Facilitators and barriers to providing HIV psychosocial support services for adolescents living with or affected by HIV: a qualitative study in Iran

This study applies an ecodevelopmental stress process model to consider the extent to which social support buffers mothers from experiencing depressive symptoms and parenting stress among a community sample of 81 Mexican American mothers of toddlers. Specifically, we examine how mother-reported perceived global and parenting-specific social support interact with economic strain and child negative affectivity in the prediction of maternal depressive symptoms and parenting stress. We also examine the extent to which both forms of social support interact with mothers’ familism support beliefs. Findings indicate that parenting-specific social support interrupts the positive associations between economic strain and negative child affect and maternal depressive symptoms, above and beyond the influence of global social support. Moreover, the combination of high familism beliefs and global social support reduces risks for maternal depressive symptoms.

Motivating Community Health Workers (CHWs)-many of whom are volunteers-is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs' motivations, including how motivation intersects with women's livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs' motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.

Resilience is known to affect the degree to which individuals adapt to the impact of stroke and its sequelae. However, few studies have examined resilience and related factors among stroke patients in Taiwan. To explore resilience and related factors among stroke patients in the recovery stage. A cross-sectional and correlational study design was adopted. Convenience sampling was employed to recruit participants from the rehabilitation inpatient wards of a regional teaching hospital in northern Taiwan. A structured questionnaire, including the social support scale and the Chinese version of the resilience scale, was used for data collection. Data were analyzed using descriptive and inferential statistics and stepwise regression analysis. A total of 128 stroke recovery in-patients who averaged 57.2 ± 11.6 years of age and were predominantly male were recruited. The results of this study showed that the global resilience of participants was moderate and that a significantly positive correlation existed between global social support and resilience. Age, marital status, and global tangible social support accounted for 25.0% of the total variation in resilience. Age, marital status and global tangible social support were identified as the crucial predictive factors of resilience in stroke patients. The results support the recommendation that healthcare providers should acquire advanced knowledge and skills through in-service education, proactive caring, and encouraging patients to learn self-care in order to enhance rehabilitation motivation and confidence levels and subsequently promote disease recovery and the ability to adapt to life through cross-disciplinary medical team cooperation and supportive relationships.

Family engagement in interdisciplinary rounds is a patient- and family-centered approach to critical care that allows family members to be present and participate in information sharing and clinical decision-making with the health care team. However, this approach has not been adopted as standard practice in adult critical care units. Thus, family engagement in care for critically ill patients remains an inconsistent practice. Moreover, it remains an underresearched family-centered care intervention. Research is needed to understand health care professionals' perspectives on feasible ways of integrating family inclusion and engagement into clinical practice flow to potentially shape the future of family engagement in care for critically ill patients. This qualitative exploratory research study aimed to (1) explore and understand the registered nurses' and physicians' perspectives on current practices and feasible approaches to family inclusion and engagement during patient- and family-centered interdisciplinary rounds and (2) identify the facilitators and barriers to implementing this vital practice. A qualitative exploratory research study was conducted to inform the main study, a randomized controlled trial that tested the impact of the Nurse-TECH-Family program during patient- and family-centered interdisciplinary rounds in the intensive care unit. For this focus group study, 7 health care providers working in an adult critical care unit were recruited via email, referrals, and personal contact. The focus group included 4 registered nurses and 3 physicians working in the intensive care unit. It was conducted using structured questions via videoconferencing. The discussions were recorded and transcribed verbatim. A rigorous data analysis method was conducted using Braun and Clarke's constructionist and contextualist approach for thematic analysis. Two essential themes that reflected health care providers' perspectives on current critical care practice and feasible ways of integrating family inclusion and engagement into clinical practice were illuminated. The first theme conveys that rounds are "information-giving" that addresses family members' questions, transparency, shared decision-making, and less uncertainty among family members. The second theme denotes that rounds are a "safe space" for caring and compassion, which helps build trust. The health care providers also identified that the barriers to family engagement in patient- and family-centered interdisciplinary rounds include diverse perceptions and practices of family inclusion and engagement during rounds, difficulty establishing logistics in integrating family engagement in interdisciplinary rounds to clinical practice, and anxiety related to disclosure of information and uncertainty about family response. The identified facilitators are clear, consistent, realistic, and feasible interdisciplinary rounds logistics and information. This qualitative exploratory research study provided a deeper understanding of the registered nurses' and physicians' perspectives on current practices and feasible ways regarding family engagement during patient- and family-centered interdisciplinary and identified barriers to and facilitators for implementing this vital practice. The study's findings informed the researchers in the sampling, design, and plan for the intervention and setting for the randomized controlled trial. The findings can pave the way for a more focused, multifaceted approach and interventions to address family inclusion and engagement during interdisciplinary rounds in the critical care unit. This offers hope for improved patient outcomes and family experiences.

