Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study

A Study on AIDS Self-Management Status and Its Influencing Factors

Purpose

To investigate and analyse the status quo of the self-management of patients living with HIV/AIDS (PLWHA) and its influencing factors and to provide the basis for formulating intervention strategies.

Methods

In this cross-sectional study, 300 PLWHA who visited the Infection Center of Beijing Youan Hospital, Capital Medical University between September 2021 and December 2021 were enrolled using the convenience sampling method. Demographic characteristics and disease-related data were collected for each participant. The HIV/AIDS Self-Management Scale was used to evaluate the self-management ability of PLWHA.

Results

A total of 251 male and 49 female PLWHA were included in this study, with an average age of 39.08 ± 12.09 years and an average disease duration of 9.61 ± 37.04 months. Univariate analysis showed that the PLWHA's place of residence, educational level, physical condition, family relations, duration of HIV disease, receipt or not of antiviral therapy and knowledge of disease had an influence on the scores of the HIV Self-Management Scale (all p < 0.05). The results of the self-management scores indicated that the total score for self-management was 41.5 ± 6.4 points, with a scoring rate of 69.6%, which was at a medium level. Long-term self-management had the highest scoring rate (12.2 ± 2.5 points), followed by daily health management (22.3 ± 4.3 points), and social support for self-management had the lowest scoring (5.1 ± 0.9 points). Multivariable analysis showed that the self-management ability of PLWHA was related to educational level, duration of disease and family relations (R2 = 0.67, F = 121.7, p < 0.05).

Conclusion

The self-management level of patients with AIDS, especially the social support of daily health management and self-management, needs to be further improved. Educational level, duration of disease and family relations are important factors influencing the self-management of PLWHA.

Perceived communication efficacy and unmet needs for chemotherapy-associated symptom management in patients with lung and colorectal cancer: a cross-sectional study

BACKGROUND

Understanding cancer patients' unmet needs for chemotherapy-related symptom management will assist clinicians in developing tailored intervention programs. Little is known about the association between perceived communication efficacy and unmet care needs for symptom management in patients with lung and colorectal cancer.

OBJECTIVES

To examine the unmet care needs for symptom management of patients with lung and colorectal cancer and their association with perceived communication efficacy.

METHODS

A cross-sectional survey was conducted in a tertiary hospital in China from July to November 2020. A convenience sample of 203 patients with lung and colorectal cancer undergoing chemotherapy completed survey questionnaires, including the MD Anderson Symptom Inventory Scale and the Perceived Efficacy in Patient‒Physician Interactions Scale.

RESULTS

Approximately 43% of participants had at least one symptom with unmet needs. Fatigue was reported as the symptom with the highest occurrence (66%), the highest demand for supportive care (36%), and the highest prevalence of unmet needs (19%). Low levels of perceived communication efficacy independently predicted participants' unmet needs for symptom management (β=-0.13, p = 0.011).

CONCLUSIONS

This study highlights the necessity of introducing clinical assessment tools and guidelines to address fatigue and other chemotherapy-induced symptoms in patients with lung and colorectal cancer. Clinical programs designed to actively engage cancer patients to voice their needs and strengthen their communication efficacy are also warranted.

Gender differences in symptom burden among people living with HIV/AIDS receiving antiretroviral therapy in Yunnan, China

ABSTRACTLittle is known about gender differences in the symptom burden of people living with HIV/AIDS (PLWHA) on antiretroviral therapy in China. This study was conducted based on a biopsychosocial-medical model to describe gender differences in symptom burden among 1035 PLWHA in Yunnan Province, China. After propensity score matching, 798 PLWHA were included in this analysis. Feeling stressed, poor sleep, and memory loss were the most burdensome symptoms among men, while feeling stressed, memory loss, and dizziness were the most burdensome symptoms among women. Among men PLWHA, factors associated with symptom burden were being of the ethnic minority, CD4 count ≥ 500 cells/mm3, physical functioning, and social support. Among women PLWHA, factors associated with symptom burden were being an inpatient, physical functioning, psychological functioning, and social support. Our findings suggest that healthcare providers need to take into account gender differences when developing optimal prevention, treatment, and care programs that provide individualized care to reduce patients' symptom burden.

Exploration of adaptation process and experience among the HIV/AIDS patients based on the comprehensive task-based adaptation model

OBJECTIVES

Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) confront multiple difficulties during the disease adaptation process. Based on the comprehensive task-based adaptation model, this study aims to explore the process and experience of adapting to living with HIV among HIV/AIDS patients and to provide evidence for promoting the adaptation of this population.

