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Nabunya P, Samuel K, Ssewamala FM. The effect of family support on self-reported adherence to ART among adolescents perinatally infected with HIV in Uganda: A mediation analysis. J Adolesc 2023; 95:834-843. [PMID: 36810778 PMCID: PMC10257769 DOI: 10.1002/jad.12157] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/13/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION This study examined the mechanisms through which family support affects self-reported adherence to antiretroviral therapy among adolescents perinatally infected with HIV in Uganda. METHODS Longitudinal data from 702 adolescent boys and girls (10-16 years) were analyzed. Structural equation models were conducted to assess the direct, indirect, and total effects of family support on adherence. RESULTS Results showed a significant indirect effect of family support on adherence (β = .112, 95% confidence interval [CI]: 0.052-0.173, p < .001). Specific indirect effects of family support through saving attitudes (β = .058, 95% CI: 0.008-0.108, p = .024), and communication with the guardian (β = .056, 95% CI: 0.012-0.100), p = .013), as well as the total effect of family support on adherence (β = .146 (95% CI: 0.032-0.259, p = .012), were statistically significant. Mediation contributed 76.7% of the total effects. CONCLUSION Findings support strategies to help promote family support and strengthen open communication between adolescents living with HIV and their caregivers.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University, St. Louis, Missouri, USA
| | - Kizito Samuel
- International Center for Child Health and Development (ICHAD), Brown School Washington University, St. Louis, Missouri, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University, St. Louis, Missouri, USA
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Rapa E, Hanna JR, Pollard T, Santos-Paulo S, Gogay Y, Ambler J, Namukwaya E, Kavuma D, Nabirye E, Kemigisha RM, Namyeso J, Brand T, Walker L, Neethling BG, Downing J, Ziebland S, Stein A, Dalton LJ. Exploring the experiences of healthcare professionals in South Africa and Uganda around communicating with children about life-threatening conditions: a workshop-based qualitative study to inform the adaptation of communication frameworks for use in these settings. BMJ Open 2023; 13:e064741. [PMID: 36707115 PMCID: PMC9884929 DOI: 10.1136/bmjopen-2022-064741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES This study aimed to explore how published communication frameworks could be amended to ensure applicability and cultural appropriateness for professionals to support family-centred conversations by investigating' healthcare professionals' (1) experiences of providing support to families when a caregiver or a dependent child (<18 years old) has a life-threatening condition, (2) perceived challenges for caregivers and healthcare professionals in communicating with children about illness, (3) perceptions of how clinicians could be equipped to facilitate conversations between caregivers and children about an adult or the child's own life-threatening condition and (4) suggestions for amendments to previously published guidelines to ensure cultural relevance in South Africa and Uganda. DESIGN A qualitative study involving two 2-day workshops with embedded focus group discussions, break out rooms and consensus discussions. SETTING Health and social care and third sector organisations in South Africa and Uganda. PARTICIPANTS Thirty-two professionals providing care to families affected by life-threatening conditions in South Africa or Uganda who were aged 18 years or older and able to converse in English. RESULTS Participants identified obstacles to having conversations with caregivers about children and to telling children about serious illness during consultations. These included patients' beliefs about illness, medicine and death, language barriers between families and the healthcare team, and emotional and practical challenges for professionals in having these conversations. Culturally appropriate adaptations were made to previously published communication frameworks for professionals to support family-centred conversations. CONCLUSIONS Culturally sensitive communication frameworks could help healthcare professionals to talk with families about what children need to know when they or a caregiver have a serious illness. More broadly, effective communication could be facilitated by promoting healthcare professionals' and communities' understanding of the benefits of telling children about illness within the family. Together these strategies may mitigate the psychological impact of global disease on children and their families.