vii Chapter 1 – Introduction 1 Chapter 2 Literature Review 7 Chapter 3 – Method 57 Chapter 4 – Results 82 Chapter 5 – Discussion 119 References 133 Appendices A. Consent Form 151 B. Attendance and Toxicology Reporting Form 154 C. Social Support Questionnaire 156 D. Important People and Activities Instrument 159 E. Unsupportive Social Interactions Inventory 162 F. Cognitive appraisal questionnaire 165 G. Center for Epidemiologic Studies Depression Scale 167 H. Situational Confidence Questionnaire 169 I. Demographic questionnaire 172 v LIST OF TABLES Page Table 1 Categorical Demographic Characteristics of Participants 59 Table 2 Quantitative Demographic Characteristics of Participants 64 Table 3 Participants’ Reported History of Substance Abuse Treatment 69 Table 4 Comparison Between Fulton County Sample Sub-groupings on Categorical Demographic Variables 83 Table 5 Comparisons Between Fulton County Sub-groupings on Continuous Demographic Variables 89 Table 6 Comparison Between Richmond and Fulton County Groups on Categorical Demographic Variables 92 Table 7 Comparison Between Richmond and Fulton County Groups on Continuous Demographic Variables 97 Table 8 Internal Consistency Estimates for Dependent and Independent Variables ...100 Table 9 Means, Standard Deviations and Ranges of the Dependent and Independent Variables 102 Table 10 Selected Item Means from the Unsupportive Social Interactions Inventory 104 Table 11 Correlations Among the Measured Variables 107 Table 12 Statistical Tests of the Association Between Outcome Variables and Potential Co-variates 111 Table 13 Hierarchical Regression Equations for the Prediction of Self-Efficacy of Recovery, Depression, Treatment Attendance, and Abstinence from Stress of Recovery, Positive Social Support, and Unsupportive Social Interactions ..113 Table 14 Hierarchical Regression Equations for the Prediction of Self-Efficacy of Recovery and Depression Stress of Recovery and Unsupportive Social Interactions 117 vi LIST OF FIGURES Page Figure 1 Conceptual Model 54 Figure 2 Participants’ Substance(s) of Choice 66 Figure 3 Participants’ Acknowledgement of Substances Tried 67 vii ABSTRACT RECOVERY FROM SUBSTANCE ABUSE: THE ROLE OF UNSUPPORTIVE SOCIAL INTERATIONS By Michelle M. Schmitt, M.A., M.S. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2003 Major Director: Kathleen M. Ingram, Ph.D., Assistant Professor, Department of Psychology It has been estimated that over 20 million individuals struggle with substance abuse and/or dependence each year. Theories of addiction and recovery have long incorporated the notion of social support and helping relationships to facilitate adjustment. However, the literature investigating the role of social support is fraught with contradictions. In addition, in substance abusing populations, researchers have just begun to investigate social support as having negative, as well as positive implications. Historically with these populations, interpersonal conflict and loss of relationships were investigated as negative life events, rather than types of unsupportive social interactions. This study was designed to explore how positive and negative social relationships are associated with adjustment among individuals struggling with addiction. Ninety-seven individuals, who were currently participants in two Drug Court programs, completed measures of global positive social support (the 6-item Social viii Support Questionnaire), recovery-specific positive social support (Important People & Activities Instrument, brief version), recovery-specific unsupportive social interactions (Unsupportive Social Interactions Inventory), recovery-specific cognitive threat appraisals, and well-being (Situational Confidence Questionnaire and Center for Epidemiologic Studies Depression Scale). Information regarding treatment attendance and positive urine toxicology reports was gleaned from treatment records. Results suggested that global positive social support accounted for the greatest proportion of variance in the well-being outcomes of self-efficacy for recovery and depression. Global positive social support eclipsed the role of recovery-specific unsupportive social interactions in relation to well-being. However, recovery-specific unsupportive social interactions were found pertinent to this population. None of the survey variables were significantly related to treatment attendance, and only self-efficacy for recovery was related to continued drug use (urine toxicology screenings). Implications for future research and interventions to enhance the well-being of individuals in recovery are discussed.

ObjectivesMen who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women’s perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan.DesignA qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan.MethodsParticipants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis.ResultsThree themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant’s recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one’s sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients’ integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding.ConclusionsThe findings from this study can help public health policy and researchers to understand this minority’s perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.

