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Psaros C, Stanton AM, Goodman GR, Blyler A, Vangel M, Labbe AK, Robbins GK, Park ER. A resiliency intervention adapted for older women with HIV: Results from a pilot randomized controlled trial in the northeastern US. J Health Psychol 2024:13591053241253050. [PMID: 38761072 DOI: 10.1177/13591053241253050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024] Open
Abstract
Aging with HIV often results in psychosocial and health-related challenges for women; however, no resiliency interventions exist for older women with HIV (WWH). WWH aged ≥50 were randomized to 10 group sessions of an adapted resiliency intervention or time-matched supportive psychotherapy. Assessments were conducted at three timepoints. Feasibility and acceptability metrics were defined a priori; differences in resilience, stress coping, anxiety, and depression across timepoints were assessed. Overall, 44 WWH enrolled; participants were 58 years old on average, and 56.4% identified as Black/African American. Among those who attended any sessions, all feasibility metrics were met, and the intervention was acceptable. The interaction of study arm and time was associated with significant decreases in depression and a trend toward significant decreases in anxiety. The intervention was not associated with changes in resilience or stress coping. Adjusting delivery modality may further reduce barriers to attendance, improving feasibility and clinical outcomes.
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Affiliation(s)
| | | | - Georgia R Goodman
- Massachusetts General Hospital, USA
- The Fenway Institute, Fenway Health, USA
- Brigham and Women's Hospital, USA
| | - Abigail Blyler
- Massachusetts General Hospital, USA
- University of Pennsylvania, USA
| | - Mark Vangel
- Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Allison K Labbe
- Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | - Elyse R Park
- Massachusetts General Hospital, USA
- Harvard Medical School, USA
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Samuels S, Dale SK. Self-esteem, adverse life events, and mental health diagnoses among Black women living with HIV. ETHNICITY & HEALTH 2023; 28:170-181. [PMID: 35200044 PMCID: PMC10097460 DOI: 10.1080/13557858.2022.2035690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Black women in the U.S. are disproportionately impacted by HIV and adverse life events (ALE). High self-esteem has been noted as a protective factor and low self-esteem has been linked to mental health diagnoses. However, the existing literature is limited in the examination of how self-esteem may buffer relationships between ALE and mental health diagnoses among Black women living with HIV (BWLWH). METHODS One hundred and nineteen BWLWH completed self-report measures on self-esteem (Rosenberg Self-Esteem Scale) and ALE (Life Events Checklist for DSM-5) (e.g. sexual assault, physical assault, accidents, natural disaster) as well as a clinical interview (via Mini-International Neuropsychiatric Inventory) to diagnose current depression, PTSD, and suicidality. RESULTS Multivariable logistic regressions indicated that higher self-esteem was associated with lower likelihood of current depression (OR = .894, p < .01), PTSD (OR = .838, p < .001) and suicidality (OR = .889, p < .05). Interactions between self-esteem and total ALE significantly predicted current depression (OR = .000003, p < .05) and PTSD (OR = 2.7182 × 10-9, p < .001); and higher total ALE related to higher likelihood of current PTSD only among BWLWH reporting lower self-esteem (OR = 1.21, p < .05). CONCLUSION Interventions addressing mental health diagnoses among BWLWH should incorporate strategies to enhance self-esteem.
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Affiliation(s)
- Sherene Samuels
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Miami, FL, USA
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Lau B, Sharma I, Manku S, Kobylianski J, Wong LY, Ibáñez-Carrasco F, Carusone SC, O'Brien KK. Considerations for developing and implementing an online community-based exercise intervention with adults living with HIV: a qualitative study. BMJ Open 2022; 12:e059294. [PMID: 35428647 PMCID: PMC9014056 DOI: 10.1136/bmjopen-2021-059294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To describe the need for, and utility of, online community-based exercise (CBE) interventions with adults living with HIV and identify factors to consider in developing and implementing an online CBE intervention with adults living with HIV. DESIGN Qualitative descriptive study using web-based semistructured interviews. PARTICIPANTS We recruited adults representing at least one of five stakeholder groups with experience in CBE and/or HIV: (1) adults living with HIV, (2) rehabilitation professionals, (3) fitness personnel, (4) educators with eLearning experience and (5) representatives from HIV community-based organisations (CBOs). DATA COLLECTION We asked participants to describe their experiences with online CBE, need and utility for online CBE and factors in developing and implementing online CBE interventions. We analysed data using a group-based thematic analytical approach. RESULTS Among the 11 participants, most had experience working with adults living with HIV (73%) or with telehealth/rehabilitation/coaching in HIV or other chronic conditions (91%). Participants (eight women; two men; one non-binary; median age: 49 years), identified the need and utility for online CBE interventions to increase accessibility and continuity of care with adults living with HIV. Six factors to consider in developing and implementing online CBE included: (1) person-specific considerations (episodic nature of HIV, stigma, HIV disclosure), (2) accessibility of programme (physical space to exercise, reliable internet, access to devices, digital literacy), (3) programme delivery and technology (live vs prerecorded online classes, multiple online platforms for delivery, physical activity tracking, troubleshooting technology), (4) attributes of programme personnel (working with CBOs, relatable instructors, diverse staff), (5) programme content and design (tailored exercise classes, educational sessions) and (6) building community (shared experiences, peer support, social opportunities). CONCLUSIONS There is a need and utility for online CBE in the context of HIV. Considerations for development and implementation span individual, structural and technical, and community dimensions. Results can inform the future development and implementation of online CBE with adults living with HIV and other chronic episodic conditions.
