Effects of an empowerment program on coping, quality of life, and the maternal role adaptation of Thai HIV-infected mothers

An explanatory model of quality of life in high-risk pregnant women in Korea: a structural equation model

PURPOSE

This study aimed to develop and validate a structural model for the quality of life (QoL) among high-risk pregnant women, based on Roy's adaptation model.

METHODS

This cross-sectional study collected data from 333 first-time mothers diagnosed with a high-risk pregnancy in two obstetrics and gynecology clinics in Cheonan, Korea, or participating in an online community, between October 20, 2021 and February 20, 2022. Structured questionnaires measured QoL, contextual stimuli (uncertainty), coping (adaptive or maladaptive), and adaptation mode (fatigue, state anxiety, antenatal depression, maternal identity, and marital adjustment).

RESULTS

The mean age of the respondents was 35.29±3.72 years, ranging from 26 to 45 years. The most common high-risk pregnancy diagnosis was gestational diabetes (26.1%). followed by preterm labor (21.6%). QoL was higher than average (18.63±3.80). Above-moderate mean scores were obtained for all domains (psychological/baby, 19.03; socioeconomic, 19.00; relational/spouse-partner, 20.99; relational/family-friends, 19.18; and health and functioning, 16.18). The final model explained 51% of variance in QoL in high-risk pregnant women, with acceptable overall model fit. Adaptation mode (β=-.81, p=.034) and maladaptive coping (β=.46 p=.043) directly affected QoL, and uncertainty (β=-. 21, p=.004), adaptive coping (β=.36 p=.026), and maladaptive coping (β=-.56 p=.023) indirectly affected QoL.

CONCLUSION

It is essential to develop nursing interventions aimed at enhancing appropriate coping strategies to improve QoL in high-risk pregnant women. By reinforcing adaptive coping strategies and mitigating maladaptive coping, these interventions can contribute to better maternal and fetal outcomes and improve the overall well-being of high-risk pregnant women.

Implementing civic engagement within mental health services in South East Asia: a systematic review and realist synthesis of current evidence

INTRODUCTION

Civic engagement (CE) has the potential to transform mental health services and could be particularly important for low and middle-income countries (LMICs), which are rapidly developing to respond to the burden of poor mental health. Research from high income countries has found many challenges associated with the meaningful implementation of CE in practice, but this has been underexplored in LIMCS and in South East Asia (SEA) in particular.

METHODS

We completed a realist synthesis and systematic review of peer reviewed publications and grey literature to identify the context and actions which promote successful implementation of CE approaches in SEA. We used a theory-driven approach-realist synthesis-to analyse data and develop context-mechanism-outcome configurations that can be used to explain how civic engagement approaches operate in South East Asian contexts. We worked closely with patient and public representatives to guide the review from the outset.

RESULTS

Fifty-seven published and unpublished articles were included, 24 were evaluations of CE, including two Randomized Controlled Trials. The majority of CE interventions featured uptake or adaptation of Western models of care. We identified important cultural differences in the enactment of civic engagement in SEA contexts and four mechanisms which, alongside their contextual barriers and facilitators, can be used to explain how civic engagement produces a range of outcomes for people experiencing mental health problems, their families and communities. Our review illustrates how CE interventions can be successfully implemented in SEA, however Western models should be adapted to fit with local cultures and values to promote successful implementation. Barriers to implementation included distrust of services/outside agencies, stigma, paternalistic cultures, limited resource and infrastructure.

CONCLUSION

Our findings provide guidance for the implementation of CE approaches within SEA contexts and identify areas for further research. Due to the collectivist nature of many SEA cultures, and the impact of shared traumas on community mental health, CE might best be implemented at community level, with a focus on relational decision making.Registration This review is registered on PROSPERO: CRD42018087841.

Black Mothers Living With HIV Picture the Social Determinants of Health

The purpose of our study was to explore the social determinants of health for Black mothers living with HIV in the southeastern region of the United States. In this exploratory study, we used qualitative methods of in-depth interviewing and photo elicitation at three time points to provide a comprehensive examination of the meaning that the constructs held for participants (n = 18). The social determinants of health, identified primarily as positive health determinants by the participants, included social support, religion, animal companions, and the physical environment. The social determinants of health identified as mixed determinants, having both positive and negative qualities, were transportation and housing. Each of these social determinants is presented with definitions and exemplars. Additionally, aspects of each determinant of health that may be meaningfully addressed through process and structural level interventions are explored.

