The effect of a social support boosting intervention on stress, coping, and social support in caregivers of children with HIV/AIDS

Intensity of Social Support Matters: A Latent Class Analysis to Identify Levels of Social Support Associated with Optimal Health Outcomes Among Women Living with HIV

Social support is associated with improved HIV care and quality of life. We utilized latent class analysis to identify three classes of baseline emotional and tangible perceived social support, termed "Strong", "Wavering" and "Weak". "Weak" vs. "Strong" perceived social support was associated over time with an 8% decreased risk of optimal antiretroviral therapy (ART) adherence for emotional and 6% decreased risk for tangible perceived social support. Importantly, "Wavering" vs "Strong" social support also showed a decreased risk of ART adherence of 6% for emotional and 3% for tangible support. "Strong" vs. "Weak" perceived support had a similar association with undetectable viral load, but the association for "Strong" vs. "Wavering" support was not statistically significant. Intensity of social support is associated with HIV care outcomes, and strong social support may be needed for some individuals. It is important to quantify the level or intensity of social support that is needed to optimize HIV outcomes.

Characteristics of Persons Living With HIV Who Have Informal Caregivers in the cART Age of the Epidemic

People living with HIV (PLWH) are aging and many suffer with multimorbidities, making caregiving a relevant and important area of study. The purpose of our study was to understand the occurrence and role of informal caregivers in the current stage of the HIV epidemic. We conducted a Web-based survey with 1,373 PLWH to assess: how many had an informal, unpaid caregiver; the type of relationship with the informal caregiver; and the number of hours the caregiver provided support each day. Among respondents, 333 had an informal caregiver. Blacks, those with low income, individuals who ever had an AIDS diagnosis, those with basic cellphone service, and those living with other comorbid conditions were significantly more likely to have an informal caregiver. Given the demographic profile of those PLWH who were most likely to have caregivers, further study is needed to understand the needs of both caregivers and care recipients.

Burden Among Caregivers of Children Living with Human Immunodeficiency Virus in North India

Background:

Due to wider access to and free antiretroviral therapy (ART) program, the number of children dying due to acquired immune deficiency syndrome (AIDS)-related causes has declined and the nature and duration of human immunodeficiency virus (HIV)/AIDS caregiving has also dramatically altered. The care of children living with HIV/AIDS (CLHA) places a significant additional burden on the caregivers.

Aims:

This study was conducted to assess the perceived burden among caregivers of children living with HIV in North India.

Materials and Methods:

A hospital-based cross-sectional study among 156 CLHA-caregiver dyads in North India was conducted from June 2010 to May 2011. Data were collected by using a pretested structured interview schedule. The caregiver burden was measured with a 36-item scale adapted from Burden Assessment Schedule of Schizophrenia Research Foundation (BASS). Child characteristics, caregiver characteristics, caregiving burden, the knowledge of caregivers, and issues related to health care, nutrition, education, and psychological aspects were studied.

Results:

Caregivers had a mean age of 35.9 ± 10.2 years. Women accounted for over three-fourth (76.9%) of the caregivers. Nearly two-third of them (65.4%) reported as living with HIV. The mean caregiver burden score was 68.7 ± 2.9. A majority of the caregivers reported either low or moderate burden. Standardized percentage score was high in the domains of physical and mental health, external support, patients’ behavior, and caregivers’ strategy and seemed to be comparatively less in the other domains such as support of the patient and taking responsibility.

Conclusions:

Caring of children is a universal practice but there is a need of special care for children living with HIV. The majority of caregivers who were usually the mothers perceived the burden and need to be assisted in caring for the child. Stigma and discrimination with HIV infection further increased the burden as caregivers did not disclose the HIV status to any near and dear one.

Mental health and social support among HIV-positive injection drug users and their caregivers in China

The burden of HIV/AIDS in China is due to injection drug use. Non-clinical caregivers provide much of the care for HIV patients but are often not included in HIV care or research. The objective of this study is to examine the relationships between the caregiver context and mental health of HIV-positive injection drug users and their caregivers. We interviewed 96 patient-caregiver dyads using quantitative methods. A conceptual model was developed as a framework for multivariate linear regression modeling. The strongest predictor of poor patient mental health was lack of social support, which was largely determined by the caregiver's stigma towards HIV/AIDS and caregiver burden. Patient disability and caregiver burden were the primary predictors of poor caregiver mental health. The interrelated nature of caregiver and patient mental health supports the inclusion of caregiver health into the patient's HIV/AIDS treatment to maximize support provision and health for the patient and caregiver.

A discussion of HIV/AIDS family interventions: implications for family-focused nursing practice

AIM

This article presents a discussion on the role of family interventions in HIV/AIDS disease prevention and care.

BACKGROUND

Although HIV/AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual-level HIV prevention, HIV/AIDS family-focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV/AIDS family intervention.

DATA SOURCES

The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were 'nurse', or 'nursing', 'HIV/AIDS', 'family interventions', 'family support' and 'family education', and/or 'family subsystems'.