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Affiliation(s)
- Bernice Lau
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isha Sharma
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sukhbir Manku
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kobylianski
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lin Yin Wong
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
- Casey House, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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Sevelius JM, Neilands TB, Dilworth S, Castro D, Johnson MO. Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women. AIDS Behav 2020; 24:1551-1559. [PMID: 31562572 DOI: 10.1007/s10461-019-02683-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transgender women experience disproportionate risk of HIV acquisition and transmission. We piloted 'Sheroes', a peer-led group-level intervention for transgender women of any HIV status emphasizing empowerment and gender affirmation to reduce HIV risk behaviors and increase social support. Participants (N = 77) were randomized to Sheroes (n = 39) or a time- and attention-matched control (n = 38). Sheroes is 5 weekly group sessions; topics include sexuality, communication, gender transition, and coping skills. Control participants attended 5 weekly group movie sessions. At 6-month follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control. Among participants living with HIV, both the control and intervention groups reduced their total number of sex partners; this change was sustained at 6-month follow-up for Sheroes participants but not for control participants relative to baseline. Sheroes was deemed highly feasible and acceptable to participants; findings support preliminary efficacy of Sheroes.
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Affiliation(s)
- Jae M Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA.
- Center of Excellence for Transgender Health, University of California, San Francisco, USA.
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Samantha Dilworth
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Danielle Castro
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
- Center of Excellence for Transgender Health, University of California, San Francisco, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
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Hamilton JB. Rigor in Qualitative Methods: An Evaluation of Strategies Among Underrepresented Rural Communities. QUALITATIVE HEALTH RESEARCH 2020; 30:196-204. [PMID: 31274057 DOI: 10.1177/1049732319860267] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Achieving rigor using selected criteria to determine trustworthiness using qualitative methods has been without critical evaluation. In this article, strategies such as prolonged engagement and thick, rich description; negative case analysis; peer review or briefing; clarifying researcher bias; member checking; and, investigator triangulation and intercoder reliability are evaluated for appropriateness among an African American Appalachian rural population. Achieving rigor using qualitative methods among participants living in rural communities is time intensive requiring attention to quality versus quantity of time spent in interviews, building trusting relationships, an awareness of interviewer bias and assumptions, and appropriately evaluated strategies that enhance validity. Strategies to achieve rigor in qualitative methods should not be used as a one size fits all approach as this practice might actually diminish rigor. Among underrepresented populations, strategies should be adapted or not used at all.
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Sisto A, Vicinanza F, Campanozzi LL, Ricci G, Tartaglini D, Tambone V. Towards a Transversal Definition of Psychological Resilience: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E745. [PMID: 31744109 PMCID: PMC6915594 DOI: 10.3390/medicina55110745] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/25/2023]
Abstract
Background and objectives: This paper addresses psychological resilience, a multidisciplinary theoretical construct with important practical implications for health sciences. Although many definitions have been proposed in several contexts, an essential understanding of the concept is still lacking up to now. This negatively affects comparisons among research results and makes objective measurement difficult. The aim of this review is to identify shared elements in defining the construct of resilience across the literature examined in order to move toward a conceptual unification of the term. Materials and methods: A literature review was performed using the electronic databases 'PubMed' and 'PsycINFO'. Scientific studies written in English between 2002 and May 2019 were included according to the following key terms: 'Psychological', 'resilience', and 'definition'. Results: The review identifies five macro-categories that summarize what has been reported in the recent literature concerning the resilience phenomenon. They serve as a preliminary and necessary step toward a conceptual clarification of the construct. Conclusions: We propose a definition of psychological resilience as the ability to maintain the persistence of one's orientation towards existential purposes. It constitutes a transversal attitude that can be understood as the ability to overcome the difficulties experienced in the different areas of one's life with perseverance, as well as good awareness of oneself and one's own internal coherence by activating a personal growth project. The conceptual clarification proposed will contribute to improving the accuracy of research on this topic by suggesting future paths of investigation aimed at deeply exploring the issues surrounding the promotion of resilience resources.