Empowering Malian women living with HIV regarding serostatus disclosure management: Short-term effects of a community-based intervention

OBJECTIVE

The objective of this study was to assess the short-term effects of Gundo-So-a program aimed at empowering Malian women living with HIV (WLHIV) regarding serostatus disclosure management.

METHODS

A pre-experimental study with two measures (one week before and four weeks after Gundo-So) was carried out. A 35-item questionnaire was administered to a convenience sample of 210 WLHIV. Six outcomes were considered: ability to decide whether or not to disclose HIV status, self-efficacy to keep HIV status a secret, self-efficacy to disclose HIV status, feeling crushed by the weight of secrecy, perceived physical health, and perceived psychological health. For each outcome, temporal changes associated with the intervention were assessed using linear regressions with random intercepts.

RESULTS

Statistically significant change was observed for all six outcomes between the pre- and post-intervention measures. Furthermore, several variables were associated with the baseline levels of the outcomes and the intervention effect.

CONCLUSION

The results suggest that Gundo-So empowers Malian WLHIV with regard to serostatus disclosure management, thus improving their perceived physical and psychological health.

PRACTICAL IMPLICATIONS

These results highlight the need for programs to empower WLHIV regarding serostatus disclosure, so that WLHIV can make free and informed decisions regarding serostatus disclosure.

Promoting mental health in Asia-Pacific: Systematic review focusing on Thailand and China

Mental health is essential for functioning, general health, and quality of life in low and middle-income countries (LAMICs), as for high-income countries. This study aimed first to search in the English language peer-reviewed literature for reviews of mental health promotion interventions in the Asia-Pacific region. A global rapid review by Barry and colleagues indicated a paucity of publications on this topic in the peer-reviewed literature. The second aim of the study followed from this observation. Two systematic reviews of English language literature were conducted as case studies in two countries with known interest in mental health promotion, Thailand and China. The reviews covered publications in peer-reviewed journals and the "grey" literature. In Thailand, the review demonstrated: strong evidence for an empowerment program for human immunodeficiency virus (HIV)-infected mothers; a reduction in HIV-related stigma in a community-based program; and a coping program for adolescents. The second review concerned suicide prevention interventions in China. It found one relevant study, a WHO multi-site study of suicide prevention. We found surprisingly little evidence in either country of interventions focused on health equity or modifying the social determinants of mental health. We agree with Barry and colleagues that there is an urgent need to invest in the policy, practice, and research capacity for mental health promotion in LAMICs so that mental health promotion can be incorporated into the wider health promotion and global health development agenda. This includes the Global Action for Health Equity Network. Evidence-based interventions in parenting, schools, workplaces, and among older people can be initiated or adapted and evaluated in LAMIC settings.

Contribuições de uma Intervenção Psicoeducativa para o Enfrentamento do HIV durante a Gestação

RESUMO O estudo investigou as contribuições de uma intervenção psicoeducativa para o enfrentamento da doença entre gestantes vivendo com HIV. Participaram quatro mães com idades entre 29 e 37 anos, sendo que duas souberam da infecção na gestação. Trata-se de estudos de casos longitudinal envolvendo avaliações antes, durante, depois da intervenção e aos três meses de vida do filho/a. Os achados revelaram que a notícia do HIV durante a gestação se associou a grande risco psicológico, pois envolvia imenso esforço de adaptação e sobrecarga emocional potencializadas pelo risco de transmissão do vírus ao filho. A intervenção apresentou contribuições positivas para o enfrentamento da doença e o bem-estar emocional das mães. Discutese a necessidade de ampliar o apoio psicológico dos serviços de saúde a essas mulheres.

Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries

People living with HIV (PLWH) experience greater psychological distress than the general population. Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms, quality of life, and HIV care engagement. However, little is known about the effectiveness of mental health interventions for PLWH in low and middle-income countries (LMICs), where the large majority of PLWH reside. This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these settings. A systematic search strategy was undertaken to identify peer-reviewed published papers of intervention trials addressing negative psychological states or disorders (e.g., depression, anxiety) among PLWH in LMIC settings. Search results were assessed against pre-established inclusion and exclusion criteria. Data from papers meeting criteria were extracted for synthesis. Twenty-six papers, published between 2000 and 2014, describing 22 unique interventions were identified. Trials were implemented in sub-Saharan Africa (n=13), Asia (n=7), and the Middle East (n=2), and addressed mental health using a variety of approaches, including cognitive-behavioral (n=18), family-level (n=2), and pharmacological (n=2) treatments. Four randomized controlled trials reported significant intervention effects in mental health outcomes, and eleven preliminary studies demonstrated promising findings. Among the limited mental health intervention trials with PLWH in LMICs, few demonstrated efficacy. Mental health interventions for PLWH in LMICs must be further developed and adapted for resource-limited settings to improve effectiveness.

Self-management interventions for people living with human immunodeficiency virus: a scoping review

BACKGROUND

Self-management is an important emerging intervention for people with human immunodeficiency virus (PHAs). The principles of self-management are consistent with the principles of client-centred occupational therapy.

PURPOSE

This scoping review addressed three questions about self-management interventions for PHAs: (a) What knowledge, skills, and attitudes are taught? (b) What outcomes are intended? (c) What are the participation experiences of PHAs?

METHOD

Questions were searched in six databases. Two researchers independently reviewed abstracts and articles before inclusion. Extracted data were iteratively themed.

FINDINGS

Thirty-five articles were included. Interventions taught self-care, interpersonal skills, technical knowledge, cognitive skills, positive attitudes, planning for the future, and role management. Outcomes included well-being, health and illness management, and health services use. Participation experiences reflected social experiences, needs of PHAs, specific needs of women, participation, empowerment, intervention importance, and experiences with service delivery.

IMPLICATIONS

Self-management interventions are a promising approach for occupational therapists to enable PHAs' occupational performance goals.

Proxemic communication between HIV-infected mother-child pairs

Proxemic communication (behaviours and relations of human interaction) offered by the mother in an HIV-infected mother-child pair during infancy was analysed to determine which proxemic factors promote the exchange of affection. This study, conducted in an experimental laboratory in 2007, included mother-child pairs in which the mother was HIV-positive and the children, under 6 months of age, were born exposed to the virus. Video recordings of the mother-child interaction were analysed according to proxemic factors. Of the 364 interactions recorded for analysis of proxemic communication between the mother-child pair, the most significant proxemic factors were axis, contact behavior, visual code, and tone of voice. The mothers developed communicative strategies such as closer proximity, touch, vocalisation, and smiling to promote the exchange of affection when engaging in maternal care.

[Effects of an empowerment program on the adjustment of older adults to nursing home life]

PURPOSE

This study aimed to evaluate the effectiveness of the empowerment intervention on the levels of self-esteem, interpersonal relationships and adjustment to nursing home life of the Korean nursing home residents.

METHODS

Participants (n=47) whose period of stay was less than one year were purposefully selected from 3 nursing homes in Korea. The experimental group (n=21) attended 10 weekly hour-long empowerment sessions. The empowerment program comprised two components; group education and group discussion. The control group (n=26) received a two-hour education about health management.

RESULTS

Compared with the control group, the experimental group showed significantly higher mean scores of self-esteem (t=5.51, p<.001), interpersonal relationships (t=2.73, p=.009) and adjustment to nursing home life (t=2.10, p=.041).

CONCLUSION

Findings of this study suggest that empowerment interventions may be effective in enhancing nursing home residents' self-esteem, interpersonal relationships and adjustment to nursing home life. Future research is needed to determine if such an empowerment program could be used with newly institutionalized elders to speed as well as enhance their adjustment to nursing home life.

