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The influence of religious beliefs health and social care essay

What influence does religious beliefs have on HIV-testing rate in Sub-Saharan Africa? AIM: To investigate the relationship between religious beliefs and HIV-testing rate in Sub-Saharan AfricaOBJECTIVES: To critically appraise the existing literature on the influence of religious beliefs on HIV-testing rate in Sub-Saharan AfricaIdentify gaps in the existing literature on the influence of religious beliefs on HIV-testing rate in Sub-Saharan AfricaDraw conclusions based on the literature reviewed on the influence of religious beliefs on HIV-testing rate in Sub-Saharan AfricaTo make propositions as a result of findings from the literature reviewTo make recommendations for improvement of HIV prevention efforts involving religious leaders in Sub-Saharan AfricaINTRODUCTIONPriore (year) remarks that the HIV/AIDS pandemic is one of an unprecedented scale with social and economic impacts on both the government and individuals. Although, there has been a 25% reduction in new infections between 2001 and 2011 and increased testing has been recorded in Sub-Saharan Africa, almost two in three persons who are HIV infected reside in Sub-Saharan Africa (UNAIDS, 2012). This is in contrast to North America, western and central Europe where the combined prevalence is one-tenth of that seen in Sub-Saharan Africa (UNAIDS, 2012). Furthermore, HIV-testing is pertinent to both individual and public health because despite advances in medical science (development of medicines and care practices) in recent years which have ensured an improved quality and length of life for people living with HIV, life expectancy is still dependent on how soon an HIV infected person gets diagnosed as late diagnosis predicts a lower life expectancy and increases the likelihood that the individual has infected others (www. nat. org. uk). It is established knowledge that beliefs influence both covert and overt behaviour (Ajzen, 1985; Lau et al., 1990; Fishbein and Ajzen, 2005). Thus, whenever behaviours need to be understood and modified as with health behaviours, the underlying cognitive processes and beliefs are usually targeted (Fishbein and Ajzen, 2005). Although, literature exists which have explored the mechanisms by which cognitive processes and beliefs affect health behaviour, the discourse on the role that religion plays in influencing health behaviour remains relatively sparse and inconclusive (Zou et al., 2009). The elucidation of the particular mechanisms by which religious beliefs may influence health behaviours (HIV-testing included) is particularly pertinent to the Sub-Saharan African context where religion plays a central role in everyday life and influences the interpretative framework with which people view their world (Smith, 2004). Consequently, an understanding of the extent to which this moralistic view influences such an important health behaviour will impact greatly on the efficiency and effectiveness of HIV prevention efforts in this region. PRELIMINARY LITERATURE REVIEWIn Africa, the influence of religion on various aspects of HIV-related behaviour is profound because of the trust and respect Africans have for their religious leaders as messengers of God (Trinitapoli, 2011). Takyi (2003) in a study of HIV/AIDS preventive and protective behaviour remarked that religion was associated with increased HIV/AIDS stigma, stereotyping and lower AIDS risk status which may inhibit HIV-testing. Also, a third of Muslim and a fourth of Christian participants were oblivious of transmission modes of the HIV virus and for those who reported HIV knowledge, it was not significantly associated with HIV-protective behaviours. However, Trinitapoli (2011) in a study of AIDS-related activities of religious heads in Malawi discovered that they were engaged in preaching against promiscuity, monitoring their congregation’s sexual behaviour, encouraging condom use and advocating HIV-testing and counselling. The study also found that members of these religious bodies where HIV-prevention messages were preached reported higher levels of responsible HIV-related behaviour. Finally, contrary to Takyi (2003), it was found that religious bodies displayed less stigmatising behaviour and provided support to people living with HIV/AIDS which may encourage HIV-testing (Trinitapoli). Although, some elements of the existing literature have arrived at definitive conclusions on the influence of religious beliefs on HIV–related behaviours, most studies’ findings are less clear-cut. Zou et al. (2009) sought to ascertain the relationship between religious beliefs and HIV perceptions, attitudes to HIV drug treatment and divulgence in Tanzania. Using a convenience sample, they discovered that participants who were religious believed HIV was a punishment from God and that prayer could cure HIV. However, these findings were only in rural areas and majority of the participants identified that they would begin treatment if they were HIV positive. Furthermore, this