Background: The concept ‘street children’ and/or ‘street kid’ encompasses any child or adolescent under the age of eighteen who works and/or lives in the street alone or with his or her family or asylum seekers who are technically homeless and without support. This study aimed to assess the association of knowledge and family support with premarital sex among street children in Medan, North Sumatera. Subjects and Method: This was a cross-sectional study conducted at KKSP Foundation in Medan, North Sumatera. A sample of street children was selected for this study by purposive sampling. The dependent variable was premarital sex. The independent variables were knowledge and family support. The data were collected by questionnaire and analyzed by a multiple logistic regression. Results: Poor knowledge (OR= 2.34; p=0.019) and weak family support (OR= 3.10; p= 0.003) were associated with an increased risk of premarital sex. Conclusion: Poor knowledge and weak family support are associated with an increased risk of premarital sex among street children. Keywords: knowledge, family support, premarital sex, street children

Background : According to WHO and Global Youth Tobacco Survey, Indonesia is the third largest country with current smokers in the world, including young smokers. It is widely known that smoking is hazardous to health and detrimental to economy. Surakarta is one of the major cities in Central Java where the prevalence of current smokers has been increasing among adolescents. This study aimed to determine the effect of personal factors, family support, pocket money, and peer group, on smoking behavior in adolescents in Surakarta, Central Java. Subje cts and Method : This was an analytic observational study using cross-sectional design. This study was carried out in 5 sub-districts in Surakarta, Central java, from February to March 2017. A sample of 50 adolescent smokers and 150 adolescent non-smokers was selected for this study by fixed disease sam­pling. The dependent variable was current smoking status. The independent variables were cigarette availability, peer-group, family support, pocket money, cigarette advertisement, attitude toward smoking, subjective norm, perceived preventive behavioral control, and intention. The data were collected by a set of questionnaire. The data were analyzed by path analysis. Results : Smoking behavior was affected by strong intention (b= 3.7; 95% CI=2.5 to 4.9; p<0.001), and weak perceived behavioral control (b=3.1; 95% CI= 1.7 to 4.5; p<0.001). Intention to smoke was affected by weak perceived preventive behavioral control (b= 2.1; 95% CI= 1.1 to 3.2; p<0.001), weak preventive subjective norm (b= 1.8; 95% CI= 0.7 to 2.9; p= 0.001), negative attitude (b= 1.9; 95% CI= 0.8 to 2.9; p<0.001), and exposure to cigarette advertisement (b= 1.6; 95% CI= 0.5 to 2.6; p= 0.004). Weak perceived preventive behavioral control was affected by pocket money ≥ Rp 10.000 (b= 1.3; 95% CI= 0.5 to 2.0; p= 0.001). Weak preventive subjective norm was affected by weak family support (b= 2.1; 95% CI= 1.3 to 2.8; p<0.001) and smoker peer-group (b= 1.4; 95% CI= 0.6 to 2.1; p<0.001). Cigarette advertisement was affected by cigarette availability (b= 0.7; 95% CI= 0.1 to 1.3; p= 0.028). Conclusion : Smoking behavior was directly affected by strong intention and weak perceived behavioral control. Smoking behavior was indirectly affected by weak preventive subjective norm, negative attitude, exposure to cigarette advertisement, pocket money ≥ Rp.10.000, weak family support, smoker peer-group, and cigarette availability. Keyword : path analysis, smoking behavior, intention, adolescents. Correspondence: Ardiansyah Pandayu. Master Program in Public Health, Sebelas Maret University, Surakarta. Email: ardiansyahpandayu07@gmail.com. Mobile: +6287864018631. Journal of Health Promotion and Behavior (2017), 2 (2): 98-111 https://doi.org/10.26911/thejhpb.2017.02.02.01

Background: Tuberculosis (TB) remains a major public health problem in developing countries. This study aimed to examine the association between family support and the risk of lung TB in Subulussalam, Aceh. Subjects and Method: This was a cross sectional study conducted at Pus¬kes-mas (Community Health Center) Penanggalan in Subulussalam, Aceh. A sample of 30 patients was selected for this study. The dependent variable was lung TB. The independent variables were family support, sex, and knowledge. Data on tuberculosis diagnosis status was obtained from the medical record. The other data we¬re collected by questionnaire. The data were analyzed by a multiple logistic regression. Results: The risk of lung TB was positively associated with weak family support (OR= 4.28; 95% CI= 2.15 to 6.60; p= 0.027), after adjusting for the effects of sex and knowledge. Conclusion: The risk of lung TB is positively associated with weak family sup-port after adjusting for the effects of sex and knowledge. Keywords: lung tuberculosis, family support, sex, knowledge.