METHODS

With the design of the phenomenon study, we purposefully recruited 43 HIV/AIDS patients and conducted semi-structural interviews. The qualitative data was analyzed by Van Manen method.

RESULTS

There were 1 307 significant quotes and 6 themes with 14 sub-themes. "The shadow comes along with the sunshine" was proposed to describe the process of adapting to life with HIV. Another 5 themes emerged to represent the tasks as follows: the direction of the mental anchor, the management of physical tasks, social network and support, the occupational dilemma and benefits, and the consideration of the future.

CONCLUSIONS

The adapting process possesses both common and personalized characteristics. Future intervention development should address the integrality and interaction of the adaptation tasks, contributing to the positive adaptation outcomes of HIV/AIDS patients.

Factors influencing self-management among patients diagnosed with anxiety disorders in China: A cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Self-management comprises five core skills: "Problem Solving, Decision-Making, Resource Utilization, Forming a Patient/Healthcare Provider Partnership and Taking Action." Effective self-management among patients diagnosed with anxiety can reduce the number of relapses and improve treatment outcomes. Knowledge of the impact of the family atmosphere, well-being and illness symptoms on self-management in patients diagnosed with anxiety disorders is limited. WHAT DOES THE PAPER ADD TO THE EXISTING KNOWLEDGE?: This is the first study in China to explore whether family atmosphere and well-being of patients diagnosed with anxiety disorders affects self-management. This paper adds to the list of factors influencing self-management among patients diagnosed with anxiety disorders. SAS scores are a major factor influencing self-management among patients diagnosed with anxiety disorders. The subjective well-being of patients diagnosed with anxiety disorders can influence their self-management behaviour. Patients who experienced family harmony had significantly higher self-management scores than those who experienced family disharmony. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should encourage patients diagnosed with anxiety disorders to manage their condition while receiving treatment at home. Nurses should focus on patients diagnosed with anxiety disorders who have significant anxiety symptoms and low well-being. Nurses should emphasize the importance of the home environment in family self-management and affirm that a good home environment promotes patient self-management.

ABSTRACT

INTRODUCTION: Better self-management can improve treatment outcomes and reduce the number of relapses for patients diagnosed with anxiety disorders. However, the impact of well-being and the home environment on self-management among patients diagnosed with anxiety disorders is unclear in China.

AIM

This study sought to determine the impact of the home environment, well-being and illness symptoms on self-management during home treatment for patients diagnosed with anxiety disorders.

METHOD

This cross-sectional study was conducted with patients diagnosed with anxiety disorders. Data were collected with SAS, Self-Management Scale for People with Anxiety Disorders and Index of Well-being. Frequency, percentage, analysis of variance, Kruskal-Wallis and multiple linear regression analyses were used.

RESULTS

Home environment (p < .001), self-perceived quality of life (p = .015), well-being index (p = .002) and SAS total score (p = .033) had a major impact on self-management in patients diagnosed with anxiety disorders (n = 245).

DISCUSSION

Family disharmony, poor self-perceived quality of life, high SAS scores and low levels of well-being were significant influences on self-management among people diagnosed with anxiety disorders.

IMPLICATIONS FOR PRACTICE

Nurses should focus on the self-management of patients diagnosed with significant anxiety symptoms and low well-being and value the importance of the home environment in facilitating self-management among patients diagnosed with anxiety disorders.

The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis

BACKGROUND

Peer support is an important supplement to medical resources for persons living with HIV (PLHIV). However, previous studies have shown mixed results about intervention effects. It is necessary to explain the mechanism of peer support interventions' effectiveness and sustainability to help design more valid peer support interventions.

OBJECTIVE

To identify and explain the mechanisms that drive the effectiveness and maintain the sustainability of peer support interventions.

METHODS

A preliminary theoretical framework was developed through a scoping review of the grey literature and international project frameworks in five professional websites. We then refined the framework by systematically searching evidence in databases including PubMed, EMBASE, Web of Science, ProQuest, CINAHL, CNKI and Wanfang. Qualitative methods were used to generate codes and themes relating to the studies' context, mechanisms and outcomes. We checked chains of inference (connections) across extracted data and themes through an iterative process.

RESULTS

A total of 6345 articles were identified, and 52 articles were retained for final synthesis. The refined theoretical framework presents five areas of peer support, including informational support, instrumental support, emotional support, affiliational support and appraisal support; five types of outcomes that peer support can improve for PLHIV, including physiological outcomes, psychological outcomes, behavioural outcomes, cognitive outcomes and social outcomes; the effectiveness mechanism coding system from peer volunteers and the relationship between peer volunteers and PLHIV; and the sustainability mechanism coding system in terms of peer volunteers, PLHIV and study context.