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Affiliation(s)
- Antonella Sisto
- Clinical Psychological Service, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (A.S.); (F.V.)
| | - Flavia Vicinanza
- Clinical Psychological Service, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (A.S.); (F.V.)
| | - Laura Leondina Campanozzi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Giovanna Ricci
- School of Law, Medico-Legal Section, University of Camerino, 62032 Camerino (Macerata), Italy;
| | - Daniela Tartaglini
- Department of Professional Health Care Services, Campus Bio-Medico University Hospital, 00128 Rome, Italy;
| | - Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University, 00128 Rome, Italy;
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Dulin AJ, Dale SK, Earnshaw VA, Fava JL, Mugavero MJ, Napravnik S, Hogan JW, Carey MP, Howe CJ. Resilience and HIV: a review of the definition and study of resilience. AIDS Care 2019; 30:S6-S17. [PMID: 30632778 DOI: 10.1080/09540121.2018.1515470] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We use a socioecological model of health to define resilience, review the definition and study of resilience among persons living with human immunodeficiency virus (PLWH) in the existing peer-reviewed literature, and discuss the strengths and limitations of how resilience is defined and studied in HIV research. We conducted a review of resilience research for HIV-related behaviors/outcomes of antiretroviral therapy (ART) adherence, clinic attendance, CD4 cell count, viral load, viral suppression, and/or immune functioning among PLWH. We performed searches using PubMed, PsycINFO and Google Scholar databases. The initial search generated 14,296 articles across the three databases, but based on our screening of these articles and inclusion criteria, n = 54 articles were included for review. The majority of HIV resilience research defines resilience only at the individual (i.e., psychological) level or studies individual and limited interpersonal resilience (e.g., social support). Furthermore, the preponderance of HIV resilience research uses general measures of resilience; these measures have not been developed with or tailored to the needs of PLWH. Our review suggests that a socioecological model of health approach can more fully represent the construct of resilience. Furthermore, measures specific to PLWH that capture individual, interpersonal, and neighborhood resilience are needed.
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Affiliation(s)
- Akilah J Dulin
- a Center for Health Equity Research, Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Sannisha K Dale
- b Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Valerie A Earnshaw
- c Department of Human Development and Family Sciences , University of Delaware , Newark , DE , USA
| | - Joseph L Fava
- d Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - Michael J Mugavero
- e Division of Infectious Diseases, Department of Medicine, Center for AIDS Research , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sonia Napravnik
- f Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joseph W Hogan
- g Center for Statistical Sciences, Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Michael P Carey
- h Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior , The Miriam Hospital, Alpert Medical School of Brown University , Providence , RI , USA
| | - Chanelle J Howe
- i Centers for Epidemiology and Environmental Health, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
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Dale SK, Safren SA. Resilience takes a village: black women utilize support from their community to foster resilience against multiple adversities. AIDS Care 2019; 30:S18-S26. [PMID: 30628458 DOI: 10.1080/09540121.2018.1503225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Black women living with HIV (BWLWH) represent the highest percentage of women with HIV in the U.S. and experience worse health outcomes than other women living with HIV, in part due to experiences of trauma, racism, HIV-stigma, and stressors they face as women. However, their own stories of resilience in the face of multiple adversities and insights of community stakeholders may inform our field on how to best empower this population to strive despite adversities. Thirty BWLWH in the U.S. and fifteen community stakeholders were interviewed about women's experiences and adaptive coping strategies used to cope with trauma, racism, HIV-stigma, and gender-related stressors. Interviews were coded using thematic content analysis. A major theme that spanned across interviews with BWLWH and community stakeholders was that resilience was fostered by members of their "village". In the midst of or following adverse experiences BWLWH used social support from their children, grandchildren, other family members, friends/peers, and caring providers in order to overcome their adversities and focus on their health and well-being. Promoting resilience among BWLWH requires an understanding of the most adaptive strategies utilized to "bounce back" following or in the face of adversities. Our findings highlight that both BWLWH and community stakeholders recognize social support from their "village" as an importance resilience resource. Research and applied efforts need to be geared at strengthening both BWLWH and their "village" in order to promote resilience and reduce health disparities.
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Affiliation(s)
- Sannisha K Dale
- a Department of Psychology , University of Miami , Miami , FL , USA.,b Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA.,c Harvard Medical School , Boston , MA , USA
| | - Steven A Safren
- a Department of Psychology , University of Miami , Miami , FL , USA
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