method of data analysis assumes a serial crossover
Segment Design.
Conceptually, it is simple to consider data analysis from the perspective of repeated measurements (ANCOVA)
The attitude towards stigma is the result of a person's two measurements (
That is, the measure of personal and professional stigma).
According to years of research, professional level is regarded as an orderly factor;
Gender, HIV knowledge level, and degree course type are treated as nominal variables, interval variables, and nominal covariates, respectively.
In the preliminary phase, exploratory data analysis will be used to check and describe the data.
However, the repeated measurement of ANCOVA is not described because of its simple concept, but rather fitting a mixed effect linear model into the data to control the repeated stigma measurement on a person
The biggest advantage of a mixed effect linear model designed for repeated measurement is that if a result measurement is missing (
For example, if the participant fails to complete the personal stigma scale but does complete the professional stigma scale)
, The remaining data from the individual can still be retained.
The data will be analyzed using the R statistical environment.
32 The measurement tool currently does not have a measurement tool to measure the stigma attitude in the professional and private fields alone, which is the second goal of the study.
In order to develop the measurement tool, we will design a sequential hybrid method (
Questionnaire Survey).
We will form a group of health care experts (s)
, Health scholars and medical team members with at least 5 years of clinical experience, namely nurses, doctors, pharmacists, etc, we will implement 4-
Step-by-step methods for creating new measurement tools we will define the main aspects and areas of measurement tools based on "personal stigma field" and "professional stigma field in health professional working environment.
We anticipate that this can be achieved by creating short hypothetical scenarios about HIV-positive individuals and HIV-negative individuals in a healthy environment.
Scenarios of these assumptionsvignettes—
It can be themed on the fear of infection.
For example, "doctors refuse to operate on people with HIV/AIDS to protect themselves from HIV/AIDS.
We will decide the projects of "personal field of bean flower" and "professional field of bean flower" by adopting the available projects or developing new projects from the available verification measurement tools.
For example, we will search for relevant sources of information, namely published articles, book chapters, organizational documents, such as international and national professional conduct and ethics in the field of health, develop new projects for "Shame in the professional field.
2, 13, 33-38 we expect that a common theme reflecting professional mental traits can be extracted from the above-mentioned sources of information.
For example, fear of infection, risk of transmission, secrecy, and resource allocation may be the subject of a possible occurrence.
We will design new projects to capture social, professional or personal responsibility and potential stigma (HIV positive)or non-stigmatised (HIV negative)characteristic.
We will draft the final project to create a scaleA questionnaire
And will verify it.
We will manage measurement tools at a range of time points to capture any changes (s)in attitude.
Data collection we will collect data using newly developed questionnaires by managing papers
Based on and/or online surveys.
The online version of the survey will be provided through the "blackboard" class management system, with a link in the announcement as a login for the student (Australia). The paper-
Version-based will be distributed in the classroom at the end of the lecture (Malaysia).
There is no risk that students receive online versions and papers-based version.
The questionnaire will include population issues and a library of preliminary projects on HIV/AIDS --related stigma.
We will also provide questionnaires and explanatory statements to each participant --
The purpose and method of the study are described.
Participation in sites we expect health care students will be invited to attend 1-year period.
This will allow us to examine the differences in stigma attitudes between different years.
Group, control appropriate covariates such as age, gender, ethnographic background, cultural background, and curriculum.
The ideal design for this study is 4-year to 5-
Annual longitudinal study on the change of attitude of medical and health students in measuring professional courses;
However, an alternative approach was proposed to limit the expenditure on resources while demonstrating the merits of this idea well.
Instead of vertical design, serial crossover
Segment Design (
In different study years, check the difference between the queues)
Will merge with the two
Longitudinal design of time points (
Examine the differences between the beginning and end of a single annual study; figure 1).
The stigma level will be measured once at the beginning of a single annual study and once at the end of the same year, which will be carried out throughout the year.
Download the figure open in the research design of the new tabDownload powerpoint figure 1 MBBS project.
Monash University is an Australian university with campuses in Australia, Malaysia and South Africa.
In this study, we will recruit health care students from Monash University from three campuses (
Two campuses in Australia, one in Malaysia).
Students over the age of 17, Study 4-
Professional, health care qualifications, degree courses will be eligible.
Students with health care qualifications will be excluded;
For example, a nurse returns to college to pursue medicine.
In addition, students under the age of 17 will be excluded.
There are no other exclusion criteria.
Sample size calculation is usually the number of predictive variables, variability of result variables, correlation between repeated measurements, planned statistical test types used to calculate the minimum number of respondents required to obtain significant results with known probabilities.
29 The variability of the results measurements is unknown, and the correlation between personal stigma and professional stigma repeated measurements is also unknown, which makes realistic sample size calculations almost impossible.