study discovered moralistic behaviour was believed to preclude one from HIV infection so that although religion fosters healthy HIV-related behaviours, it is not always the case. Zou et al. (2009) also remarked that religion may foster stigmatisation, affect the acceptance of HIV education and influence the use of health facilities which all may have a detrimental effect on HIV testing. Similarly, Uneke et al. (2007) in a study of pre-marital HIV-testing in Nigeria discovered that although religious bodies may encourage testing by pushing for mandatory testing before marriage, the stigmatisation, non-confidential handling of result, risk of refusal to marriage that accompanies these mandatory tests may discourage individuals from participatingIn light of the above opposing views about the influence of religion on HIV-testing and considering that most studies examine a specific group: religion, ethnic group, country, gender, age-group etc.; a critical review of these findings would allow for a more generalisable conclusion to be drawn in answering the question: ‘ What influence does religious beliefs have on HIV-testing rate in Sub-Saharan Africa?’METHODOLOGYIn the research planning process, the methodology is the link between the research question and data collection. It clarifies the approach the researcher wishes to take to obtain the data required to answer the question(s) posed by the study (Punch, 2000). Theoretical perspective: The post-positivist approach by Hirschheim (year) forms the theoretical basis for the proposed review. This methodological tradition advocates the mixed-methods approach and posits that the exact methods to be used in a research should be dependent on the specific research question. It merges the positivist tradition which advocates the objectivity of reality and relativism which focuses on the subjectivity of reality (Hart 1998). A literature review as a research methodology involves making sound inferences based on critical appraisal of systematically presented evidence from comprehensively understood existing literature on a given topic (Machi & McEvoy, 2009). In addition, a properly done literature review allows the reader to see a logical basis for the conclusion reached at the end of the review (Hart, 1998). Fink (2009) further asserted that literature reviews allow the assessment of the rigour of existing research. This, according to Hart (1998) allows the reader of the review to make a decision on the findings. In the context of the proposed review then, it would appear that the literature review methodology would be most appropriate because of the disagreement which exists in the discourse on the influence of religion on self-efficacy in HIV-testing in sub-Saharan Africa; by producing a synopsis from critically appraised existing evidence, a sound conclusion may be drawn that enables the reader to see the logical basis for it. Furthermore, all the literature review methodology requires is the inquiring mind of a competent researcher, a well-stocked library or an online database hence it is cost-efficient and time-friendly (Marreli, 2010). However, there are no compromises on rigour because the method is an intentional process which allows for identification of nuances in the current discourse (Machi & McEvoy, 2009; Marreli, 2010). This is important because the proposed review is to be conducted in the pursuance of an academic award which lasts twelve calendar months and a method which combines rigour and time-friendliness is ideal. METHODSA list of key words derived from the research question with Boolean operators will be used to search mainly in the following databases: Cochrane library, PubMed, PsycINFO, MEDLINE, HMIC, TRIP database, CAB Abstracts, ASSIA, Sociological Abstracts, Source, Web of Science. The Boolean operators (AND, OR) and truncation indicated by (*) will be used to achieve precision with the search (Blaxter et al., 2001). Thus, the Boolean query would look like this; Search 1Religious beliefs OR religion OR faithSearch 2HIV test*Search 3Rate OR uptakeSearch 4Sub-Saharan Africa OR SSASearch 5Search 1 AND Search 2 AND Search 3 AND Search 4The same Boolean query will be entered into all databases to ensure access to a range of relevant literature. Finally, any key articles identified during the search will be entered into the Web of Science database for a cited reference search. HIERARCHY OF EVIDENCE: The proposed review will use mainly cross-sectional studies as a literature survey shows that most studies into the influence of religion on HIV-testing rates used this methodology (Smith, 2004; Green). Furthermore, because cross-sectional studies are quantitative, they are generalizable to other contexts and effectively capture the characteristics of a defined population at a given time (Aveyard, year). Although, unlike randomised control trials (RCTs), causal inferences may not be drawn from cross-sectional studies, the proposed review seeks to find an association if any between religious beliefs and HIV-testing rates and in doing so, elucidate the