Health-related quality of life in relation to sense of coherence in a Swedish group of HIV-infected patients over a two-year follow-up

Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran

PURPOSE

We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV).

METHODS

This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT.

RESULTS

Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL.

CONCLUSION

Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.

Salutogenesis: A sense of coherence and health among British military veterans exposed to impactful life challenges - the emergence of post-traumatic growth and positive deviance within a life-story approach

Background

This study sought to capture the perspectives and experiences of two sub-groups of military veterans, namely those who had previously been identified as offenders and those employed as practitioners within the criminal justice system in the United Kingdom.

Methods

The lead author undertook narrative inquiry in the form of life story research. The life stories of 17 in-depth interviews were conducted across England and Wales, allowing for insight into the lived experiences of two life story trajectories of the health of military veterans. Existing literature on salutogenesis, health, post-traumatic growth, and positive deviance has also been investigated.

Results

Life story interviews were transcribed verbatim and analyzed concurrently using thematic analysis to identify emergent themes. The researchers used thematic analysis as an analytical framework to allow descriptive themes from the literature on salutogenesis, health, post-traumatic, and positive deviance to be compared with those of life-story interviews.

Conclusion

The study adopts a salutogenic approach, which suggests that an important indicator for a sense of coherence is enabled through the positive utilization of resilience through the reconstruction of military identity and experience. Notably, the concept of salutogenesis demonstrates the ability to draw from internal and external resources as circumstances require, to survive, and because of this, the participants' health is maintained or improved. Hence, adaptation was notable through the coherence identified by the identity of being a veteran noted between the two subgroups and represents a continuous and dynamic process. The study suggests that the development of a sense of coherence is not restricted to the early decades of life but is a continuous process as contexts, personal circumstances, and opportunities arise. This later point is realized through the presence of post-traumatic growth and positive deviance, as they aid in the nurturing and development of a renewed sense of coherence via the known identity of military service and life.

Sense of Coherence and Health-Related Quality of Life in Patients with Multiple Sclerosis: The Role of Physical and Neurological Disability

Multiple sclerosis is a progressive demyelinating disease of the central nervous system that can lead to permanent disability and significantly impact the quality of life. The present study explores the relationship between neurological disability and disease symptoms, quality of life, and the level of sense of coherence, which is an important resource for coping with the disease. EDSS, GNDS, SOC-29, and MSIS-29 were used in the presented study. The study group consisted of 137 people diagnosed with multiple sclerosis. The study showed the correlation between most of the analyzed variables. Mood disability and fatigue were significant predictors of the sense of coherence and explained 34% of its variance. Physical disability and fatigue served as significant predictors of the physical aspect of quality of life, explaining 49% of its variance. Fatigue and sense of coherence were significant predictors of the psychological aspect of quality of life, explaining 47% of the variance. In studies on a group of people with multiple sclerosis, it is worth considering, in addition to the level of disability, also invisible symptoms, such as fatigue or mood disability, which are important for the quality of life and the level of resources. As this study suggests, a sense of coherence is a resource essential for the quality of life of people with disabilities.

Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies

Objectives

The breast cancer stigma affects Health-related quality of life (HRQoL), while general resilience resources (GRRs), namely, sense of coherence (SOC), social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.

Methods

In this cross-sectional study, Stigma Scale for Chronic Illness 8-item version (SSCI-8), SOC-13, Medical Outcome Survey- Social Support Scale (MOS-SSS), Brief COPE, and Functional Assessment of Cancer Therapy-Breast (FACT-B) were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson's correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.

Results

An analysis of 221 women (response rate of 87.5%) with the mean age of 47.14 (9.13) showed that stigma was negatively correlated to all HRQoL's dimensions (r = -0.27∼0.51, p < 0.05), SOC (r = -0.26∼0.35, p < 0.01), social support (r = -0.23∼0.30, p < 0.01), and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support (except for tangible), and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.

Conclusion

While GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn.

Fear of COVID-19 and Life Satisfaction: The Role of the Health-Related Hardiness and Sense of Coherence

Introduction: The COVID-19 pandemic is contributing to increased fear and anxiety throughout society, which may affect life satisfaction. Health-related hardiness and sense of coherence (SOC) are personal resources that help people adapt to difficult circumstances. The purpose of this study was to investigate the relationship between fear of COVID-19, SOC, health-related hardiness, and life satisfaction. Methods: A total of 907 Polish people (522 women and 385 men) participated in this study. The Fear of COVID-19 Scale (FOC-6), the Health-Related Hardiness Scale, the Sense of Coherence Scale (SOC-29), and the Satisfaction with Life Scale were used. Results: Correlation showed that fear of COVID-19 was negatively related to health-related hardiness, SOC, and life satisfaction. Health-related hardiness and SOC were positively related to life satisfaction. Both SOC and hardiness were mediators between fear of COVID-19 and life satisfaction during the current pandemic. Conclusion: SOC and health-related hardiness are personal resources that are important for dealing with the effects of the COVID-19 pandemic. According to our study, SOC and hardiness can mediate between fear of COVID-19 and life satisfaction. Presented cross-sectional results have to be verified in future longitudinal studies in order to strengthen the conclusions presented in this manuscript. This study verified the role of only two personal resources, so more research is needed on the role of other personal resources during COVID-19 pandemic.