However, recent research on HIV knowledge and stigma among health care population in Malaysia provides a rough guide.
31 in studies without repeated measurements, a sample size of 340 was calculated.
Exaggerate this estimate to consider repeated measurements, which is equivalent to the conservative Design Effect of 2.
5, resulting in an estimated sample size of 850.
However, the ethical mechanisms that operate within the university for students as participants prevent random sampling and, in fact, people have to try to contact all students.
If the data analysis plan is assumed, we expect to use a mixed-effect linear model to examine the difference in stigma attitudes between different years
Group, control appropriate covariates such as age, gender, ethnographic background, and curriculum.
The method of data analysis assumes a serial crossover
Segment Design.
Conceptually, it is simple to consider data analysis from the perspective of repeated measurements (ANCOVA)
The attitude towards stigma is the result of a person's two measurements (
That is, the measure of personal and professional stigma).
According to years of research, professional level is regarded as an orderly factor;
Gender, HIV knowledge level, and degree course type are treated as nominal variables, interval variables, and nominal covariates, respectively.
In the preliminary phase, exploratory data analysis will be used to check and describe the data.
However, the repeated measurement of ANCOVA is not described because of its simple concept, but rather fitting a mixed effect linear model into the data to control the repeated stigma measurement on a person
The biggest advantage of a mixed effect linear model designed for repeated measurement is that if a result measurement is missing (
For example, if the participant fails to complete the personal stigma scale but does complete the professional stigma scale)
, The remaining data from the individual can still be retained.
The data will be analyzed using the R statistical environment.
32 The measurement tool currently does not have a measurement tool to measure the stigma attitude in the professional and private fields alone, which is the second goal of the study.
In order to develop the measurement tool, we will design a sequential hybrid method (
Questionnaire Survey).
We will form a group of health care experts (s)
, Health scholars and medical team members with at least 5 years of clinical experience, namely nurses, doctors, pharmacists, etc, we will implement 4-
Step-by-step methods for creating new measurement tools we will define the main aspects and areas of measurement tools based on "personal stigma field" and "professional stigma field in health professional working environment.
We anticipate that this can be achieved by creating short hypothetical scenarios about HIV-positive individuals and HIV-negative individuals in a healthy environment.
Scenarios of these assumptionsvignettes—
It can be themed on the fear of infection.
For example, "doctors refuse to operate on people with HIV/AIDS to protect themselves from HIV/AIDS.
We will decide the projects of "personal field of bean flower" and "professional field of bean flower" by adopting the available projects or developing new projects from the available verification measurement tools.
For example, we will search for relevant sources of information, namely published articles, book chapters, organizational documents, such as international and national professional conduct and ethics in the field of health, develop new projects for "Shame in the professional field.
2, 13, 33-38 we expect that a common theme reflecting professional mental traits can be extracted from the above-mentioned sources of information.
For example, fear of infection, risk of transmission, secrecy, and resource allocation may be the subject of a possible occurrence.
We will design new projects to capture social, professional or personal responsibility and potential stigma (HIV positive)or non-stigmatised (HIV negative)characteristic.
We will draft the final project to create a scaleA questionnaire
And will verify it.
We will manage measurement tools at a range of time points to capture any changes (s)in attitude.
Data collection we will collect data using newly developed questionnaires by managing papers
Based on and/or online surveys.
The online version of the survey will be provided through the "blackboard" class management system, with a link in the announcement as a login for the student (Australia). The paper-
Version-based will be distributed in the classroom at the end of the lecture (Malaysia).
There is no risk that students receive online versions and papers-based version.
The questionnaire will include population issues and a library of preliminary projects on HIV/AIDS --related stigma.
We will also provide questionnaires and explanatory statements to each participant --
The purpose and method of the study are described.
Participation in sites we expect health care students will be invited to attend 1-year period.
This will allow us to examine the differences in stigma attitudes between different years.
Group, control appropriate covariates such as age, gender, ethnographic background, cultural background, and curriculum.
In the context of future healthcare professionals, the year of professional development can be seen as an indicator of specialization.
With the implementation of the health care program, clinical knowledge and knowledge of infection and transmission will increase.
However, there is also a concern about professional ethics and professional practice in modern health care programs --
Usually implicit, not explicit.
It may increase as the program shifts from pre-clinical to clinical years.
In this case, years of training have become a reasonable indicator of specialization.
Unfortunately, the professional spirit is troubled by the dissemination of knowledge.
Advantages and disadvantages the advantage of this study is that
Time point longitudinal design enables us to investigate the relationship between stigma attitudes and specialization of PLWHA by observing changes (s)
Attitude in a period of time.
The method of sampling is not ideal, but a constraint of moral requirements, which increases the possibility of selection bias.
In the more general invitation to participate to all students, those students with a special attitude (
Or the tendency to change attitudes through professional contact)may self-select.