DISCUSSION

The process of theorizing about 'family interventions' and 'HIV/AIDS-family interventions' is critical for putting forth essential components unique for designing culturally specific HIV/AIDS family interventions. In addition, any proposed design of HIV/AIDS family intervention should consider the impact of HIV/AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective.

CONCLUSION

Training needs of family nurses should be met when designing multidisciplinary HIV/AIDS-FIs. Furthermore, nurses should be proactive in advocating for HIV/AIDS family intervention and HIV/AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family-focused approaches.

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.

Social support interventions: do they work?

Presence of support has repeatedly been linked to good long-term health outcomes based on demonstrations of better immune function, lower blood pressures, and reduced mortality (among others). Despite a massive literature on the benefits of support, there is surprisingly little hard evidence about how, and how well, social support interventions work. Using a computerized search strategy, 100 studies that evaluated the efficacy of such interventions were located. The presenting problems ranged from cancer, loneliness, weight loss, and substance abuse to lack in parenting skills, surgery, and birth preparation. For the purpose of review and evaluation, studies were subdivided into (1) group vs. individual interventions, (2) professionally led vs. peer-provided treatment, and (3) interventions where an increase of network size or perceived support was the primary target vs. those where building social skills (to facilitate support creation) was the focus. On the whole, this review provided some support for the overall usefulness of social support interventions. However, because of the large variety of existing different treatment protocols and areas of application, there is still not enough evidence to conclude which interventions work best for what problems. Specific methodological and conceptual difficulties that plague this area of research and directions for future research are discussed.

Informal caregiving burden: an overlooked aspect of the lives and health of women transitioning from welfare to employment?

Informal caregiving occurs among communities in all socioeconomic strata and is largely provided by women. Although an extensive amount of research focusing on caregiver burden has been conducted within nursing, little is known about informal caregiving among low-income women, particularly within the context of welfare reform. This study examined the extent of informal caregiver burden in low-income women transitioning off welfare and the relationship between informal caregiving and maintaining employment. A random sample of 32 adults who had recently received welfare was obtained (n = 31 women), although there was significant difficulty locating potential subjects. Sixty-three percent of participants were providing nonparental forms of informal caregiving. Caregiver burden scores among this group were highest in the time-dependence dimension of caregiving. Over 30% of participants reported having to leave a job within the past year because of their caregiving responsibilities. These findings suggest that the informal caregiving responsibilities of low-income women may be an overlooked aspect of welfare reform policy. Given the emphasis on case management and policy advocacy in their roles, public health nurses are uniquely positioned to partner with local welfare-to-work organizations, educate program staff, and further develop existing assessment processes to better address caregiving responsibilities within low-income families.

Social support and cardiovascular health promotion in families

This article looks in depth at the concept of social support and the potential it has to influence cardiovascular health promotion in families. The health behaviors that families share influence the health of family members. Exploring these health behaviors can help nurses identify opportunities that can assist families to encourage positive health behaviors and change negative behaviors that may decrease the risk of cardiovascular disease for the entire family.

Child-rearing practices of primary caregivers of HIV-infected children: An integrative review of the literature

The number of human immunodeficiency virus (HIV)-infected children has increased because of the HIV and acquired immunodeficiency syndrome epidemic. Yet little is known about the child-rearing practices of these children's primary caregivers. The purpose of this article is to describe what is known about the child-rearing practices of primary caregivers of HIV-infected children. The review covers a 10-year period from 1990 to 2000. Three electronic bibliographic databases (MEDLINE, CINAHL, and AIDSLINE) were explored. Key words used were HIV-positive children, caregivers, and child-rearing. A total of 50 papers were examined. Using the Matrix Method, each paper was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to identity salient themes. Themes that emerged were: caregiver, child, and interactions or child-rearing practices. These findings affirm the parent-child interaction model generated by Kathryn E. Barnard and support this framework as a tool for investigating the relationships between these children and their caregivers.

Nursing intervention studies: a descriptive analysis of issues important to clinicians

When reading a report of an intervention study, clinicians are interested in knowing: whether the intervention is effective, with whom it is effective, how much benefit it produces, and whether associated, adverse outcomes occur. Recommendations have been made in the research literature regarding how to conduct and report intervention studies so as to produce knowledge regarding these questions. This descriptive study was conducted to estimate the frequency with which these recommendations are being used in nursing intervention studies. Data pertinent to five research questions were extracted from 84 experimental and quasi-experimental study reports published between 1998 and 2000. Seventeen percent of the studies used a design that could statistically test for variation in intervention effect depending on the level of an individual characteristic. However, a test of interaction was actually conducted in only 8% of the studies. The magnitude of the intervention's effect was addressed in 38% of the study reports. Providing the proportion of persons in the intervention group who attained a discrete outcome was the most frequently used way of showing intervention magnitude. Associated, adverse outcomes were examined in 23% of the studies, and were most often measured as continuous variables. The low level of use of recommended methods leads the author to suggest dialogue between clinicians and researchers to determine if intervention studies are being conducted and reported in ways that produce knowledge that is useful to clinicians.

Health disparities among vulnerable populations: evolution of knowledge over five decades in Nursing Research publications

BACKGROUND

Considerable attention has been focused recently on conducting research on the health disparities experienced by some Americans as the result of poverty, ethnicity, and/or marginalized social status. Nursing research has a major role to play in developing this body of knowledge.

