Adaptation of a social vulnerability index for measuring social frailty among East African women

Sandeep Prabhu,Melissa K Andrew,Jane M Simoni,Walter Jaoko,Brenda Oyaro,Francis Otieno,Kishor Mandaliya,Wayne Mccormick,Susan M Graham,George Wanje,R Scott Mcclelland,Frances M Aunon

doi:10.1186/s12889-022-12597-z

Abstract

BackgroundThe number of older women living with HIV in Africa is growing, and their health outcomes may be adversely impacted by social frailty, which reflects deficits in social resources that accumulate over the lifespan. Our objective was to adapt a Social Vulnerability Index (SVI) originally developed in Canada for use in a study of older women living with or without HIV infection in Mombasa, Kenya.MethodsWe adapted the SVI using a five-step process: formative qualitative work, translation into Kiswahili, a Delphi procedure, exploration of potential SVI items in qualitative work, and a rating and ranking exercise. Four focus group discussions (FGD) were conducted (three with women living with HIV and one with HIV-negative women), and two expert panels were constituted for this process.ResultsThemes that emerged in the qualitative work were physical impairment with aging, decreased family support, a turn to religion and social groups, lack of a financial safety net, mixed support from healthcare providers, and stigma as an added burden for women living with HIV. Based on the formative FGD, the expert panel expanded the original 19-item SVI to include 34 items. The exploratory FGD and rating and ranking exercise led to a final 16-item Kenyan version of the SVI (SVI-Kenya) with six domains: physical safety, support from family, group participation, instrumental support, emotional support, and financial security.ConclusionsThe SVI-Kenya is a holistic index to measure social frailty among older women in Kenya, incorporating questions in multiple domains. Further research is needed to validate this adapted instrument.

Highlights

In sub-Saharan Africa, approximately 1 in 8 persons living with HIV infection (PLWH), including 1 in 10 adults receiving antiretroviral therapy (ART), are aged 50 or older [1, 2]
While studies have shown that older African women report more chronic health conditions and have higher physical frailty rates than men, less is known about the health of older women living with HIV relative to their peers without HIV [4, 5]
In preparation for a study of social frailty among HIVpositive and HIV-negative women aged 40 and older living in Mombasa, Kenya, we aimed to investigate the relevance of the Social Vulnerability Index (SVI) items in this context and identify any new items women and their providers would consider more relevant

Summary

Introduction

In sub-Saharan Africa, approximately 1 in 8 persons living with HIV infection (PLWH), including 1 in 10 adults receiving antiretroviral therapy (ART), are aged 50 or older [1, 2]. In Kenya, a country where over a third of the population still lives in poverty, HIV care is free but care for other medical conditions is harder to access; families and other social contacts are critical sources of support for women’s overall health and psychosocial needs [6,7,8,9]. In this respect, social frailty, defined as “continuum of being at risk for losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span,” may be an important concept in these settings [10]. Our objective was to adapt a Social Vulnerability Index (SVI) originally developed in Canada for use in a study of older women living with or without HIV infection in Mombasa, Kenya

Objectives

Methods

Results

Conclusion