Social Ecological Model Research Articles

Structural barriers and facilitators to accessing HIV services for marginalized working populations: Insights from farm workers in South Africa.

Farm workers are a vulnerable working population that face significant inequalities in accessing health services, including those for HIV prevention, treatment, and care. This descriptive phenomenological study aimed to explore farm workers' experiences when accessing HIV services, and was conducted in Limpopo province, South Africa. Eighteen in-depth interviews (IDIs) were conducted in four health facilities from two districts, and two focus group discussions (FDGs) were conducted in one of the farms within the province. Purposive and systematic random sampling were used to select study participants. A deductive thematic approach was used to analyze data, informed by the social-ecological model of health. The results reveal that farm workers perceive multiple interdependent factors that inhibit or enable their access to HIV healthcare services. Key barriers to HIV healthcare were transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities, and difficult working conditions. Key facilitators to HIV healthcare included the availability of mobile health services, the presence of community health workers, and a supportive work environment. The findings suggest disparities in farm workers' access to HIV services, with work being the main determinant of access. We, therefore, recommend a review of HIV policies and programs for the agricultural sector, and models of HIV healthcare delivery that address the unique needs of farm workers.

Influence of School Feeding Programs on Student Attendance and Academic Performance in Ghana, and Its Potential as a Model for Other West African Nations

Purpose: The aim of the study was to evaluate the influence of school feeding programs on student attendance and academic performance in Ghana, and its potential as a model for other West African nations Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Influence of school feeding programs in Ghana reveals that these initiatives significantly improve student attendance and academic performance, particularly in underserved and rural areas. By providing daily meals, the programs help reduce hunger, improve concentration, and boost overall participation in school activities. Attendance rates have notably increased as families are more motivated to send their children to school, knowing meals are provided. Unique Contribution to Theory, Practice and Policy: Maslow’s hierarchy of needs theory, human capital theory & social ecological model (SEM) may be used to anchor future studies on the influence of school feeding programs on student attendance and academic performance in Ghana, and its potential as a model for other West African nations. To maximize the impact on both attendance and academic performance, programs should focus on improving the nutritional content and consistent delivery of meals. Ghana’s school feeding program should serve as a policy model for other West African nations, but adaptations must be made to fit the specific contexts of each country.

Context-Specific Resilience Through a Cultural Lens: Social-Ecological Factors Among Chinese Families of Children with Neurodevelopmental Disabilities.

With the rise in attention towards Neurodevelopmental Disorders in Hong Kong and worldwide, understanding the role of social ecological resilience in reducing parenting stress and enhancing child outcomes is crucial, particularly within the unique cultural context of Chinese families. This study utilized a social ecological model to examine resilience factors at individual and interpersonal levels among Hong Kong parents of children with Neurodevelopmental Disorders. It also compared the stress and resilience conditions and differential functions of social ecological resilience between parents with and without children diagnosed with Neurodevelopmental Disorders. A sample of 447 parents of children with and without Neurodevelopmental Disorders were assessed by a newly developed Social Ecological Resilience Scale, along with measures of parenting stress and the internalizing and externalizing behaviors of their children. Independent sample t-tests showed that Chinese parents of children with Neurodevelopmental Disorders report significantly higher parenting stress and more internalizing and externalizing difficulties in their children compared to those without Neurodevelopmental Disorders. Multiple linear regression analyses indicated that enhanced social ecological resilience among parents predicted improved parenting stress and better outcomes in children's behaviors. Notably, social ecological resilience factors showed varying effects between parents with and without children diagnosed with Neurodevelopmental Disorders. These findings highlight that both individual and interpersonal resilience factors among parents predicted improved parenting stress and better outcomes in children's behaviors and certain resilience factors may be contextually motivated. Policy makers and practitioners should consider developing context-specific strategies and programmes to help the focal target group.

