Expert answer:Assess the Quality of a Research Paper
Expert answer:Based upon your reading of Pomeroy, Kiam, and Abel (1999; see the attached .pdf), address the following:Section I: Critique of the Article’s Introduction/Literature Review (p. 171–174)In your own words, what was the overall purpose of Pomeroy et al.’s research study? Was the literature review adequate and relevant? That is, did it lend support to the current study? If yes, how so? If no, speak to the limitations/weaknesses of the literature review and provide recommendations for how it could be strengthened.Section II: Critique of the Article’s Methodology (p. 174–179)What type of sampling approach was used in general (re: probability or non–probability) and specifically (e.g., simple random, stratified random, etc.)? Identify the research design. That is, would you classify this as a pre–experimental, quasi–experimental, or experimental study? How did you come to that conclusion? Did Pomeroy et al. sufficiently inform their audience of potential threats to the internal and/or external validity of their study that stem from the research design? Briefly explain your response.Section III: Critique of the Article’s Discussion (p. 182–185)Did Pomeroy et al. adequately acknowledge the strengths and limitations of their study? Briefly explain your response. Are there other strengths and limitations that were not identified? Be specific. If you were to build upon this study, discuss how you would handle the sampling strategy and research design in order to enhance causality (re: strengthen enhance your ability to make causal inferences that the intervention is responsible for the outcomes).
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RESEARCH ON SOCIAL WORK PRACTICE
Pomeroy et al. / GROUP FOR WOMEN IN JAIL
The Effectiveness of a Psychoeducational
Group for HIV-Infected/Affected
Incarcerated Women
Elizabeth C. Pomeroy
University of Texas—Austin
Risa Kiam
Portland State University
Eileen M. Abel
University of Central Florida
Objective: The effectiveness of a psychoeducational group intervention for HIV/AIDS-infected
and affected women was examined at a large southeastern county jail facility. Method: A quasiexperimental pretest-posttest design was used to examine depression, anxiety, and trauma symptoms of women inmates. Results: A multivariate analysis of covariance yielded significant differences between the experimental and comparison groups. Subsequent analysis of covariance for
each dependent variable indicated significant differences between groups as well. Effect sizes
ranged from moderate to strong. Conclusions: The psychoeducational group intervention
appeared to be effective in alleviating depression, anxiety, and trauma symptoms among women
inmates infected and affected by HIV/AIDS.
The number of women entering the jail and prison systems in the United
States escalated by 202% over the past decade. Currently, women inmates
account for about 9% of the entire prison population (Stephan & Jankowski,
1991), and women of color make up 57% of this group. One of the increasing
health and emotional concerns of women prisoners and prisons themselves is
the impact of HIV/AIDS on the jail population. To date, incarcerated women
infected or affected by HIV/AIDS have received little interventive attention
from corrections personnel. Despite indications that psychoeducational
groups for people living with HIV/AIDS have been found to be effective in
Authors’ Note: Correspondence may be addressed to E. Pomeroy, School of Social Work, University of Texas at Austin, Austin, TX 78746. Research for this article was supported in part by
the Lois and Ann Silberman Award. The authors would like to thank Sandra Davy, M.S.W., for
her supervision of students at the Orange County jail and her contributions to this research. We
would also like to thank the administration of the Orange County Corrections Department, especially Don Bjoring, for their support for this project.
Research on Social Work Practice, Vol. 9 No. 2, March 1999 171-187
© 1999 Sage Publications, Inc.
171
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RESEARCH ON SOCIAL WORK PRACTICE
lessening the emotional stress experienced by these individuals (Pomeroy,
Rubin, Van Laningham, & Walker, 1997; Pomeroy, Rubin, & Walker, 1995),
few groups for jailed women have been discussed in the literature. Because
social workers often are employed in corrections systems, they have opportunities to assess, intervene, and provide needed services for incarcerated
women who are infected/affected by HIV/AIDS.
This study was developed to evaluate the effectiveness of a psychoeducational group intervention for incarcerated women who are infected/affected
by HIV/AIDS. It was part of a larger rehabilitation project within the Orange
County, Florida, jail system to provide educational and occupational skills as
well as a variety of therapeutic interventions to both male and female inmates.
Although AIDS has shown a decline recently in the gay community, an
increasing number of people diagnosed HIV-positive (positive for the human
immuneodeficiency syndrome) or with AIDS are women. Since 1981, the
Centers for Disease Control (CDC) have reported 92,242 cases of women
with AIDS. These figures represent an increase of about 63% in the number
of cases of women with HIV/AIDS over the past 3 years (personal communication with CDC, December 29, 1997).