Efficacy of an intervention for families living with HIV in Thailand: a randomized controlled trial

This study evaluates the efficacy of an intervention for persons living with HIV (PLH) and their family members in Thailand. A randomized controlled trial of 813 PLH and family members was carried out at four district hospitals in Thailand. Participants completed Computer Assisted Personal Interview assessments at baseline, 6, 12, 18, and 24 months. The primary outcome was quality of life (QoL); other measures included depressive symptoms and family functioning. Relative to the standard care condition, the intervention group reported significantly improved QoL at 6 months (P = 0.0014). When the intervention efficacy was stratified by baseline depressive symptoms (low vs. high), intervention efficacy was observed only among those with low depressive symptoms. Study findings suggest that the intervention was more efficacious for participants with less depressive symptoms and better family functioning. Extensive interventions may be optimal for those who have the capacity to learn the tools and skills.

Stress, social support and housing are related to health status among HIV-positive persons in the deep south of the United States

Self-report health status measures are consistently associated with medical outcomes and are cost-effective. Studies using such measures find that those who live in rural areas or have limited access to support experience poorer health status and poorer outcomes. A survey addressing these issues was administered to 401 HIV-positive persons throughout Alabama. Hierarchical regression models examined the relation of housing stability, stress, substance use and other variables to physical (PCS) and mental (MCS) health status. The sample was 34% female and 66% African-American. Most were receiving antiretroviral medications, and nearly 20% were in unstable housing. Age showed a significant negative relationship to health status. CD4 cell count (p < 0.01) was positively associated with PCS; perceived general stress (p < 0.02) and housing stability (p < 0.04) were negatively associated. The model accounted for 14% of the variance in PCS (p < 0.001). For MCS, general stress (p < 0.001) was negatively associated and substance use tended towards a negative association (p < 0.075). Social support (p < 0.02) was positively associated with MCS. The model accounted for nearly 31% of the MCS variance (p < 0.001). Health status among HIV-positive persons may be improved by assessing and addressing social issues such as social isolation, life stressors and housing.

Understanding Interventions and Outcomes in Mothers of Infants

The first two years after an infant's birth is a time of transition for mothers as changes in roles, responsibilities, expectations, and behaviors occur in response to the demands of caring for newborn infants and young children. Mothers play pivotal roles in overall child development and health and may benefit from nursing intervention that assists in the transition to motherhood. A review of the intervention literature related to the promotion of effective mothering was performed in order to examine the range of interventions and evidence of their usefulness for maternal-child and pediatric nursing practice. Five broad categories of interventions appropriate for nursing practice were identified through the literature review. Home visiting, skin-to-skin contact, individual, infant-focused education/counseling, and theory-based group intervention have a specific applicability for the promotion of mothering in particular populations of mothers. Based on the evidence, nurses can incorporate selected strategies into nursing care to promote effective mothering during the first years of a child's life.

Factors associated with postpartum physical and mental morbidity among women with known HIV status in Lusaka, Zambia

The objective of our study was to investigate factors associated with postpartum physical and mental morbidity among women in Lusaka, Zambia with particular reference to known HIV status. Our study was part of the Breastfeeding and Postpartum Health (BFPH) longitudinal cohort study conducted between June 2001 and July 2003. Women were recruited at 34 weeks gestation and followed up to 16 weeks postpartum. Data on maternal health were collected at 3, 7, 10, and 14 days and at 3, 4, 5, 6, 9, 12, and 16 weeks postpartum. Maternal mental health data were collected from April 2002 onwards at recruitment and at seven days and six weeks postpartum. Data on physical morbidity were collected for 429 women (218 HIV-negative, 211 HIV-positive) and data on mental morbidity were collected for 272 women (134 HIV-negative, 138 HIV-positive). Multivariate logistic regression was used to examine factors associated with postpartum physical or mental morbidity. Postpartum physical morbidity was associated with HIV status, parity > or =5 and age < 20 years. Neither antenatal nor postpartum mental morbidity, as indicated by a self-reporting questionnaire 20-item (SRQ-20) score > or =7, were associated with HIV status or with postpartum physical morbidity in this population. Larger comparative studies are required to corroborate or contest these findings.

Current issues and future directions in complementary and alternative medicine (CAM) research

This paper examines the topics discussed over the course of the Complementary Therapies in Medicine (CAM) research methods series and looks ahead at research methods that either have not been discussed so far in the series or are currently emerging as potentially useful research tools. It is emphasised that an in-depth knowledge of methodological advances (and existing tools) is vital if researchers are to design and implement appropriate programs with the ability to adequately address the vast range of research questions pertinent to CAM.