Sleep inequities in nursing: A descriptive qualitative study on causes of poor sleep among black nurses in the United States

Background: Sleep is critical to general health and occupational safety of workers. Black nurses in the United States report sleeping less than their White counterparts, indicating sleep inequity exists. Understanding what workplace factors contributing to this inequity and suggestions for improvement are vital to protecting nurses.Methods: A descriptive qualitative research design with content analysis was used to examine focus group data from Black nurses working in the United States. Participants were invited to virtual focus groups or interviews to answer questions about their sleep. Questions were guided by the Social Ecological Model for Sleep.Results: Fifteen nurses participated. Four themes emerged: Societal Impact, Workplace, Interpersonal-Cultural Context, and Individual. Twelve sub-themes were identified that described factors that affect all nurses (i.e., night shift, long work hours) versus societal and interpersonal events tied to racism that are most impactful for Black nurses’ sleep. Participants offered six suggestions for changing the healthcare setting to increase a sense of belonging.Conclusions: To improve sleep equity among Black nurses working in healthcare settings, a holistic approach towards worker health and safety may help attenuate individual risks from poor sleep. Systemic organizational efforts to increase belonging among staff could benefit from fostering trusting relationships with Black nurses, as well as increasing the diversity of healthcare leaders and managers.

Social-ecological models with social hierarchy and spatial structure applied to small-scale fisheries

Social-ecological models with social hierarchy and spatial structure applied to small-scale fisheries

Exploring Factors Influencing Cervical Cancer Screening Participation among Singaporean Women: A Social Ecological Approach

Background/Objectives: Cervical cancer screening uptake in Singapore remains suboptimal. This study employed the Social Ecological Model (SEM) to investigate factors influencing cervical cancer screening participation among Singaporean women. Methods: The study included 665 women, aged 25–69 years, who reported awareness of cancer screening and no personal cancer history. Data were collected through a previously described online survey. Hierarchical logistic regression analysis was conducted to identify significant factors influencing screening participation. Results: Only 30% of participants reported cervical cancer screening participation. Women aged 25–29 years (OR = 0.33; 95% CI = 0.12–0.77), Malay women (OR = 0.42; 95% CI = 0.20–0.83), and unmarried women (OR = 0.30; 95% CI = 0.18–0.48) were less likely to be screened. Positive associations with screening participation were observed with good cervical cancer screening knowledge (OR = 2.90; 95% CI = 1.96–4.32), awareness of primary care providers’ role in delivering screening services (OR = 1.94; 95% CI = 1.24–3.10), cancer information seeking behavior (OR = 1.59; 95% CI = 1.07–2.39), and acceptance of self-sampling options (OR = 1.81; 95% CI = 1.22–2.70). Conclusions: Our study highlights the cumulative impact of factors at various SEM levels on screening participation and underscores the necessity for more targeted and multi-pronged strategies to improve cervical cancer screening uptake in Singapore.

The use of respiratory patient reported outcome measures (PROMs) in the management of COPD: Perceptions of Australian osteopaths

BackgroundPatient reported outcome measures (PROMs) are widely used to capture patients' perspectives of their health status and treatment outcomes and to enable practitioners to evaluate the effectiveness of interventions. The aim of this study was to explore Australian osteopaths’ perceptions of the use of respiratory PROMS in the management of chronic lung conditions. MethodsThis study drew on the social ecological model (SEM), which highlights the interdependence of contextual structures and processes. Osteopaths who were initially part of a larger mixed-methods study were invited to participate in semi-structured interviews. Transcripts were thematically analysed using the SEM. ResultsSeven of the original study osteopaths were interviewed. When presented with a patient who had a co-morbid respiratory condition, they focused on the musculoskeletal aspects of that condition (intrapersonal factors). Participants described sporadic use of musculoskeletal and quality of life PROMs in practice, and scarce use of respiratory PROMs (intrapersonal and organizational factors). Participants’ perceptions of their scope of practice strongly influenced their use of respiratory PROMs (environmental factors). ConclusionIntrapersonal and environmental factors were dominant drivers for participants’ scant use of respiratory PROMs. Further education on the scope and contribution of osteopaths to the management of chronic lung conditions and the use of respiratory PROMS is called for to promote multidisciplinary patient care.

