Unmet core needs for self-determination in HIV-infected women of color in medical care

Abstract

The levels of satisfaction of the core self-determination needs (relatedness, autonomy, competence) among HIV-infected women of color as well as the association between need fulfillment and patient characteristics were examined. Having less than a high school education was associated with lowest need satisfaction: autonomy (β= −1.90; 95%CI= −3.20, −0.60), relatedness (β= −2.70; 95%CI= −4.30, −1.10), and competency (β= −2.50; 95%CI= −3.60, −1.30). Each additional point increase in affective symptoms of depression was associated with decrements in need satisfaction (−0.61 autonomy, −0.68 relatedness, −0.59 competency). Relatedness satisfaction was lower with higher responses on all three measures of violence (psychological abuse: β= −0.13, 95%CI= −0.19 to −0.07; adult traumatic experiences: β= −0.24, 95%CI= −0.35 to −0.13; childhood traumatic experiences: β= −0.24, 95%CI= −0.40 to −0.08). Interventions that address core self-determination needs, and the characteristics that influence them, may enhance the motivation for self-care of HIV-infected women.

“Like I Have No Choice”: A Qualitative Exploration of HIV Diagnosis and Medical Care Experiences While Incarcerated and Their Effects

“…Consistent with other studies, 33,44-48 we found that many participants experienced HIV diagnosis as a traumatic stressor and reacted to their HIV diagnosis with difficulties cognitively processing any HIV education provided while incarcerated, 45 as well as with denial 32 and numbing responses such as problematic substance use. 44,46 Receiving an HIV diagnosis can be traumatic and overwhelming in the best of circumstances but incarceration likely worsens this experience due to social isolation, 48 amplified HIV-stigma, 49 loss of autonomy, 50 and substandard medical care. 22 Based on these findings, clinicians who treat PLWH of color who have received an HIV diagnosis while incarcerated should be aware of and have an understanding that an HIV diagnosis can be traumatizing, particularly under the unique circumstances of being diagnosed with HIV while incarcerated.…”

Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

“…However, factors such as the convenience and privacy of home-based testing and sexual partners' encouragement and support also played an important role in motivating some men to test. Following engagement with EPIC-HIV1, most men in our sample were able to initiate a new behaviour, such as HIV testing, to achieve positive health outcomes (Quinlivan et al, 2017;. This suggests that offering EPIC-HIV1 with other interventions such as HIV self-testing, and support partner-initiated testing, has the potential to encourage men to exercise their autonomy to test.…”

“…EPIC-HIV messaging is rooted in self-determination theory (SDT) to increase men's intrinsic motivation to test (EPIC-HIV1) for HIV. SDT is a behavioural change theory that relies on individual psychological needs for autonomy, competence and relatedness to be internally motivated to adopt a new behaviour (Deci & Flaste, 1995;Quinlivan et al, 2017). Autonomy entails people's ability to make individual decisions associated with their identity, beliefs and values, while competence requires an individual to be able to act Johnson, 2007;Johnston & Finney, 2010;Quinlivan et al, 2013).…”

“…Autonomy entails people's ability to make individual decisions associated with their identity, beliefs and values, while competence requires an individual to be able to act Johnson, 2007;Johnston & Finney, 2010;Quinlivan et al, 2013). Relatedness reflects individuals feelings of connectedness and being cared for (Quinlivan et al, 2017;. The SDT components combined support for a target population to become intrinsically motivated to adopt new behaviours.…”

“…The SDT components combined support for a target population to become intrinsically motivated to adopt new behaviours. Studies that adopted SDT in developing behavioural change interventions have shown effect across a variety of behaviours such as diabetes, smoking cessation, ART adherence, and hepatitis C treatment (Houston et al, 2012;Igreja et al, 2000;Morse et al, 2012;Quinlivan et al, 2017;Toth et al, 2013;Williams et al, 2011). There is, however, limited literature on the use of SDT to promote positive health behaviours in the HIV care continuum.…”