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Affiliation(s)
- Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Teresa Pollard
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children, London, UK
| | | | - Yasmin Gogay
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Julia Ambler
- Department of Paediatrics, Nelson Mandela Medical School, Durban, South Africa
- Umduduzi - Hospice Care for Children, Durban, South Africa
| | | | - David Kavuma
- Department of Health Sciences, Mildmay Uganda Institute of Health Sciences, Kampala, Uganda
| | | | | | | | - Tracey Brand
- Umduduzi - Hospice Care for Children, Durban, South Africa
| | | | - Beverley G Neethling
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Julia Downing
- Department of Medicine, Makerere University, Kampala, Uganda
- International Palliative Care Network, Durban, South Africa
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alan Stein
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
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Rakhmawati W, Fitri SYR, Sriati A, Hendrawati S. Communication between Parents and Preschool-Aged Children about Tuberculosis Preventive Treatment: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:370-376. [PMID: 36524149 PMCID: PMC9745845 DOI: 10.4103/ijnmr.ijnmr_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/25/2021] [Accepted: 01/24/2022] [Indexed: 06/17/2023]
Abstract
Background Communication with preschool-aged children about Tuberculosis Preventive Treatment (TPT) is a challenge for parents. Good communication can encourage children to be involved in their treatment and enhance their adherence to the treatment. This study aimed to explore the experience of parents in communicating with their preschool-aged children about TPT. Materials and Methods This study used a qualitative approach. Participants were 10 parents who were selected using the purposive sampling technique from three community health centers in Bandung City, Indonesia. The inclusion criteria for the study were parents who have a child aged 3-5 years who received or was receiving TPT. Semi-structured interviews were conducted to obtain the data, and when saturation was reached, no further interviews were conducted. Subsequently, the interviews were transcribed and analyzed using thematic analysis. Results The findings revealed three themes with eight categories. The themes were persuading children, lack of understanding, and supporting communication. Conclusions The findings are relevant for nurses and other health professionals who need to provide adequate information related to TPT and to develop media for parents and children during their communication. Nurses can collaborate with other physicians and software engineers to develop interesting media such as game applications to educate children about Tuberculosis (TB) prevention.
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Affiliation(s)
- Windy Rakhmawati
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | - Siti Yuyun Rahayu Fitri
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | - Aat Sriati
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | - Sri Hendrawati
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
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Molokwane M, Madiba S. Truth, Deception, and Coercion; Communication Strategies Used by Caregivers of Children with Perinatally Acquired HIV During the Pre-Disclosure and Post-Disclosure Period in Rural Communities in South Africa. Glob Pediatr Health 2021; 8:2333794X211022269. [PMID: 34104705 PMCID: PMC8170273 DOI: 10.1177/2333794x211022269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Typically, children with perinatal HIV (PHIV) receive antiretroviral treatment (ART) for a long time prior to receiving disclosure. Communication with children about HIV and treatment is critical for monitoring adherence and retention in care. However, there is a dearth of information on communication between caregivers and their children. This study examines what and how caregivers tell their their children about their illness and medication in the pre-disclosure and post-disclosure period. A qualitative study using semi-structured one-on-one interviews and focus group discussions was conducted with caregivers recruited via purposive sampling from a rural sub-district in South Africa. The interviews were analyzed using thematic analysis. The sample consisted of 38 caregivers, 24 of whom were the children's biological mothers, 20 had disclosed to the children and 18 had not done so. Caregivers who had disclosed had told their children the truth and named the disease as HIV, but communication about HIV was infrequent and focused on pill taking. Those who had not disclosed had lied, deflected illness-related information, and attributed the children's ill health to co-morbid conditions. To enforce adherence, most caregivers used coercion and threats of the grave consequences of non-adherence as a communication strategy. Those who had not disclosed used deception, deflecting, and coercion as strategies for coping through the pre-disclosure period. There is a need for healthcare workers to prepare, support, and empower caregivers to develop appropriate responses to children's questions and to understand the implications of deception on future full disclosure and children's acceptance of their HIV status.
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Affiliation(s)
| | - Sphiwe Madiba
- Sefako Makgatho Health Sciences
University, Pretoria, South Africa
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Stein A, Dalton L, Rapa E, Bluebond-Langner M, Hanington L, Stein KF, Ziebland S, Rochat T, Harrop E, Kelly B, Bland R. Communication with children and adolescents about the diagnosis of their own life-threatening condition. Lancet 2019; 393:1150-1163. [PMID: 30894271 DOI: 10.1016/s0140-6736(18)33201-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/10/2023]
Abstract
When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.