Impact of the Quality of Life Supports Model on the inclusion of students with disabilities in higher education: A scoping review

BackgroundThe Quality of Life Supports Model (QOLSM) is a well-suited framework for enhancing the inclusion of students with disabilities in higher education. No research aimed at assessing its impact has been identified. AimsThis review aims to map the scientific literature to assess the current impact of QOLSM on higher education. Methods and proceduresA Scoping Review of educational practices, policies, and cultures aimed at enhancing the quality of life for students with disabilities was conducted. Databases from EBSCOHost, ProQuest, and Scielo were employed to identify studies written in English or Spanish from 1978 to 2023. Four independent reviewers screened results for inclusion. Outcomes and resultsOut of 5361 records, 21 met the inclusion criteria. Students with developmental disabilities are the primary recipients of Quality-of-life support strategies. The reported educational practices were poorly aligned with the disability rights framework, the social-ecological model of disability, and the multidimensional Quality-of-Life construct. Specialized supports and mainstream settings were more common than generic supports and segregated settings. Conclusions and implicationsThis review highlights the currently limited impact of the QOLSM in fostering the inclusion of students with disabilities in higher education. Conducting a systematic review or meta-analysis is not recommended at this stage.

Using the Social-Ecological Model to Assess Vaccine Hesitancy and Refusal in a Highly Religious Lower-Middle-Income Country.

(1) Background: The aim of this study was to understand the factors associated with vaccine hesitancy and refusal in Indonesia using the Social-Ecological Model (SEM). (2) Methods: Data on demographics, religiosity, family dynamics, and perceptions of public health efforts were collected through an online survey and compared to the rates of vaccine hesitancy and refusal. (3) Results: Income and sex were significantly associated with vaccine hesitancy. Based on a vaccine passport policy to enter public spaces, people who felt inhibited to enter public spaces or perceived privacy threats were twice as likely to exhibit vaccine hesitancy. Participants who believed that religious groups had a difficult time getting vaccinated were nearly twice as likely to exhibit vaccine hesitancy and three times more likely to exhibit vaccine refusal. However, participants who believed in a higher religious power were 58% less likely to exhibit vaccine hesitancy. Religious leaders significantly influenced participants to make the decision regarding vaccination. Individuals with vaccine refusal were more than twice as likely to share information with others without fact-checking. Notably, structural barriers such as distance and transportation were most strongly associated with vaccine hesitancy and refusal. (4) Conclusion: Cultural factors play a significant role in vaccine hesitancy and refusal. The SEM can be used to propose multi-level interventions with collaboration and communication among stakeholders to improve community health.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment

BackgroundA minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment.MethodsPWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels.ResultsA quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care.ConclusionsPWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

Emerging Adults’ Experiences of Dating Violence: A Qualitative Exploration

ABSTRACT Dating violence is a significant issue among emerging adults. Using Bronfenbrenner’s ecological model, this study investigates its precursors through interviews with 21 individuals aged 18–25 who experienced dating abuse. By applying the social-ecological model, this study underscores the complexity of dating violence, highlighting the necessity of addressing it through a multifaceted approach. Four main themes emerged: personal experiences of dating violence, precursors to violence, technology’s impact, and coping strategies. Psychological violence, particularly controlling behavior, being most common. Findings highlight the importance of individual and relational factors, social networks, and media influence. Overall, a comprehensive approach integrating social support, professional intervention, and societal changes seem to be essential.

Spinoza, Liberation From Causation, and Community Health Promotion.

What sense does it make to say that a new program implemented in a community with roots as old as evolution caused an observed health benefit? Evaluation of community approaches has often sought to isolate the causal roles of interventions. Central to this is the assumption that there are causes to be proven and isolated. Benedict Spinoza (1632-1677) dismissed the concept of cause, arguing that all things, "substances," are not caused but simply are. Actions of things in nature can influence each other, e.g., erosion of a mountain, but their substance, the mountains simply are. For Spinoza, satisfaction in life comes from realizing and acting in accord with our substance, but this requires communities that support such realization and action. Thus, communities and the vast influences they contain are central to human welfare. Interventions within them do not cause benefits but join with the history, culture, and numerous other features of the community in becoming part of how the community influences its members. Implications include a) expanding the social ecological model fully to embrace multiple influences - including innovative programs - and interactions among them, and c) varied research methods to identify practical lessons about how communities may adopt and incorporate innovations to engender change, rather than a catalogue of interventions that are supposed to change them.