Health-related quality of life among military HIV patients on antiretroviral therapy

OBJECTIVE

The aims of this study were: (i) to determine the factors associated with HRQOL at baseline in our cohort, and (ii) to evaluate if there are differences in baseline HRQOL measures by antiretroviral treatment.

METHODS

The Short Form 36 (SF-36) was administered between 2006 and 2010 among members of the United States HIV Natural History Study cohort (NHS), and participants who completed the SF-36 were included in the study. Physical component summary (PCS) and mental component summary (MCS) scores were computed based on standard algorithms. Multivariate linear regression models were constructed for PCS and MCS to estimate the association between selected variables and HRQOL scores.

RESULTS

Antiretroviral therapy (ART) was not independently associated with HRQOL scores. Factors associated with PCS were CD4+ count < 200 cells/mm3 (β = -5.84, 95% CI: -7.63, -4.06), mental comorbidity (β = -2.82, 95% CI: -3.79, -1.85), medical comorbidity (β = -2.51, 95% CI: -3.75, -1.27), AIDS diagnosis (β = -2.38, 95% CI: -3.79, -0.98). Others were gender, military rank, marital status, and age. Factors independently associated with MCS were CD4+ count < 200 cells/mm3 (β = -1.93, 95% CI: -3.85, -0.02), mental comorbidity (β = -6.25, 95% CI: -7.25, -5.25), age (β = 0.37, 95% CI: 0.14, 0.60), and being African American (β = 1.55, 95% CI: 0.63, 2.47).

CONCLUSION

Among military active duty and beneficiaries with HIV, modifiable factors associated with HRQOL measures included advanced HIV disease, and mental or medical comorbidity. Addressing these factors may improve quality of life of HIV-infected individuals in the NHS cohort.

Sense of coherence as a mediator of health-related quality of life dimensions in patients with breast cancer: a longitudinal study with prospective design

BACKGROUND

In our previous study, we found that the degree of sense of coherence (SOC) and baseline ratings of several dimensions of health-related quality of life (HRQoL) were the most important predictors of HRQoL changes 6 months after the pre-diagnosis period of breast cancer. To find a way to explain these findings, the aim of this study was to explore the mediating effect of the SOC between ratings of HRQoL dimensions before final diagnosis, and ratings of the same dimensions at the 6 months follow up, within a sample of women with breast cancer.

METHODS

A longitudinal study with a prospective design at baseline (T1) and 6 months later (T2) was conducted on 162 women with breast cancer. To measure HRQoL dimensions three different questionnaires, the European Organization for Research and Treatment of Cancer QLQ-30, the SF-12 Health Survey version 2 and the Health Index were applied at T1 and T2 to cover both diagnostic-specific and generic dimensions. Measurement of the SOC as a mediator was done by the SOC-13 scale.

RESULTS

Mediational analyses on eight significant pairs of HRQoL dimensions showed that the degree of SOC totally mediated variations of global quality of life (p < 0.001) as well as cognitive and social functioning (p <0.05) scores between T1 to T2. Changes in the scores of emotional functioning (p < 0.01), fatigue (p < 0.05), financial difficulties (p < 0.05), well-being (p < 0.001), and mental health component (p < 0.001) were partially mediated. The degree of SOC explained 16% to 45% of the variances in HRQoL dimensions at T2.

CONCLUSIONS

The mediating pathway of the SOC in the context of this study appears to be the key to understanding how a higher sense of coherence as an inner resource may serve as a protective psychological factor in the adaptation process of the patients. Clinicians might consider coherence-oriented structure of the SOC and the connection between the SOC and HRQoL data in intervention plans from the first visit onwards. It may assist the identification of women who are at greater risk for maladaptation to the breast cancer trajectory.

Stability of the 13-item sense of coherence (SOC) scale: a longitudinal prospective study in women treated for breast cancer

PURPOSES

To test the stability of the SOC scale over time and to test the stability of the latent construct in 417 breast cancer patients at the time of diagnosis, after 1 year and in a subsample (n = 80) also 2 and 3 years later.

METHODS

The 13-item SOC scale was firstly tested with mean values and ICC over time and secondly explored with cross-sectional factor analysis, separately for two time points (baseline and after 1 year), followed by a longitudinal factor analyses.