Setting and organization of care for persons living with HIV/AIDS

BACKGROUND

Treating the world's 40.3 million persons currently infected with HIV/AIDS is an international responsibility that involves unprecedented organizational challenges. Key issues include whether care should be concentrated or decentralized, what type and mix of health workers are needed, and which interventions and mix of programs are best. High volume centres, case management and multi-disciplinary care have been shown to be effective for some chronic illnesses. Application of these findings to HIV/AIDS is less well understood.

OBJECTIVES

Our objective was to evaluate the association between the setting and organization of care and outcomes for people living with HIV/AIDS.

SEARCH STRATEGY

Computerized searches from January 1, 1980 to December 31, 2002 of MEDLINE, EMBASE, Dissertation Abstracts International (DAI), CINAHL, HealthStar, PsychInfo, PsychLit, Social Sciences Abstracts, and Sociological Abstracts as well as searches of meeting abstracts and relevant journals and bibliographies in articles that met inclusion criteria. Searches included articles published in English and other languages.

SELECTION CRITERIA

Articles were considered for inclusion if they were observational or experimental studies with contemporaneous comparison groups of adults and/or children currently infected with HIV/AIDS that examined the impact of the setting and/or organization of care on outcomes of mortality, opportunistic infections, use of HAART and prophylaxis, quality of life, health care utilization, and costs for patient with HIV/AIDS.

DATA COLLECTION AND ANALYSIS

Two authors independently screened abstracts to determine relevance. Full paper copies were reviewed against the inclusion criteria. The findings were extracted by both authors and compared. The 28 studies that met inclusion criteria were too disparate with respect to populations, interventions and outcomes to warrant meta-analysis.

MAIN RESULTS

Twenty-eight studies were included involving 39,776 study subjects. The studies indicated that case management strategies and higher hospital and ward volume of HIV-positive patients were associated with decreased mortality. Case management was also associated with increased receipt of ARVs. The results for multidisciplinary teams or multi-faceted treatment varied. None of the studies examined quality of life or immunological or virological outcomes. Healthcare utilization outcomes were mixed.

AUTHORS' CONCLUSIONS

Certain settings of care (i.e. high volume of HIV positive patients) and models of care (i.e. case management) may improve patient mortality and other outcomes. More detailed descriptions of care models, consistent definition of terms, and studies on innovative models suitable for developing countries are needed. There is not yet enough evidence to guide policy and clinical care in this area.

Improving networks between acute care nurses and an aged care assessment team

BACKGROUND

Acute care nurses have an important role in the discharge planning of older people from hospital to home. However, few nurses understand the changing aged care system or the consequences of poor referral on the lives of older people postdischarge.

AIMS AND OBJECTIVES

This paper reports the findings of a research project, which aimed to investigate the possibilities for facilitating the transition of older people from hospital to home through improving the working relationship between nurses and members of a multidisciplinary aged care assessment team (ACAT).

DESIGN AND METHODS

The paper reports one action research cycle from a larger project. Action research was chosen because its focus on knowledge development and action leads to practical solutions to clinical problems. The research approach included interactive forums designed to facilitate effective collaboration between the nurses and ACAT in the discharge planning of older people. Data collection strategies included audiotapes of ACAT research discussions, field notes, policy documents, referral forms and an evaluation tool.

RESULTS AND CONCLUSIONS

The findings illustrate that ward nurses have, at best, a limited knowledge and understanding of the aged care system, its function, or how to access services. They need assistance to develop their knowledge of services available to support older people following discharge. The conduct of interactive forums, which utilize a case study approach, facilitated such knowledge development and empowered the nurses to become more involved in discharge planning. Participation in the forums also facilitated new collaborative partnerships between the nurses and ACAT, which enhanced effective discharge planning.

RELEVANCE TO CLINICAL PRACTICE

The paper outlines practical strategies to support collaboration between ward nurses and community providers and/or multi disciplinary assessment services. It provides a list of key considerations for the development of effective ward/community networks to facilitate the discharge of older people.