PURPOSE

The purpose of this paper is to review the contributions that Nursing Research made through its publications over the last five decades in developing the body of tested knowledge about health disparities in vulnerable groups and to analyze the progress made.

METHODS

Criteria for reviewing the literature were established. All Nursing Research publications between 1952 and 2000 were searched manually, indexes of each year's bound volumes were reviewed, and computer searches were conducted. Included in the review were research reports, research briefs, and methodology articles.

RESULTS

Seventy-nine papers were found that met basic criteria for inclusion. The number of relevant publications increased each decade, with a sizable increase in numbers since 1990, and may be related to the social, political, and economic climate of each decade. The research questions asked and the methods used became more complex over time.

CONCLUSIONS

Nursing Research has made a significant contribution in disseminating the body of tested knowledge related to the health disparities experienced by vulnerable populations and the methodologies associated with vulnerable populations research. Areas for future research are community-based studies, intervention studies that provide tangible resources, and methodologic approaches that involve participants in the research process.

HIV serostatus and factors related to physical and mental well-being in Latina family AIDS caregivers

In a survey of 154 Latina AIDS caregivers living in Los Angeles, we examined differences in the stress process for those who were HIV seropositive, seronegative, and those with an unknown serostatus. Most caregivers were monolingual, poor, suffered from chronic physical illness unrelated to HIV, and received few services. All three subsamples reached clinical cut-off levels for depression on the brief symptom inventory. In the sample as a whole and in all three groups we examined differences in primary and secondary stressors as predictors of mental and physical well-being; differences in background factors as they relate to mental and physical well-being; and differences in predictive value of various factors that may attenuate the relationship between stress and mental and physical well-being. Models predicting both mental and physical well-being differ across subsamples divided on the basis of serostatus. Based on these findings, we discuss implications for service provision designed to target these underserved Latina AIDS caregivers.

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

The objective of this study was to explore strategies for improving the appropriateness of a health care delivery model to meet HIV-infected mothers' complex needs. A participatory action research paradigm was used as a process for an empowerment program (EP) and to elucidate the essential components of the program identified by these mothers. To test the EP's effectiveness, a nonequivalent control group pretest-posttest, quasi-experimental design was used. The participants included 94 Thai HIV-infected mothers rearing their own infants, with 46 in the 6-week experimental group and 48 in the control group. Study findings showed that the mothers in the EP group significantly increased levels of coping ability, quality of life, and maternal role adaptation when compared to mothers in the control group. In addition, data analysis revealed five components of the EP that were identified by mothers as essential for HIV-infected mothers' psychological well-being and their maternal role adaptation. These interventions included peer group meetings, professional support on infant rearing and maternal self-care, stress management, access to available social support, and alternative medicine. The mothers reported greater autonomy, accountability, collegiality, and more effective communication by the implication process of the EP.

Caring for the child and family with HIV disease

Caring for children with HIV infection is a much more optimistic process than in the beginning of the epidemic. Antiretroviral therapies are available, and additional drugs are receiving approval from the US Food and Drug Administration. Cautious optimism must be tempered with an understanding that living with the disease is a complicated and daunting process for these children and their families. Although scientific knowledge and medical treatments are moving forward, the social and environmental uncertainties remain for families. Comprehensive care is a balance of health care services and supportive, community-based services offered in a compassionate manner.

Boosting social support in caregivers of children with HIV/AIDS

Providing care for a child that is infected with human immunodeficiency virus (HIV) is challenging for the child's caregiver and affects the entire family system. Research has demonstrated that social support has the potential to buffer caregiver stress and facilitate caregiver coping. A two-group experimental study was implemented to test the effect of a social support boosting intervention on caregiver stress, coping and social support among caregivers of children with HIV/acquired immune deficiency syndrome (AIDS). The subjects in the study were caregivers of children with HIV/AIDS. The sample strata included seropositive caregivers (biological parents) and seronegative caregivers (foster parents and extended family members). The measures for the study included the Derogatis Stress Profile, The Family Crisis Oriented Personal Evaluation Scale, and the Tilden Interpersonal Relationship Inventory. These data were then analyzed descriptively and then with a repeated measure MANOVA. Initially, there were no statistically significant differences found between the control and intervention groups. However, when subject HIV status was included in the analysis, the combined dependent variables of stress, coping, and social support were significantly related to the interactions of group by HIV status over time. F values were then computed and no statistically significant differences were found for stress or coping. There were, however, significant differences in measures of social support between groups when adjusting for HIV status of caregivers. In this study, social support levels over time for seronegative caregivers were significantly different from those of seronegative caregivers in the control group. Three case studies are presented that illustrate differences between seronegative and seropositive caregivers. The case studies describe the problems identified by caregivers and the effectiveness of problem solving using the social support boosting intervention. Finally, the mobilization of social support is discussed. Contrasts between the problems of caregivers are made relative to their HIV status. The potential for the effectiveness of the social support boosting intervention is discussed within the context of the caregiver's HIV status.