RESULTS

Our results provide support for the stability over time (ICC 0.68, effect size 0.06). The cross-sectional factor analysis revealed a modified three-factor and a second-order factor model meeting criteria for goodness of fit. The longitudinal modified second-order factor model confirmed the construct stability character of the SOC scale with an acceptable goodness-of-fit criteria; X (2)/df = 2.91; GFI = 0.87; RMSEA = 0.07; CFI = 0.84; AIC = 962.3. The proportion of variance (R (2)) was 0.42.

CONCLUSIONS

The SOC scale is stable over time when applied to women with breast cancer. The longitudinal factor analysis gives support of a stable latent construct in the second-order factor model, allowing for merging all items to one scale reflecting the theoretical construct of SOC. Measurement errors between some items challenge future studies on alternative factor structures.

Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: a prospective study with comparative design

Background

There is disagreement among studies of health-related quality of life (HRQoL) changes in breast cancer patients over time. Reportedly, assessment of HRQoL prior to diagnosis may be crucial to provide a clear point of comparison for later measurements. The aims of this study were (1) to investigate changes in HRQoL, sense of coherence (SOC), spirituality and religious coping in a group of women with breast cancer from the pre-diagnosis phase to 6 months later in comparison with a control group, and (2) to explore the predictor role of SOC, spirituality, and religious coping within the breast cancer group at the 6-month follow-up.

Methods

A sample of women with breast cancer (n = 162) and a matched control group (n = 210) responded to the following instruments on both occasions: the European Organization for Research and Treatment of Cancer QLQ-C30, the SOC Scale, the Spiritual Perspective Scale and the Brief Religious Coping Scale. A series of General Linear Model (GLM) Repeated Measures was used to determine changes between the groups over time. Also, Multiple Linear Regression analyses were applied to each of the HRQoL dimensions, as dependent variable at the 6 months follow-up.

Results

Physical and role function, fatigue, and financial difficulties were rated worse by the women with breast cancer during the first 6 months in comparison to the controls, which was both a statistically (p < 0.001) and clinically significant difference. Women had better scores for global quality of life (p < 0.001), and emotional functioning (p < 0.01) during the same period of time. The degree of SOC (p < 0.01) and baseline ratings of several dimensions of HRQoL (p < 0.05) were the most important predictors of HRQoL changes.

Conclusions

Collecting HRQoL data before a final diagnosis of breast cancer is important to identify women at risk of deterioration in HRQoL during and after treatment. Special attention should be paid to physical and role functioning impairment, fatigue, and financial difficulties experienced by these women. These results underscore that the degree of SOC may be more important as a predictor for HRQoL changes in this sample than spirituality and religious coping.

Predictors of medication adherence among HIV-positive women in North America

OBJECTIVE

To explore the relationships among contextual, environmental, and regulatory factors with antiretroviral (ARV) medication adherence to assist care providers in improving care for women living with HIV.

DESIGN

Descriptive, multicenter study.

SETTING

Sixteen HIV clinics and service organizations in North America.

PARTICIPANTS

This convenience sample was drawn from a larger study of 2,182 persons living with HIV recruited from clinics and service from September 2009 to January 2011. We included 383 women living with HIV who were taking ARV medications.

METHODS

We assessed the relationship of contextual, environmental, and psychological factors specific to women living with HIV in relation to adherence to ARV medication. Descriptive and multivariate statistics were used to examine the effects of these factors on self-reported ARV drug adherence.

RESULTS

Age, depression symptoms, stigma, engagement with health care provider, and four psychological factors were correlated with self-reported ARV medication adherence (p = .01). Regression analysis indicated that adherence self-efficacy and depression symptoms accounted for 19% for 3-day and 22% for 30-day self-reported medication adherence.

CONCLUSIONS

Adherence self-efficacy and depression symptoms predict ARV medication adherence in women and should be evaluated by nurses. Future research is needed to identify antecedents to and interventions that support adherence self-efficacy and decrease depression symptoms.

Breaking through the silence: the experience of living with HIV-positive serostatus, and its implications on disclosure

AIDS has reached pandemic proportions and despite advances in medical treatment both the medical and social consequences of HIV-positive serostatus continue to be of concern throughout the world. In countries with greater access to antiretroviral therapy (ARV), HIV/AIDS it is no longer defined as fatal, but rather a chronic disease, thereby this study seeks to understand the experience of individuals living with HIV-positive serostatus, a multifaceted disease, from the time the infection is diagnosed through the four post-diagnosis years, and in particular its implications on the issue of disclosure. A qualitative analysis was conducted, based on 13 in-depth interviews with participants who are HIV-positive and the data was analyzed by inductive content analysis. The results identify six themes, four central elements that compose the experience of living with HIV: the emotional experience, the stigma attached to HIV, the inner dialogue, and disclosure. A three-phase coping process and personality differences were found, all of which will be discussed. The issue of disclosure was found to be cardinal and problematic in its impact on the patient's wellbeing.