According to Hoffman (1993), 90% of women with HIV/AIDS have
dependent children, are single parents, may have lost a partner to AIDS, and
are often grappling with issues of poverty. Frequently, these families affected
by HIV/AIDS are at a pronounced risk of becoming homeless (Reidy, Taggart, & Asselein, 1991). This situation may be due to a multitude of factors,
such as discrimination, declining health, loss of employment, and dwindling
finances resulting from intravenous drug use, treatment expenses for infected
members, and poverty.
Initial responses to an HIV/AIDS diagnosis are often “heightened anxiety,
retreat into defense mechanisms such as denial, and understandable preoccupation with maintaining health” (Buckingham & Rehm, 1987, p. 7). Often, a
woman is asymptomatic and unaware of her HIV status until she becomes
pregnant or her baby is diagnosed (Herdt & Boxer, 1991; Tiblier, Walker, &
Rolland, 1989). In addition, the pregnancy itself may accelerate the woman’s
own disease process. Another threat to immune functioning is the seropositive person’s self-beliefs. Bandura (1990) suggests that “perceived coping
inefficacy increases vulnerability to stress and depression and activates biochemical changes that can affect various facets of immune function” and
influence health habits (p. 129).
Issues affecting HIV/AIDS-infected women participating in a support
group included the following: feelings of isolation, stigma, and shame; lack of
medical information; and poor self-image (Chung & Magraw, 1992).
Regardless of their illness, women were still expected to be the central
Pomeroy et al. / GROUP FOR WOMEN IN JAIL
173
caretakers for their families. They worried about infecting other family members through casual contact and feared becoming a burden. Other concerns
included if, when, and how to tell their children about their own illness or
their children’s illness. Women also processed feelings of loss regarding their
sexuality and desirability following diagnosis, resulting in loss of self-esteem
and mourning for the loss of reproductive choice (Chung & Magraw, 1992).
Mayer and Spiegel (1992) found similar concerns raised in parental support groups conducted in a pediatric AIDS clinic. Women expressed guilt
about HIV transmission to their children and feelings of isolation from family, friends, and medical staff.
The majority of women infected or affected by HIV/AIDS are members of
ethnic minority groups and live in impoverished inner cities where community services are sparse and difficult to obtain. Although the gay and lesbian
community has provided overwhelming support for HIV/AIDS infected people in their own cohort, disadvantaged women and intravenous drug users
who become infected find little help available in their own communities
(Walker, 1991).
As the number of women infected with HIV/AIDS has increased, so too
has the need for safe, nonjudgmental environments in which women can
express their needs and concerns. Support groups for people living with
HIV/AIDS, initially composed primarily of gay men, have spread to other
subpopulations of infected individuals. Interventions that focus primarily on
the gay client (El-Mallakh & El-Mallakh, 1989; Getzel, 1991; Miller &
Green, 1985; Morokiff, Holmes, & Weisse, 1987; Rounds, Galinsky, & Stevens, 1991), the gay partner (Carl, 1986), or significant others (i.e., friends,
family members, or spouses) (Bowes & Dickson, 1991; Frierson, Lippman,
& Johnson, 1987; Greif & Porembski, 1988; Land & Harangody, 1990) have
been the foci of most of the existing effectiveness studies. The literature on
women who are infected or affected by HIV/AIDS has been limited to
descriptive and anecdotal accounts of this population.
Just as there has been little research conducted on interventions for
women with HIV/AIDS, there is a proportionate dearth of information on
interventions for incarcerated female inmates. Since the beginning of the
1980s, the population of female inmates in the United States has increased by
over 200% (Gabel & Johnston, 1995). It is estimated that 25% of all women
inmates are HIV positive (Stephan & Jankowski, 1991).
The majority of these women are arrested for nonviolent crimes. Typical
offenses include fraud, drugs, and/or prostitution (Singer, Bussey, Song, &
Lunghofer, 1995). Nearly half of women inmates report that they were physically or sexually abused as children (U.S. Department of Justice, 1991). As
many as two thirds of women inmates require mental health services at, or
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soon after, their initial incarceration (James, Gregory, Jones, & Rundell,
1985). Gabel and Johnston (1995) reported that prior to incarceration, one in
five women inmates had received some form of mental health treatment.
In their recent investigation of female inmates, Singer et al. (1995) found
that 64% of their sample fell within the clinical range for mental health problems. The same study found that 83% of the women were in the substance
abuse range, and 81% had been victimized at some point in their lives. In an
effort to respond to the mental health needs of incarcerated populations, jailbased rehabilitation programs have been established. Most programs that
have been established within a corrections setting have been educational and
preventative in nature (Coulson & Nutbrown, 1992; El-Bassel et al., 1995)
and have focused on providing information to inmates. Recently, a skill
building and social support enhancement group was established to prevent
HIV/AIDS in drug-abusing incarcerated women (El-Bassel et al., 1995).