CONCLUSIONS

Given that peer support has huge potential human resources, that is, all the qualified PLHIV, irreplaceable advantages in dealing with barriers to HIV-related discrimination and potential comprehensive benefits for PLHIV, it is necessary to develop and organise more peer support projects for PLHIV. Our study highlights that the expansion of peer support projects should be based on their effectiveness and sustainability.

PROSPERO REGISTRATION NUMBER

CRD42022339079.

Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care

With more than 38 million people living with HIV worldwide, the scale-up of antiretroviral therapy ensures nearly 28 million of them receive regular treatment. However, a substantial number of deaths still occur every year from AIDS-related complications, with approximately 680 000 deaths in 2021. Of the estimated 56·8 million people globally in need of palliative care in 2020, only 7 million can access services. Providing palliative care services can help alleviate health-related suffering, such as pain and disease-related symptoms, and improve wellbeing. This Viewpoint discusses the unrealised potential of palliative care in individuals with advanced HIV disease. Key areas of training for health-care workers include appropriate sensitisation, training in palliative care, and effective communication. Advance care planning supports both the individual and their family and is therefore of crucial importance. Integration of palliative care in HIV programmes is needed to address health-related suffering, particularly for advanced HIV disease.

Exploring core mental health symptoms among persons living with HIV: A network analysis

CONTEXT

Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships.

OBJECTIVE

This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH.

METHODS

From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters.

RESULTS

Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (r_S = 0.59, r_C = 0.61, r_B = 0.06), followed by feeling discouraged about the future (r_S = 0.51, r_C = 0.57, r_B = 0.04) and feelings of worthlessness (r_S = 0.54, r_C = 0.53, r_B = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (r_S = 1, r_C = 1, r_B = 0.43).

CONCLUSION

Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.

Relationship between self-management of patients with anxiety disorders and their anxiety level and quality of life: A cross-sectional study

PURPOSE

To explore the correlation between self-management and anxiety and quality of life in patients with anxiety disorders and to understand whether self-management can influence the relationship between anxiety and quality of life and provide a basis for improving their anxiety and quality of life.

METHODS

A cross-sectional survey of 245 patients with anxiety disorders in West China Hospital of Sichuan University was conducted using the Self-Management of Anxiety Disorders Scale, Self-rating anxiety scale (SAS), and World Health Organization Quality of Life-BBREF. The data were then analyzed using descriptive tests and Pearson correlation in SPSS 25. Bootstrap mediated effects tests were used to test the effect relationship between anxiety, quality of life and self-management scores in patients with anxiety disorders and Amos was used to establish the structural equation model.

RESULTS

The results of the correlation analysis showed that the total self-management score was positively correlated with the total quality of life score (r = 0.695, P <0.001), physical domain score (r = 0.552, P <0.001), psychological domain score (r = 0.661, P <0.001), social relations domain score (r = 0.542, P <0.001), and environmental domain score (r = 0.614, P <0.001). Additionally, it was negatively correlated with SAS score (r = -0.470, P <0.001). Self-management partially mediates the relationship between anxiety and quality of life, and the direct effect value of anxiety on quality of life was -0.44. The indirect effect value of self-management was -0.27, accounting for 38% of the total effect value.

CONCLUSION

Self-management of patients with anxiety disorders was negatively correlated with anxiety and positively correlated with quality of life. It played a partially mediating effect between anxiety and quality of life. We recommend that healthcare providers pay attention to self-management interventions for patients with anxiety disorders to further improve their quality of life.

How the Term 'Self-Management' is Used in HIV Research in Low- and Middle-Income Countries: A Scoping Review

This scoping review assessed how the term 'self-management' (SM) is used in peer-reviewed literature describing HIV populations in low- and middle-income countries (LMIC). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. OVID Medline, Embase, CAB Abstracts, and EBSCO CINAHL, Scopus, and Cochrane Library were searched up to September 2021 for articles with SM in titles, key words, or abstracts. Two team members independently screened the titles and abstracts, followed by the full-text. A data extraction tool assisted with collecting findings. A total of 103 articles were included. Since 2015, there has been a 74% increase in articles that use SM in relation to HIV in LMIC. Fifty-three articles used the term in the context of chronic disease management and described it as a complex process involving active participation from patients alongside providers. Many of the remaining 50 articles used SM as a strategy for handling one's care by oneself, with or without the help of community or family members. This demonstrates the varied conceptualizations and uses of the term in LMIC, with implications for the management of HIV in these settings. Future research should examine the applicability of SM frameworks developed in high-income settings for LMIC.