The relationship between positive psychological attributes and psychological well-being in persons with HIV/AIDS

The relationship between personal psychological attributes and psychological well-being was assessed among adults with HIV/AIDS. The predictive power of sense of coherence, dispositional optimism and perceived competence (PC) on positive affect (PA), negative affect (NA) and relative mood (PA-NA) were assessed using hierarchical linear regression analysis of two data collections, 2 months apart, from 124 HIV-infected participants. In cross-sectional models all of the baseline psychological attributes accounted for a significant amount of variance in the well-being measures. In longitudinal analyses, changes in PA were predicted by PC and dispositional optimism but not by sense of coherence. The positive psychological attributes did not predict changes in NA. Sense of coherence, dispositional optimism and PC, individually and in composite form, significantly correlate with psychological well-being among HIV infected persons. However, change in psychological well-being might be best predicted by PC.

Mediators of antiretroviral adherence: a multisite international study

The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

Qualidade de vida, aspectos sociodemográficos e de sexualidade de pessoas vivendo com HIV/AIDS

Estudo transversal realizado em dois serviços públicos de saúde de um município paulista com objetivo de avaliar a Qualidade de Vida de indivíduos com HIV/aids e sua relação com fatores sociodemográficos e referentes à sexualidade, utilizando-se o HIV/aids Targeted Quality of Life. Dos 228 participantes, 122 são homens e 106 mulheres, com idade média de 39 anos. Diferentes variáveis estiveram associadas com piores escores de qualidade de vida tais como as categorias ser analfabeto, menor escolaridade e não ter renda ou vínculo empregatício. Com referência às variáveis relacionadas à sexualidade, os piores escores de qualidade de vida estiveram associados com não ter vida sexual ativa e ter parceiro com HIV/aids. Viver com o HIV/aids repercute em vários domínios da qualidade de vida, requerendo para a sua avaliação e intervenção, melhor conhecimento e compreensão das diferentes variáveis que podem ter impacto negativo na qualidade de vida destes indivíduos.

Health perceptions of African HIV-infected patients and their physicians

OBJECTIVE

We explored how patients from Sub Saharan Africa (SSA) infected with HIV and living in Switzerland, and their treating physicians perceived their health, whether these perceptions correlated with biological markers, and what organisational changes participants considered likely to improve quality of care.

METHODS

A prospective standardized questionnaire was submitted to HIV-infected patients from SSA and their physicians. Results were correlated with biological data.

RESULTS

While physicians deduced improved health status from laboratory results, these did not provide an adequate surrogate marker of good health for patients. Patients experienced important social and economical difficulties with adverse consequences on their mental health. They requested social assistance, whereas physicians sought improved cultural competency.

CONCLUSION

Patients and physicians did not agree in their evaluation of patients' health status. Patients did not perceive their health through biological markers, but linked their mental health with their socioeconomic context. Physicians underestimated patients' biological health and their evaluation of global health.

PRACTICE IMPLICATIONS

Exploring difficulties perceived by physicians with specific patients lead to identification of structural weaknesses, resulting in suggestions to improve physicians' medical training and patients' care. This illustrates the importance of accessing patients' perspective and not relying solely on physicians' perception of the problem.

Change in quality of life after being diagnosed with HIV: a multicenter longitudinal study

The objective of this study was to assess in patients with HIV perceptions of life pre-HIV versus post-HIV diagnosis and examine whether such perceptions change over time. We conducted interviews and chart reviews of 347 outpatients with HIV from three cities in 2002-2004. In two interviews 12-18 months apart, patients compared their life now with their life before HIV was diagnosed. Independent variables included demographic and clinical characteristics; HIV-specific health status, symptoms, and concerns; spirituality/religion; social support; self-perception; and optimism. The patients' mean (standard deviation [SD]) age was 44.8 (8.3) years; half were minorities; and 269 (78%) were taking antiretroviral therapy. Comparing life at time 1 versus before diagnosis, 109 (31%) patients said their life was better at time 1, 98 (28%) said it was worse, and the rest said it was about the same or did not know. By time 2, approximately one fifth of the patients changed their answers to indicate life improvement and one sixth changed them to indicate life deterioration. In multivariable analysis, change in perception for the better between time 1 and time 2 (versus prediagnosis) was positively associated with time 1 positive religious coping scores, whereas change in perception for the worse was associated with study site, heterosexual orientation, a detectable viral load, shorter duration of HIV, lower spirituality scores, and lower positive religious coping scores. We conclude that many patients with HIV feel that their life is better than it was before their diagnosis, although results of such comparisons often change over time.