Exploring the socio-political construction of mental health issues of the Tibetan diaspora in India: coping strategies and implications for care

IntroductionLike many diasporas, the Tibetan diaspora has also had cataclysmic events and migratory movements and wish to return to their exiled homeland one day. In their countries of settlement, they face various challenges as they try to cope with their loss and adapt to a new environment.PurposeThis study aims to attempt to explore the socio-political construction of the mental health issues and coping strategies of the members from different generations of the Tibetan diaspora in India using the social ecological model as the theoretical framework. This study further aimed to provide suggestions based on findings to inform culturally sensitive care.Design/methodology/approachUsing the snowball sampling method, 20 Tibetans residing in North India were interviewed about their socio-political experiences. The obtained narratives were analyzed using thematic content analysis framework by Braun and Clarke (2006).FindingsFindings suggest that several socio-political conditions shape the mental health issues of the Tibetans that are inclusive of the acculturative stress, distress, intergenerational trauma and negative affectivity. A range of coping strategies, including spiritual-religious coping, collective coping and nostalgic coping emerged from the analysis.Research limitations/implicationsThis study has few limitations that must be considered to accurately interpret the findings. First, the sample size is small and hence may not be an accurate representation of the entire Tibetan diaspora. Second, the study uses self-reported data that may be subject to personal biases. Third, having been conducted in a specific socio-political context, the findings of this study may not be generalizable to other settings or to the members of the Tibetan diaspora elsewhere.Practical implicationsThe findings of the study will help spread awareness about mental health issues within the Tibetan diasporic community. The study will also help the mental health professionals to recognize the need for culturally responsive approaches to care. It also highlights the need to use the benefits of traditional healing practices, spirituality and cultural identity. The findings also will be relevant to developing interventions that are effective at individual, interpersonal, community and societal levels. The tailored interventions should address political issues surrounding the Tibetans, emphasize on their education and support cultural activities that can be essential for identity affirmation of these individuals.Originality/valueShifting focus: Instead of viewing mental health solely through a psychological lens, it recognizes the powerful influence of political and social forces on their well-being. Generational lens: It explores how different generations within the diaspora grapple with the complexities of exile and its impact on their mental health. Unveiling coping strategies: It goes beyond the diagnosis, showcasing the diverse coping mechanisms used by Tibetans, including spiritual practices, collective support and even nostalgia.

A quarantine paradox: understanding Gender-Based Violence (GBV) in post-COVID-19 era: insights from Golden Valley mining community, Zimbabwe

The COVID-19 pandemic has brought unprecedented challenges globally, with a notable surge in gender-based violence (GBV) incidents. This descriptive, exploratory study conducted in the Golden Valley mining community in Kadoma, Mashonaland West Province, Zimbabwe, delves into the challenges faced by GBV survivors during and after the pandemic, alongside community perceptions of GBV in the post-COVID-19 era. Guided by Bronfenbrenner's Social-Ecological Model which offers insights into the various levels of influence on GBV behavior and experiences,aiding in the development of contextually relevant prevention strategies. The study used qualitative methods such as interviews and focus group discussions, there were 24 study participant classified by random and convenient sampling techniques including traditional and community leaders, gbv surviours medical personnel and male and female, community members. The research followed the COREQ guidelines to transparently document the research process and findings. The research sheds light on the multifaceted nature of GBV exacerbated by societal norms and economic instability in a low-income, masculine-dominated work culture experience in the COVID-19 period. Findings underscore the urgent need for comprehensive prevention programs, effective legislation, and community engagement to address GBV in post-pandemic communities. The research provides valuable lessons for enhancing GBV prevention efforts globally, emphasizing the significance of survivor voices and addressing root causes of GBV.

Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri's Young Mentor Mother Program.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

Barriers to physical activity in the Iranian population: findings from the STEPwise surveillance 2021

BackgroundPhysical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies.MethodsThis cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed.ResultsLack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value < 0.001, OR: 0.76, P value < 0.001).ConclusionIntra- and inter-personal domain barriers might reduce the odds of being active. Developing action plans addressing these factors is suggested to increase physical activity levels.

Empowering Healthcare Professionals: Exploring Experiences Leading a Violence Prevention Course for Adults With Intellectual Disability.