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Affiliation(s)
- Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Myra Bluebond-Langner
- The Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Emily Harrop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Helen & Douglas House, Oxford, UK
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
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Kalembo FW, Kendall GE, Ali M, Chimwaza AF. Socio-demographic, clinical, and psychosocial factors associated with primary caregivers' decisions regarding HIV disclosure to their child aged between 6 and 12 years living with HIV in Malawi. PLoS One 2019; 14:e0210781. [PMID: 30645639 PMCID: PMC6333381 DOI: 10.1371/journal.pone.0210781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022] Open
Abstract
The World Health Organisation (WHO) recommends that children living with HIV should be informed about their HIV status within the ages of 6 to 12 years using age-appropriate resources. The aim of this study was to assess the socio-demographic, clinical and psychosocial factors associated with primary caregivers’ decisions to disclose HIV to children living with HIV aged 6 to 12 years in Malawi. A cross-sectional study of 429 primary caregivers of children living with HIV were systematically recruited from all regions of the country. Information on HIV disclosure, family and child socio-demographic characteristics, child clinical characteristics, and child and family psychosocial characteristics was collected using validated instruments. Logistic regression was used to analyse data. The prevalence of non-disclosure of HIV status to children was 64 per cent. Concerns about the child’s inability to cope with the news (29%), a lack of knowledge on how to disclose HIV status (19%), and fear of stigma and discrimination (17%) were the main reasons for non-disclosure. On multivariate analysis, the odds of non-disclosure were higher among primary caregivers who were farmers (aOR 3.0; 95% CI: 1.1–8.4), in younger children (6–8 years) (aOR 4.1; 95% CI: 2.3–7.4), in children who were in WHO HIV clinical stage one (aOR 3.8; 95% CI: 1.4–10.2), and in children who were not asking why they were taking ARVs (aOR 2.9; 95% CI: 1.8–4.8). On the other hand, nondisclosure of HIV status was less likely in underweight children (aOR 0.6; 95% CI: 0.3–0.9). Many children living with HIV in Malawi are unaware of their HIV status. Non-disclosure is associated with a number of clinical and demographic characteristics. The findings highlight the need to provide guidance and support to primary caregivers to help them to effectively disclose HIV status to their children.
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Affiliation(s)
- Fatch Welcome Kalembo
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
- Faculty of Health Sciences, Mzuzu University, Mzuzu, Malawi
- * E-mail:
| | - Garth E. Kendall
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mohammed Ali
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Bernays S, Paparini S, Seeley J, Rhodes T. "Not Taking it Will Just be Like a Sin": Young People Living with HIV and the Stigmatization of Less-Than-Perfect Adherence to Antiretroviral Therapy. Med Anthropol 2017; 36:485-499. [PMID: 28379042 DOI: 10.1080/01459740.2017.1306856] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Global health priorities are being set to address questions on adherence to HIV antiretroviral therapy in adolescence. Few studies have explored young people's perspectives on the complex host of social and relational challenges they face in dealing with their treatment in secret and their condition in silence. In redressing this, we present findings from a longitudinal qualitative study with young people living with HIV in the UK, Ireland, US, and Uganda, embedded within the BREATHER international clinical trial. Drawing from Goffman's notion of stigma, we analyze relational dynamics in HIV clinics, as rare spaces where HIV is "known," and how young people's relationships may be threatened by non-adherence to treatment. Young people's reflections on and strategies for maintaining their reputation as patients raise questions about particular forms of medicalization of HIV and the moralization of treatment adherence that affect them, and how these may restrict opportunities for care across the epidemic.
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Affiliation(s)
- Sarah Bernays
- a School of Public Health , University of Sydney , Sydney , Australia.,b London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Sara Paparini
- b London School of Hygiene and Tropical Medicine , London , United Kingdom.,c Graduate Institute of International and Development Studies , Geneva , Switzerland
| | - Janet Seeley
- d Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Tim Rhodes
- b London School of Hygiene and Tropical Medicine , London , United Kingdom
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