reasons behind the association such as underpinning attitudes and then generalise to similar contexts which cross-sectional studies allows (Aveyard). Additionally, RCTs are not possible in this case as people may not be randomly assigned religions for research purposes. Finally, as Aveyard(year) notes, although achieving representativeness can be difficult with cross-sectional studies, random sampling may be used to achieve this(Aveyard). Qualitative research although limited in its generalizability, is a rich source of information because of it’s subjectivity (Blaxter et al., 2001). Thus, the proposed review will consider mixed-methods research as second place in the hierarchy of evidence as their appraisal may provide insight into some of the reasons for the association between religious beliefs and HIV-testing identified by strictly quantitative methods. SAMPLE AND ACCESSAccording to Punch (2000), the sample not only details who the study participants are but should include information on the eligibility criteria. In other words, giving reasons for inclusion (and exclusion of potential participants) is crucial. In the context of the proposed literature review, the evidence relevant to the research question would be obtained from journals and books. A wide array of journals will be searched, ensuring an international perspective so that sound conclusions may be drawn. The sampling techniques that would be used to obtain the relevant data for the review will most approximate the snowball and simple random probability sampling technique (Wellington, 2000 as in Smith, 2010). Snowball sampling typically involves the researcher requesting that participants identify other potential participants who meet the inclusion criteria of the research in question. Thus, in the context of the proposed review, the Web of Science database will be used to conduct a cited reference search to discover other potential review articles that cite a parent article. In this case, the parent article represents the initial subject that leads to the discovery of the potential review articles. The advantage of this technique is that it will be used to access articles missed by the Boolean query. Furthermore, the use of Google scholar in the review loosely resembles the snowball sampling technique as it will provide leads for further exploration in the Oxford Brookes university online database. Secondly and more importantly, the manner in which the journal articles will be gotten from the university online database will mostly resemble a simple random probability sampling method. In which case, the online database represents the sampling frame and all potential relevant articles have an equal chance of being identified ensuring accurate results. DATA COLLECTIONData for the proposed literature review will mainly be obtained from journal articles available from the Oxford Brookes university electronic database. However, journal articles not available on the Oxford Brookes university electronic database would be sought from the Bodleian library of the University of Oxford. Books will be consulted mainly to obtain established knowledge such as definitions and information on sound research methodology. ‘Google scholar’ will serve as a preliminary source of information and a citation search will be carried out on the Web of Science database. All potential articles’ abstracts would be read to ascertain relevance, year of publication, ethical considerations, research methodology (and position on hierarchy of evidence) after which all appropriate studies (qualifying for inclusion as shown in the table below) would be included in the review. Although Walsh and Downe(2005) assert that literature should be appraised for quality before being included in a review, Noyes and Popay(2007), and Thomas and Harden (2008) note that insufficient evidence exist to justify exclusion of studies based on quality assessment. Furthermore, they posit that in order to provide a comprehensive appraisal, all relevant literature should form part of the review hence the proposed review will include all relevant literature identified during the search. INCLUSION AND EXCLUSION CRITERIA FOR THE PROPOSED RESEARCHInclusion criteriaExclusion criteriaRationaleEthically sound studiesThis is an indicator of research quality (Punch, 2000)Studies in EnglishResources: time and money for translation are limited as the proposed review will be done for academic purposes. Studies published between 1993 and 2013Studies done before 1993To identify current trends around the research topic (reference)Cross-sectional, mixed methods studiesQualitative studiesA literature survey suggests cross-sectional and mixed methods are the most used methods for research in this area. Qualitative studies are not generalizable beyond context they were conducted (Blaxter et al. (2001)Primary studiesSecondary studies including report of unpublished dataTo avoid error in reporting (Aveyard)DATA ANALYSISAveyard (year) remarks that a dearth exists in the literature on appraisal tools for cross-sectional