Violence prevention approaches using social-ecological models inform interventions for people with intellectual disability, who often face barriers to accessing generalist courses. This study explores the experiences of healthcare professionals leading a prevention course specifically designed for adults with intellectual disability. Through semistructured interviews, 12 Norwegian course leaders highlighted the importance of raising awareness and comprehension about rights, and the social and individual factors influencing experiences of violence and its prevention. Challenges were encountered in tailoring the course to the diverse lived experiences of participants with disabilities and addressing ongoing support needs for their safety. The study suggests that adopting a pedagogical or didactic model could serve as a foundation to enhance the planning and delivery of the course.

Older Adult Family Homicide in Victoria, Australia 2001–2015: A Description of Family and Family Violence Homicide Victimisation

Abstract Purpose This study examined factors present among older adult family homicide victims and their offenders compared to younger adult family homicide using the social-ecological model. Method The study used a population-based single-jurisdiction cross-sectional design of consecutive homicide cases of adults (aged 18 years and older) reported to the coroner in Victoria, Australia for the period 2001–2015. Included were homicides involving an intimate or familial relationship. The data source was the Victorian Homicide Register, maintained by the Coroners Court of Victoria. Descriptive and multivariate analysis was performed to compare the presence of factors between younger and older adult family homicides. Results During the study period 37/283 (13.1%) family homicides occurred among older adult victims (aged 65 years and older) and 246/283 (86.9%) occurred among younger adults (aged 18–64 years). The deceased older adult was often male (57%), with a documented physical illness (54%). Offenders against the older adult were frequently male (68%), non-intimately related (73%), with diagnosed mental illness, a history of substance use and/or historical exposure to violence (all 57%). There were 15 older adult family violence (FV) homicide victims, eight that were previously victims of the homicide offender, primarily enduring emotional, physical and psychological violence as well as the perpetrator assaulting another family member. Seven older adults had perpetrated FV against their offender. Conclusions The history of violence perpetration in the deceased and mental health factors in their offender, as well as the greater proportion of parent-child and other familial relationships offer interesting focal points for future prevention research.

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students

BackgroundAustralia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia.MethodsSemi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels.ResultsChinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information.ConclusionsOur study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Multilevel factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China: a social-ecological model-informed study

BackgroundHIV-related stigma continues to hinder optimal HIV care, and its determinants should be understood at multiple levels. Based on the social-ecological model, this study aimed to explore factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China.MethodsA cross-sectional study was conducted from July to August 2022 to recruit newly reported women living with HIV with a history of pregnancy or current pregnancy in 2021 in 21 cities in Guangdong Province. HIV-related stigma was assessed using an abbreviated Chinese version of Berger's HIV Stigma Scale. Univariate and multivariable hierarchical regression analyses based on the social-ecological model were conducted to explore factors associated with HIV-related stigma and its four dimensions (personalized stigma, disclosure concerns, negative self-image and concerns about public attitudes) at the community/hospital, interpersonal, and individual levels.ResultsA moderate level of HIV-related stigma was found among the 360 participants included, with a mean score of 45.26. Multivariable hierarchical regression analysis showed that at the community/hospital-level, individuals were more likely to experience high levels of HIV-related stigma if they had experienced the discriminatory behaviors from health care workers (aOR = 2.34, 95%CI: 1.48–3.70) and if they rated serostatus disclosure services as less helpful (aOR = 0.69, 95%CI: 0.48–0.98). At the interpersonal-level, individuals with an HIV-positive partner (aOR = 1.71, 95%CI: 1.01–2.90) were more likely to experience high levels of HIV-related stigma than those with an HIV-negative or unknown partner. Individuals with high resilience (aOR = 0.22, 95%CI: 0.13–0.35) had lower levels of HIV-related stigma at the individual-level. In addition, ever experiencing discriminatory behaviors from health care workers, thinking serostatus disclosure services helpful, having ever seen publicity about personal interest protection services and complaint channels for people living with HIV(PLHIV), knowing about care and support services for PLHIV from social organizations at the community/hospital-level, partner notification and support at the interpersonal-level, and violations of personal interests, resilience at the individual-level were also associated with different dimensions of HIV-related stigma.ConclusionsHIV-related stigma was moderate among women living with HIV. The social-ecological model can facilitate a better understanding of factors associated with HIV-related stigma. Multilevel intervention strategies need to be tailored to reduce HIV-related stigma.