This pilot study evaluated the effectiveness of a group intervention for reducing the spread of HIV/AIDS among 145 female inmates. The study, “confirmed the feasibility of implementing a skill-building intervention for drugusing women in jail” (El-Bassel et al., 1995, p. 131).
Despite the enormous need for interventions targeting women prisoners,
there has only been a minimal amount of research conducted in this area. As
in other areas of social work, few studies have been conducted that examine
the effectiveness of the interventions that social workers employ within the
jail system. This study examined the effectiveness of a time-limited, psychoeducational, task-centered group for incarcerated women infected or affected
by HIV/AIDS. Three primary hypotheses were tested in this research and are
stated as follows:
Hypothesis 1: The psychoeducational group intervention will reduce the amount
of depression experienced by women inmates.
Hypothesis 2: The psychoeducational group intervention will reduce the amount
of anxiety experienced by women inmates.
Hypothesis 3: The psychoeducational group intervention will reduce the amount
of trauma symptoms experienced by women inmates.
METHODS AND PROCEDURES
Clients
The research participants in the study were drawn from the population of
HIV-infected or affected women incarcerated at the Orange County jail.
Pomeroy et al. / GROUP FOR WOMEN IN JAIL
175
Announcement of the group was made prior to the initiation of the study, and
women had the opportunity to sign up for it. If more than 12 women signed up
for the group, the overflow inmates were placed in the comparison group and
were given the opportunity to participate in the following group. Each of the
nine experimental groups filled to capacity for a total of 108 women. Twentyone women dropped out of the experimental group due to being transferred or
released from the jail. The total number of women who completed the group
intervention was 87. Fifty-two women were placed on a waiting list for the
group intervention and served as the comparison group. Thus, the total sample size for the study consisted of 139 women. Because of strict laws regarding confidentiality and AIDS in the state, we were not allowed to ask the
women to divulge their HIV status; however, many women who were HIVpositive shared this information with group participants during the course of
the intervention. Due to constraints of the jail system, subjects were not randomly assigned to the experimental and comparison conditions.
Psychoeducational Group Intervention
The intervention approach used in the current study is based on previous
research by one of the authors of a psychoeducational group intervention for
family members of people living with HIV/AIDS (Pomeroy et al., 1995). The
psychoeducational approach proved to be effective in alleviating the emotional turmoil associated with caring for people living with HIV/AIDS. The
authors also examined the effectiveness of a psychoeducational group for
heterosexuals with HIV/AIDS and found similar, positive results (Pomeroy
et al., 1997; Rubin, Pomeroy, & Gordon, 1995). Because of the prior success
of this intervention with other populations, modification of this approach to
specifically meet the informational needs and emotional concerns of incarcerated women who are infected or affected by HIV/AIDS and then test its
effectiveness with this female target population appeared to be warranted.
The educational component of the psychoeducational intervention is
based on the assumption that people coping with HIV/AIDS need accurate
information about the disease. Due to the wide variety of rare opportunistic
infections that may develop as a result of the illness, people affected by
HIV/AIDS often develop inaccurate or false assumptions about the disease.
Information about medication is also an important issue, particularly in light
of the recent advances in treatment with protease inhibitors. Women also
need to be informed about their ability to increase their chances of preventing
the transfer of this illness to their newborn infants with medication protocols
and good prenatal care. People coping with HIV/AIDS are often seeking
information that is comprehensible and accurate.
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RESEARCH ON SOCIAL WORK PRACTICE
In addition to education, the intervention provides social and emotional
support, the need for which has been well-documented in the literature on
coping with a chronic illness (Biegel, Sayles, & Schultz, 1991). A safe, confidential group environment can ameliorate the loneliness, isolation, and emotional distress experienced by people affected by a chronic/terminal illness.
People infected or affected by HIV/AIDS, in particular, need this group support due to the high degree of stigma associated with this illness (Cadwell,
1991; Pomeroy, 1994; Powell-Cope & Brown, 1992).
Although the psychoeducational approach provides the structure for the
group intervention, the conceptual framework also consists of elements of
cognitive-behavioral theory and the task-centered approach (Reid & Epstein,
1972). Cognitive behavioral techniques have proven to be effective in the
reduction of anxiety and depression as well as trauma symptoms. Numerous
studies have indicated the efficacy of cognitive-behavioral techniques in
individual or group therapy settings (Rehm, 1995). The basic assumption
underlying cognitive-behavioral theory is that dysfunctional cognitions
make a person vulnerable to anxiety and depression and lower self-esteem
(Hammen, 1995).