studies. Katrak et al. (2004) also highlight the lack of consensus that exists in the decision to use appraisal tools however as Aveyard (year) suggests; in order to achieve rigour and objectivity in literature reviews, appraisal tools should be employed by novice researchers (as is the case with the proposed review). Furthermore, Katrak et al. (2004) posit that although a number of appraisal tools exist, the choice of an appropriate tool is ultimately the researcher’s responsibility. Consequently, the proposed review will use the Milton Keynes Primary Care Trust (2002) cross-sectional studies appraisal tool because it addresses issues relating to validity, reliability, presentation and sampling which were identified by Aveyard(year) as the factors which determine the quality of cross-sectional studies. Similarly, an appraisal tool by Long (2005) will be employed for the mixed methods studies used in the proposed review. The appraisal tool has items addressing validity and reliability as identified by Aveyard(year) as indicators of the quality of quantitative research. Additionally, although other markers of qualitative research quality have been identified (e. g. Yardley, 2000 as in Bryman, year) the most authoritative appears to be Guba’s (1985) credibility, transferability, and dependability which the appraisal tool also addresses with items measuring member validation, triangulation, reflexitvity, thick description, evidence of decision trail etc. SYNTHESISAveyard (year) identifies the synthesis stage as that where the research question is answered by producing a synopsis of all appraised papers to produce new knowledge. The steps below are adapted from Aveyard, 2010, Machi and McEvoy, 2009, and Robertson et al., 2011. Step one – Using a table details of each study appraised will be provided as follows: The table columns will note; author, year (in chronological order), country of research, aims, methodology-outcome measures and participant characteristics, research quality as evidenced by the critical appraisal, research placement on hierarchy of evidence, religious group studied, and outcome measures as shown in the table belowAuthor(year)CountryMethodologyResearch qualityPlacement on hierarchy of evidenceReligious group studiedOutcome measuresStep two – Codes will be assigned to each paper’s key findings. Step three – These key findings will be grouped according to similarity such that clear ‘themes’ begin to emerge (Aveyard pg…). A justification for the classification of the findings into themes will be included in the appendix of the dissertation specifying the reasoning pattern adopted; one-on-one, side-by-side, chain, or joint reasoning in arriving at this classification (Fisher 2004 as in Machi and Mcevoy). . Although as Machi and Mcevoy note, different criteria may be employed to categorise key findings however, what is pertinent to the proposed research is to show what influence religion is having on HIV-testing rates irrespective of chronology, religion or country hence they would not be used as variables for categorisation. Step four – A list of themes and accompanying codes will be compiled and a thorough check will be done to ensure all codes belong in the themes they have been assigned and that all themes are appropriately named considering all the codes assigned to them. Step five – Any opposing themes will be examined using the literature review’s hierarchy of evidence and the methodological quality of the studies that make up the themes as criteria. This is similar to the divergent reasoning pattern identified in Machi and Mcevoy and would enable the identification of the stronger claim/theme which would then be discussed. At this stage, the research question may be revised in light of emerging themes. Step six – A literature review ‘ tally matrix’ will be constructed as belowPlacement on hierarchy of evidenceMethodological strengths and weaknessesKey findingsCodesThemesAuthor (year)Author (year)Author (year)Adapted from Machi and McEvoy pg. 84Step seven – Each theme will then be addressed in detail as it answers the research question. Step eight – Themes will be discussed as they relate to theory and broader public health practice. Recommendations will be made for practice and future research. ETHICAL ISSUES: The moral codes that informed the conduct of the research and researcher will be critically examined in the proposed review as they are an indicator of research quality (Punch, 2000; Smith, 2010). Thus, the proposed literature review will only use research which obtained informed consent from participants and any indication of coercion in the selection process would disqualify a study from being used (Miles & Huberman, 1994, as cited in Punch, 2000). Studies which do not protect the anonymity of its participants or organisations or breaches their confidentiality in any way will not be reviewed. This is most pertinent to the proposed literature review because of the sensitive nature of the study area. Also, any research which exposes participants to psychosocial harm; damaging their