Introduction: The present study aimed at presenting and testing a model to describe the adaptation phenomenon among the patients engaged with type 2 diabetes (T2D). Methods: This is a correlational research design wherein a total of 350 individuals referring to four special medical centers for diabetes at Tehran (Iran). The research instruments included the Jackson’s five-factor questionnaire, demographic and social support subscales of diabetes care profile, cognitive appraisal of diabetes scale, problem areas in diabetes survey, Billings and Moos coping strategies scale, appraisal of adaptation to diabetes scale, and HbA1C level. Results: The outputs of the tests on the final model of the research showed that the behavior activating system, fight, flight and freeze system, global social support, and “Get” social support impose significant effects on the cognitive appraisal. Moreover, the “Get-Want” & Global Social support, Fight, Flight & freeze System and the cognitive appraisal affected the adaptive tasks significantly. The Fight, Flight & freeze System and the adaptive tasks imposed significant effects on the problem-focused emotional-physical coping. The Problem focused socio-cognitive coping and the emotional-physical coping affected the initial adaptation significantly. Behavior inhibition system, all the three components of social support, and Problem focused Socio-cognitive coping imposed significant effects on the secondary adaptation. And finally, Global social support and initial adaptation affected the HbA1C significantly. In addition, a number of intermediate effects were verified. Conclusion: Upon accessing the model of adaptation to disease for a particular individual, one can access his/her adaptation profile and evaluate the strengths and weaknesses of his/her adaptation structure and formulate the required interventions accordingly. Declaration of Interest: None

Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

Resulting from prolonged obstructed labour, iatrogenic and traumatic aetiologies, female genital fistula in low-resource settings causes a significant physical and psychosocial burden. Social support is an important mechanism to build resilience to health challenges. This study aimed to understand the role of emotional, informational and tangible social support for Ugandan women affected by fistula. Thirty-three participants who had had fistula surgery 6–24 months prior to the study were recruited from Mulago Hospital in Kampala, Uganda. Data from in-depth interviews (n = 16) and 4 focus group discussions were analysed thematically using a social support framework. Various individuals were key providers of social support across the different domains. They included family, friends, community organisations, and other women affected by fistula. Social support was critical in helping women cope with fistula, access fistula care, and post-repair recovery. Women relied heavily on tangible and emotional support to meet their physical and psychological needs. Support-enhancing interventions for women and their families, particularly those offering emotional and tangible support, may be a promising strategy for improving the experiences and quality of life of women affected by fistula.

ABSTRACTSocial capital is a crucial factor for expatriates to employ as they cope with the demands of an international assignment. This longitudinal study used a mixed method approach to examine the social support benefits of expatriate contact with a local host. Western expatriates in the Netherlands were randomly divided into two groups: an experimental group (n = 33), that had contact with a Dutch host during 9 months, and a control group (n = 32) with no host. Qualitative methods such as interviews and diaries were included to shed light on the various types of social support that occurred. Results show that local hosts offered all four types of social support: social companionship, informational support, emotional support, and instrumental support. Furthermore, expatriates with a host increased their social capital; they received significantly more social support from host nationals than did those without a host. This study shows that HRD professionals may develop the social capital of expatriates by bringing them into contact with a local host, which can produce more social support from host nationals. Increased social capital may lead to a higher performance at both the individual and organisational levels.

Adherence in antiretroviral therapy: a review of qualitative studies

Socioeconomic status (SES) and family relationships are critical social determinants of health disparities. The mechanisms underlying their interactions remain insufficiently understood in Asian cultures with prevalent intergenerational cohabitation. This study investigates the independent and combined effects of SES and family relationships on all-cause mortality in China. A baseline survey was conducted in 2010 involving 9280 adult permanent residents from 12 counties (districts) in Guizhou Province, using stratified cluster random sampling. Two follow-ups (2016-2020, 2023) were conducted. SES was assessed using a composite score comprising household income, education, and occupation, while family relationships were classified as either "good" or "mediocre." The Cox proportional hazards model was employed to evaluate the independent and combined effects of SES and family relationships on all-cause mortality. Among 5949 participants were included, and the cumulative mortality rate was 6.4% over a median follow-up of 12years. With a decrease in mortality risk as SES increased (P < 0.001). Compared with SES ≤ 6, mortality risk with SES scores of 7, 8, and ≥ 9 decreased by 36.9% (HR = 0.631, 95% CI = 0.473-0.842), 36.6% (HR = 0.644, 95% CI = 0.469-0.886), and 73% (HR = 0.270, 95% CI = 0.183-0.397), respectively. The independent effect of family relationship on the risk of death was not statistically significant (HR = 0.847, 95% CI = 0.0.670- 1.070). The joint analysis showed the compensatory effect was significant when SES exceeded a threshold (SES ≥ 9), alleviating the mortality risk associated with family relationships (HR = 0.2197, 95% CI = 0.073-0.652). Findings demonstrate SES independently reduces mortality in Chinese populations, while the effect of family relationships is modulated by cultural background. The resource substitution hypothesis is valid at specific SES thresholds. Intervention efforts should prioritize the vulnerable group characterized by "low SES and weak family support".