Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda

Russell, Steve; Martin, Faith; Zalwango, Flavia; Namukwaya, Stella; Nalugya, Ruth; Muhumuza, Richard; Katongole, Joseph; Seeley, Janet

doi:10.1371/journal.pone.0147896

Cited by 38 publications

(63 citation statements)

References 34 publications

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“…Just over half of the qualitative studies conducted semi-structured in-depth interviews (IDIs) (49; 56.3%) [17,20–22,26,27,29,32–37,39–43,45–47,49,51,54–60,62,63,65–67,69–71,78,81,84,85,87–90,95–97,165] with their HIV-positive participants. Eighteen studies (20.7%) used focus group discussions (FDGs) [19,23–25,28,50,53,61,68,73,74,76,77,82,94,98,167,169], 16 used both IDIs and FDGs (18.4%) [18,30,31,38,44,52,64,72,75,79,83,86,92,93,99,170], one used free attitude interviews (FAIs) and FGDs (1.1%) [80], one used group sessions without more detail [168], one used IDIs and life history and illness narratives [48] and one used digital stories [91].…”

Section: Resultsmentioning

confidence: 99%

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Croome

Ahluwalia²,

Hughes³

et al. 2017

Aids

126

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Objective:The aim of this study was to identify the range and frequency of patient-reported barriers and facilitators to antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA).Design:Studies from 2005 to 2016 were identified by searching 10 electronic databases and through additional hand and web-searching.Methods:Inclusion criteria were HIV-positive adults taking ART based in any SSA country, qualitative study or quantitative survey and included at least one patient-reported barrier or facilitator to ART adherence. Exclusion criteria were only including data from treatment-naive patients initiating ART, only single-dose treatment, participants residing outside of SSA and reviews.Results:After screening 11 283 records, 154 studies (161 papers) were included in this review. Forty-three barriers and 30 facilitators were reported across 24 SSA countries. The most frequently identified barriers across studies were forgetting (n = 76), lack of access to adequate food (n = 72), stigma and discrimination (n = 68), side effects (n = 67) and being outside the house or travelling (n = 60). The most frequently identified facilitators across studies were social support (n = 60), reminders (n = 55), feeling better or healthier after taking ART (n = 35), disclosing their HIV status (n = 26) and having a good relationship with a health provider (n = 22).Conclusion:This review addresses the gap in knowledge by collating all the patient-reported barriers and facilitators to ART adherence in SSA. Current barriers measures need to be adapted or new tools developed to include the wide variety of factors identified. The factors that have the greatest impact need to be isolated so interventions are developed that reduce the barriers and enhance the facilitators.

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Section: Resultsmentioning

confidence: 99%

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Croome

Ahluwalia²,

Hughes³

et al. 2017

Aids

126

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“…The review study revealed that the lack of perception of life as meaningful was the cause and the effect of depression (Glaw, Kable, Hazelton, & Inder, ). Finding meaning in life can be seen as a positive spiritual coping strategy to help HIV‐positive patients to achieve good health status (McCormick, Holder, Wetsel, & Cawthon, ; Russell et al., ) and to cope with the negative view of self after receiving HIV/AIDS diagnosis (Kremer & Ironson, ). According to previous studies, finding positive meaning in life could reduce both suicide ideation and depression and could increase the well‐being.…”

Section: Discussionmentioning

confidence: 99%

The changes and the predictors of suicide ideation and suicide attempt among HIV‐positive patients at 6–12 months post diagnosis: A longitudinal study

Sheng

Liao

et al. 2018

Journal of Advanced Nursing

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Aims: This study examined the changes and the predictors of suicide ideation/suicide attempt and the moderating effects of psychosocial factors on the suicide ideation/suicide attempts among human immunodeficiency virus (HIV)-positive patients at 6-12 months post-diagnosis. Background: Suicide behaviours are prevalent among newly diagnosed HIV-positive patients, but the changes in suicide behaviours after diagnosis and the role of psychosocial factors in these behaviours are not well studied. Design: This study used a prospective longitudinal design. Methods: A total of 113 participants diagnosed as HIV-positive for 6-12 months were recruited from the outpatient department. Data were collected from June 2015 -October 2016. They were asked to complete Beck's Scale for Suicide Ideation, the Beck Depression Inventory-II, the Body Image Scale, the Meaning in Life Questionnaire and the Multidimensional Scale of Perceived Social Support at baseline, the third month and the sixth month. Results:The results showed the high occurrence rates for suicide ideation ranging from 27.2%, 21.6%, and 25.8% and suicide attempt ranging from 14.7%, 8.6%, and 13.3% at the baseline, the third month and the sixth month, respectively. The education level, social support from family and depressive symptoms were the predictors of suicide ideation. The history of depression disorders, depressive symptoms and social support from friends significantly predicted suicide attempt. Meaning in life-presence moderated the relationship between depressive symptoms and suicide ideation.

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“…There is a growing body of evidence from sub-Saharan Africa which documents how patients with chronic conditions—the majority of studies focussing on HIV—self-manage their conditions with the support of health care teams, family and community caregivers. These studies have highlighted the importance of patient access to peer-support groups in the context of severe shortages in human resources for health, as a way to increase opportunities for patient education and support [ 27 , 28 ]. Studies also point to the need for family caregiver knowledge on the patient’s condition, to help them make informed decisions together with the patient on issues of treatment adherence, symptom monitoring and daily adaptations within the home environment [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

“…Well-known health system challenges in sSA such as drug stock-outs, inadequately trained health professionals and poor health worker distribution, the cost of care and geographical access, have been cited as barriers in the delivery of chronic care and promotion of self-management [ 31 ]. Other studies have elaborated on patient-level challenges, resulting from economic hardship, which affect a patient’s ability to afford an appropriate diet and medication [ 28 , 30 – 32 ].…”

Section: Introductionmentioning

confidence: 99%

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi

et al. 2018

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BackgroundThe high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other sub-Saharan African countries, calls for a shift in how health care services are designed and delivered. Patient-centred care and patient self-management are critical elements in chronic care, and are advocated as universal strategies. In sub-Saharan Africa, there is need for more evidence around the practice of patient self-management, and how to best support patients with chronic conditions in the African context. Our study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource-constrained setting in Malawi.MethodsThis is primarily a qualitative study, involving patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients (from the third of four-part data collection series), 14 in-depth interviews, and four focus-group discussions with patients (n = 31 respondents). A framework approach was used for qualitative analysis, and descriptive statistical analysis was performed on survey data.ResultsPatients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included: 1) ability to acquire appropriate disease knowledge; 2) poverty level; 3) the presence of support from family caregivers and community-based support initiatives; 4) the nature of one’s social relations; and 5) the ability to deal with stressors and stigma. NCD and HIV comorbid patients were more disadvantaged in their access to care, as they experienced frequent drug stock-outs and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of (multiple) care challenges.ConclusionOur findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. We recommend expanding current peer-patient and support group initiatives to patients with NCDs, and further investments in the decentralisation of integrated health services to primary care level in Malawi.

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Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda

Cited by 38 publications

References 34 publications

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

The changes and the predictors of suicide ideation and suicide attempt among HIV‐positive patients at 6–12 months post diagnosis: A longitudinal study

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi

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