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Rosen JG, Nakyanjo N, Ddaaki WG, Zhao T, Van Vo A, Nakubulwa R, Ssekyewa C, Isabirye D, Katono RL, Nabakka P, Ssemwanga RJ, Kigozi G, Odiya S, Nakigozi G, Nalugoda F, Kigozi G, Kagaayi J, Grabowski MK, Kennedy CE. Identifying longitudinal patterns of HIV treatment (dis)engagement and re-engagement from oral histories of virologically unsuppressed persons in Uganda: A thematic trajectory analysis. Soc Sci Med 2023; 339:116386. [PMID: 37984182 PMCID: PMC10841599 DOI: 10.1016/j.socscimed.2023.116386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/01/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND There is limited study of persons deemed "harder to reach" by HIV treatment services, including those discontinuing or never initiating antiretroviral therapy (ART). We conducted narrative research in southern Uganda with virologically unsuppressed persons identified through population-based sampling to discern longitudinal patterns in HIV service engagement and identify factors shaping treatment persistence. METHODS In mid-2022, we sampled adult participants with high-level HIV viremia (≥1000 RNA copies/mL) from the prospective, population-based Rakai Community Cohort Study. Using life history calendars, we conducted initial and follow-up in-depth interviews to elicit oral histories of participants' journeys in HIV care, from diagnosis to the present. We then used thematic trajectory analysis to identify discrete archetypes of HIV treatment engagement by "re-storying" participant narratives and visualizing HIV treatment timelines derived from interviews and abstracted clinical data. RESULTS Thirty-eight participants (median age: 34 years, 68% men) completed 75 interviews. We identified six HIV care engagement archetypes from narrative timelines: (1) delayed ART initiation, (2) early treatment discontinuation, (3) treatment cycling, (4) prolonged treatment interruption, (5) transfer-related care disruption, and (6) episodic viremia. Patterns of service (dis)engagement were highly gendered, occurred in the presence and absence of optimal ART adherence, and were shaped by various factors emerging at different time points, including: denial of HIV serostatus and disclosure concerns; worsening HIV-related symptoms; psychological distress and depression; social support; intimate partner violence; ART side effects; accessibility constraints during periods of mobility; incarceration; and inflexible ART dispensing regulations. CONCLUSIONS Identified trajectories uncovered heterogeneities in both the timing and drivers of ART (re-)initiation and (dis)continuity, demonstrating the distinct characteristics and needs of people with different patterns of HIV treatment engagement throughout the life course. Enhanced mental health service provision, expanded eligibility for differentiated service delivery models, and streamlined facility switching processes may facilitate timely (re-)engagement in HIV services.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | - Tongying Zhao
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anh Van Vo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Silas Odiya
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | | | - M Kate Grabowski
- Rakai Health Sciences Program, Entebbe, Uganda; Division of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda
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Scott S, McGowan V, Bradley A, Visram S. 'How I'm feeling today, I probably won't be feeling tomorrow'. Using I-Poems to explore young people's changing emotions during the Covid-19 pandemic - A qualitative, longitudinal study. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100239. [PMID: 36817939 PMCID: PMC9927801 DOI: 10.1016/j.ssmqr.2023.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Background Relatively little published qualitative research has explored children and young people's (CYP) prolonged or longitudinal experiences of the pandemic, and their emotional responses to such unreserved change to everyday life. As part of a broader, qualitative longitudinal study, this paper explores change and continuity in young people's emotions over time during the Covid-19 pandemic in North East England. Methods I-Poems were curated for each of the 26 young people in this study from serial interview transcripts and diary entries, collected over the course of 16 months. Creation of I-Poems require researchers to focus on sentences made by the interviewee that include the word "I," and without changing the order of those sentences, to present them in poetic stanzas. Findings Young people's voices and experiences became more poignant and powerful when their 'I' narrative was centralised, silencing the presence of the researcher. Further, presenting the data in this way allowed us to see how the following emotions shifted over time: grief, sadness, frustration, anger, anxiety, joy, pleasure, excitement. We contend that young people experienced significant rupture and change over the course of our 16 month project, with both positive and negative repercussions for their emotional wellbeing. Conclusions Large scale (quantitative and qualitative) studies remain much needed to focus on the long-term impacts of the pandemic on young people's social, emotional and cultural lives. Longitudinal and creative qualitative approaches (such as I-Poems) have the potential to centralise participant voice, break down power dynamics, and allow exploration of shifting experiences and emotions over time.
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Affiliation(s)
- S Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - V McGowan
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - A Bradley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - S Visram
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
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Marques-Quinteiro P, van Dijk H, Peterson DR, Adamovic M, Buengeler C, Santos CM. A Model of Leadership Transitions in Teams. GROUP & ORGANIZATION MANAGEMENT 2022. [DOI: 10.1177/10596011221082394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Teams with shared leadership arrangements are ubiquitous in twenty-first century organizations. Although transitions in leadership are a common and key feature of such teams, there is little insight into how and when leadership arrangements transition over time. Bridging the shared leadership and team adaptation literatures, we present a model of Leadership Transitions in Teams to describe the adaptive process through which teams intentionally modify the existing leadership arrangement. The basic assumption underlying this model is that leadership transitions occur when there is a mismatch between the team’s needs and its current leadership arrangement. Such a mismatch results from an anticipated or observed change. If it is anticipated, team members can democratically discuss and try out a new leadership arrangement, preventing mismatch and thus lowered team effectiveness. In contrast, if the mismatch has already occurred, teams are more likely to adopt a less democratic process—either a coalition-based or intervening-based process—to change the leadership arrangement in their team to counteract faltering team effectiveness. We propose that the ways in which leadership transition episodes can unfold and relate to team effectiveness will depend on the type (determined by the timing of the leadership transition episode in relation to the change), approach (determined by the extent to which there is consensus on if and how to change the leadership transition episode), and boundary conditions of leadership transition episodes. We advance an agenda for research on leadership transitions in teams and outline practical implications for teams with shared leadership structures.
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Affiliation(s)
- Pedro Marques-Quinteiro
- TRIE, Escola de Ciências Económicas e das Organizações, Universidade Lusófona de Humanidades e Tecnologia, Lisboa, Portugal
| | - Hans van Dijk
- Department of Organization Studies, Tilburg University, Tilburg, The Netherlands
| | - David R. Peterson
- College of Business, James Madison University, St. Harrisonburg, VA, USA
| | - Mladen Adamovic
- Department of Human Resource Management & Employment Relations, King's Business School, King's College London
- Department of Management & International Business, Auckland Business School, University of Auckland
| | | | - Catarina M. Santos
- Maastricht University School of Business and Economics, Department of Organization, Strategy, and Entrepreneurship, Maastricht, the Netherlands
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