It should be noted that this is a limitation that may require further study.
However, assuming that the participant would change on one dimension of the stigma attitude, but would not change the other, the nature of this assumption seems to provide some protection against the reasonableness of the selection bias, as against
The lack of a generally accepted "vocational" 39-41 for health care students or health care workers is a problem.
However, in the context of this study, years of research is first and foremost a reasonable indicator.
In addition, differences in social attitudes in the private and professional fields may be less obvious than expected, and differences need to be detected by large samples.
We are also looking forward to collecting ourselves.
The attitude of the report, not the actual attitude, of course, will also raise questions about the practical importance of this issue, which may in itself be a finding.
Conclusion a fair, responsive health system requires a healthcare worker who turns a blind eye to "should not" and "ethics should be condemned.
If we cannot better understand the relationship between specialization and negative social attitudes and behaviors, whenever a new disease or a new social group depreciates, we all have the danger of re-establishing a tiered health care system.
Although the measurement challenges are outlined here, the impact on the agenda of the professional education and health system is important enough to warrant further investigation.
Ethical and communication participation in this study will be fully voluntary and the filling and return of the questionnaire will be considered as consent.
The ethics committee for human studies at Monash University approved the agreement (
Approval number: CF12/0829-201200368)
Classified as low risk.
Data storage we will save the data in a locked file cabinet at Monash University (Sunway campus)
The premises for 5 years, after which the information will be crushed and placed in a safe bin according to the regulations of Monash University, and the digital recording will be deleted.
Only the chief investigator and researcher can enter the filing cabinet.
Communication program our goal is to present and publish the results of this study in national and international conferences as well as in peers
They are review journals respectively.
In the context of future healthcare professionals, the year of professional development can be seen as an indicator of specialization.
With the implementation of the health care program, clinical knowledge and knowledge of infection and transmission will increase.
However, there is also a concern about professional ethics and professional practice in modern health care programs --
Usually implicit, not explicit.
It may increase as the program shifts from pre-clinical to clinical years.
In this case, years of training have become a reasonable indicator of specialization.
Unfortunately, the professional spirit is troubled by the dissemination of knowledge.
Advantages and disadvantages the advantage of this study is that
Time point longitudinal design enables us to investigate the relationship between stigma attitudes and specialization of PLWHA by observing changes (s)
Attitude in a period of time.
The method of sampling is not ideal, but a constraint of moral requirements, which increases the possibility of selection bias.
In the more general invitation to participate to all students, those students with a special attitude (
Or the tendency to change attitudes through professional contact)may self-select.
It should be noted that this is a limitation that may require further study.
However, assuming that the participant would change on one dimension of the stigma attitude, but would not change the other, the nature of this assumption seems to provide some protection against the reasonableness of the selection bias, as against
The lack of a generally accepted "vocational" 39-41 for health care students or health care workers is a problem.
However, in the context of this study, years of research is first and foremost a reasonable indicator.
In addition, differences in social attitudes in the private and professional fields may be less obvious than expected, and differences need to be detected by large samples.
We are also looking forward to collecting ourselves.
The attitude of the report, not the actual attitude, of course, will also raise questions about the practical importance of this issue, which may in itself be a finding.
Conclusion a fair, responsive health system requires a healthcare worker who turns a blind eye to "should not" and "ethics should be condemned.
If we cannot better understand the relationship between specialization and negative social attitudes and behaviors, whenever a new disease or a new social group depreciates, we all have the danger of re-establishing a tiered health care system.
Although the measurement challenges are outlined here, the impact on the agenda of the professional education and health system is important enough to warrant further investigation.
Ethical and communication participation in this study will be fully voluntary and the filling and return of the questionnaire will be considered as consent.
The ethics committee for human studies at Monash University approved the agreement (
Approval number: CF12/0829-201200368)
Classified as low risk.
Data storage we will save the data in a locked file cabinet at Monash University (Sunway campus)
The premises for 5 years, after which the information will be crushed and placed in a safe bin according to the regulations of Monash University, and the digital recording will be deleted.
Only the chief investigator and researcher can enter the filing cabinet.
Communication program our goal is to present and publish the results of this study in national and international conferences as well as in peers
They are review journals respectively.
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The openurlpubmedfootnote contributions Jia changed it by developing the concept and the demobilization programme.
KA and DDR made substantial intellectual contributions to the manuscript.
PA and MAAH critically revised the manuscript and improved the expression of ideas.
All four authors have finally approved the publication of the manuscript.
The work was funded internally by the global public health sector (GPH)
Research force of the School of Medicine and Health Sciences at Monash University Shuangwei campus.
The grant number is 5140056.
There is no competitive interest.
MBBS executive committee and the ethics committee for human studies at Monash University.
Uncommissioned source and peer review;
External peer review.