Factors related to the incidence of unmet need in couples of reproductive age in the working area of Marawola Health Center

OBJECTIVE

This study aimed at determining factors associated with the incidence of unmet need for family planning among couples of reproductive age in the working area of Marawola Health Center, Sigi Regency.

METHOD

This research was an analytic observational study with a cross-sectional study design. The variables in this study included age, education, family planning history, husband's support and unmet need. Data were in the form of primary and secondary data. Data were collected using a questionnaire. The data were analyzed using univariate and bivariate analysis utilizing the Chi-Square test. Population in this study were 4715 couples of reproductive age in the working area of Marawola Health Center. By using Lemeshow's calculation technique and simple random sampling, a sample of 90 people was obtained.

RESULT

The results demonstrated a relationship between age and the incidence of unmet need with p value=0.004 (p-value ≤0.05); education and the incidence of unmet deed with p value=0.005 (p-value ≤0.05); family planning history and the incidence of unmet need with p value=0.002 (p-value ≤0.05); as well as husband's support and the incidence of unmet need with p value=0.001 (p-value ≤0.05).

CONCLUSION

This study concludes that there is a relationship between age, education, family planning history, and husband's support and the incidence of unmet need for family planning in the working area of Marawola Health Center, Sigi Regency. Therefore, health workers, local governments, and traditional institutions are expected to provide education about family planning to couples of reproductive age (husband and wife) as an attempt to reduce the number of unmet needs in the working area of Marawola Health Center.

Evolving symptom networks in relation to HIV-positive duration among people living with HIV: A network analysis

OBJECTIVES

To explore and visualize the relationships among multiple symptoms in people living with HIV (PLWH) and compare centrality indices and the density of symptom networks among groups of individuals with different HIV-positive durations.

METHODS

We conducted a secondary analysis of data from the HIV-related Symptoms Monitoring Survey conducted in China. Networks were constructed among 27 symptoms. Centrality properties, including strength and closeness, and network density were used to describe relationships among symptoms in 5 different HIV-positive duration groups.

RESULTS

The findings showed that PLWH with longer HIV-positive durations did not have more severe symptoms; instead, their symptom networks were denser than those of their newly HIV-diagnosed counterparts (F = 27.073, P < 0.001). Fatigue was the most severe and central symptom in PLWH with an HIV-positive duration <10 years (r_S = 7.79-10.09, r_B = 18-44, r_C = 0.01). Confusion was the most central symptom across the 3 centrality indices (r_S = 11.81, r_B = 14.00, r_C = 0.02) in PLWH who had HIV-positive durations >10 years.

CONCLUSION

This study demonstrates a need to include an assessment of PLWH symptom networks as an essential component of HIV care. We recommended evaluating cognitive function and cognitive training as essential components of HIV care for long-term survivors, even in younger populations (aged ≤50 years).

The Development of a Personalized Symptom Management Mobile Health Application for Persons Living with HIV in China

Persons living with HIV (PLWH) continuously experience symptom burdens. Their symptom prevalence and severity are also quite different. Mobile health (mHealth) applications (apps) offer exceptional opportunities for using personalized interventions when and where PLWH are needed. This study aimed to demonstrate the development process of the symptom management (SM) app and the structure and content of it. Our research team systematically searched for evidence-based resources and summarized up-to-date evidence for symptom management and health education. Our multidisciplinary research team that included physicians, nurses, software engineers, and nursing professors, evaluated the structure and content of the drafted app. Both quantitative data and qualitative results were collected at a group discussion meeting. Quantitative data were scores of sufficient evidence, situational suitability, practicability, cost-effectiveness, and understandability (ranged from one to four) for 119 items of the app contents, including the health tracking module, the self-assessment module, coping strategies for 18 symptoms (80 items), medication management, complementary therapy, diet management, exercise, relaxation techniques, and the obtaining support module. The SM app was comprised of eight modules and provided several personalized symptom management functions, including assessing symptoms and receiving different symptom management strategies, tracking health indicators, and communicating with medical staff. The SM app was a promising and flexible tool for HIV symptom management. It provided PLWH with personalized symptom management strategies and facilitated the case management for medical staff. Future studies are needed to further test the app's usability among PLWH users and its effects on symptom management.