social standing, and relationship with family members and religious group members or leads to stigma will not be included in the review (Punch, 2000). The proposed review will ensure a fair representation of all reviewed studies, avoiding falsification and misrepresentation of other researchers’ work. This will be achieved by taking a reflexive approach to the research i. e. identifying potential sources of bias in form of beliefs and proclivities and understanding how they might affect the research work (Smith, 2010). By identifying them, they can be controlled (Machi & McEvoy, 2009). Also, being in constant communication with the dissertation supervisor will further ensure an unbiased approach. Plagiarism will be avoided and all ideas, assertions and conclusions, where not that of the researcher will be appropriately cited. RIGOURRigour refers to how well the researcher follows previously laid out research plans and controls for potential bias (Gerrish & Lacey). Machi and McEvoy (year) also note that the proclivities of the researcher can bias the research work and suggest that these should be reduced as much as possible in order to achieve objectivity. Additionally, Gerrish and Lacey (year) posit that the quality of research has two components; reliability and validity. Extrapolating from these, rigorous research is objective, reliable and valid. Reliability in the context of the proposed review is carried out by a different researcher in the context of the subsaharan african setting the results arrived at will be the same (blaxter). Bryman (2008) posits that explicitly outlining research procedures ensures that it is replicable. Thus, the methodology of the proposed review details the key words, boolean operators, inclusion and exclusion criteria to be employed in the literature search and collection , as well as providing the list of databases to be searched.

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Validity of any given research methodology refers to whether it mesaures what it sets out to measure (blaxter). To achieve this within the context of the proposed literature review, first, all findings would be explained in the context of the subsaharan African setting as this ensures that generalisations are not drawn out of context(Hart, 1998). Second, all findings will be discussed in light of theory (hart). Finally, Hart (1998) posits that defining the aim of the study ensures that the research works towards achieving it. The propsed review seeks to investigate (understand and explain) the relationship between religion and HIV-testing rate in subsaharan Africa hence, validity will be achieved by doing what the research set out to do. LIMITATIONS: Methodology, researcher, topic/question-must say what u ll do to address theminclusion exclusion criteriatopic/question-upon surveying research had to expand itaccess to data-religion data are grey literaturelimited resources-money aint an issue, time-this is an educational coursenovice researcher-supervisor and read booksit is just me doing the review… looking at other ppl work: will not look at 2ndary dataTIMEFRAMEMachi and McEvoy note the importance of allocating sufficient time to research work hence a time chart detailing the proposed literature review process over twelve calendar months is presented below; MonthActivity123456789101112Data searchWriting proposalcritical appraisal and data analysisCompilation of resultsWriting dissertationDissertation submission and disseminationDISSEMINATIONDissemination refers to the process of making research conclusions available to as many readers as possible (Saywell et al., 2007 cited in Neale). Channels of dissemination vary and Neale advocates the use of more than one channel to ensure a wide reach. Furthermore, although the choice of dissemination channels will be dependent on topic as well as intended audience all output should be clear, easy to understand, comprehensive and structured (Neale)The proposed review’s primary audience would be the academic supervisor as well as other markers so i ll follow all directions in handbook such as…….. the format can then be modified to suit other channels such as report for government agencies in subsaharan Africa, oral presentations to faith based organisations and for relevant websites. the most ideal channels for the proposed review include academic journals as they have an international audience and this is particularly pertinent to the propsed literature review which focuses on such a broad population(Allison & Race, 2004 as cited in Neale). This wil be achieved by sending abstracts to editors and seeing what they say. mass media is also acceptable because of the social nature of the topic. in this case the language will be devoid of jargon, use of lay terms. finally oral presentation will be ideal because the proposed review doesnt require too much elaboration on the research design hence (day and gartel, 2006). these oral presentation can be carried out at conferences and faith based organisations.

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