The task component or homework assignments are seen as a way to help
clients work on the emotional impact of HIV/AIDS in their lives between
group sessions. Whereas information can be readily assimilated if presented
in a coherent manner, making emotional changes can be far more timeconsuming and difficult. Therefore, it is important for group participants to
spend time working daily on the emotional issues with which they are confronted, especially given the time-limited nature of the intervention.
Each of the 1.5-hour psychoeducational group sessions consisted of an
educational, didactic component and a supportive component. The first part
of each session lasted about 45 minutes and consisted of a presentation and/or
discussion concerning an educational topic relevant to HIV-infected or
affected women. The second part of each session, also 45 minutes in length,
focused on supportive group processes using cognitive-behavioral and taskcentered techniques. Some of the topics in the supportive component of the
sessions include ways to cope with depression, anxiety, and stress; the importance of social support; self-esteem and empowerment issues; grief over multiple losses; and coping skills (see Table 1).
Outcome Measures
The dependent variables in this research study were anxiety, depression,
and trauma symptoms of the HIV-infected or affected incarcerated women.
These variables appear to exemplify the psychological consequences and
Pomeroy et al. / GROUP FOR WOMEN IN JAIL
TABLE 1:
Group
Session
177
Psychoeducational Content of Group Intervention
Educational
Component
Support
Component
Homework
Assignment
1
Overview of HIV/AIDS/
Establishing group trust
Trust and self-esteem
“I am” exercise
2
Opportunistic infections/
Challenging irrational
thoughts
Coping with depression
Automatic
thoughts exercise
3
Medication issues/
Recognizing inner
strengths
Depression (continued)
Changing negative
thoughts
4
Safer sex/Healthy versus
unhealthy relationships
Dealing with anxiety
Stress reduction
exercise
5
Safer sex (continued)/
Decision-making skills
Anxiety (continued)
Stress reduction
exercise
6
Nutritional needs/
Communication skills
Coping with anger,
grief, and loss
Anger
management
7
Women and children with
Anger, grief, and loss
HIV/AIDS/Parenting issues (continued)
Anger
management
8
Financial issues/
Building confidence
Problem solving and
goal setting
Goal-setting
exercise
9
Planning for the future/
Recognizing personal
resources
Empowerment
Strengths exercise
10
Termination
Accomplishments in
the group
Moving out and
moving on
relationship issues associated with the impact of HIV/AIDS on women as
discussed in an earlier section.
At the beginning and the end of the group sessions, participants in the
treatment group were given scales to measure the above named symptoms.
Participants in the comparison group were also given the instruments at times
that paralleled the beginning and end of the experimental group. Anxiety was
measured with the state version of the State-Trait Anxiety Inventory (STAI),
a standardized scale that has been validated and shown to have coefficient
alpha reliability coefficients ranging from .86 to .95 (Spielberger, 1983).
Depression was measured using the Beck Depression Inventory (BDI). The
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RESEARCH ON SOCIAL WORK PRACTICE
BDI has been shown to be sensitive to clinical changes, to be valid, and to
have reliability coefficients ranging from .74 to .93 (Beck, Ward, Mendelson,
Mock, & Erbaugh,1961; Corcoran & Fischer, 1987). Trauma symptoms were
measured using the Trauma Symptom Checklist (TSC-33), a 33-item instrument that has been employed in clinical research as a measure of traumatic
impact. It has been used in relation to the long-term effects of childhood
physical/sexual abuse. The scale has been shown to have internal consistency
with an alpha of .89 (Briere & Ruentz, 1989).
Research Design
A time-limited psychoeducational group intervention was provided to
HIV-positive infected and affected women in a county jail system. Due to the
varying lengths of stay of the women in the jail, the intervention was conceptually similar to the groups in prior studies (Pomeroy et al., 1995, 1997). The
length of the group, however, was modified to 5 weeks with two 90- minute
groups per week rather than the 6- or 8-week, once a week format of the prior
studies.
To test the hypotheses of this study, an experimental/treatment group and a
comparison group were established. To have an adequate sample size, the
group was held on five occasions for a 5-week period with two intervening
weeks to recruit new members. Each treatment group had a comparison
group. Two treatment groups ran concurrently with the exception of one
occasion. A total of nine treatment groups and eight comparison groups composed the research design. Because the participants were not randomly
assigned to the two groups, the study used a quasi-experimental nonequivalent control group design. This type of group design has, as its major weaknesses, the chance of statistical regression and the interaction of …
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