Doctoral Degrees (Nursing and Midwifery)

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Browsing Doctoral Degrees (Nursing and Midwifery) by Subject "HIV infections -- Treatment"

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    The development of an instrument to measure adolescent HIV self-management in the context of the Western Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2018-03) Crowley, Talitha; Skinner, Donald; Van der Merwe, Anita S.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY: Introduction and rationale: South Africa is home to 20% of the global human immunodeficiency virus (HIV)-infected adolescent population of 1.8 million. The clinical HIV management of adolescents may be challenging and are compounded by the physical and psychological changes that occur during adolescence. With the advent of antiretroviral treatment access, HIV is managed as a chronic disease and elements such as self-management become an important component of care. Research to date has not focused on adolescent HIV self-management or the measurement thereof. Aim: To develop an instrument to measure adolescent HIV self-management in the context of the Western Cape, South Africa. Methods: A mixed-method explorative sequential design was used. The study setting included selected healthcare facilities in the Cape Metropole of the Western Cape. Adolescents aged 13 to 18 who attended HIV services, their caregivers and healthcare workers/academics experienced in adolescent HIV care and research, were the target population groups. Individual interviews were conducted with six adolescents, six caregivers and six healthcare workers, followed by five focus groups with adolescents. Interpretive phenomenology was used to situate the experiences of participants in their social and cultural context. In the second study phase, items were inductively developed based on the participants’ experiences, the theoretical framework for the study and literature. Thirdly, adolescents and caregivers in focus groups had an opportunity to evaluate whether the developed items resonated with their experiences using cognitive questioning. Following this, a group of experts evaluated the content validity and clarity of each item thereby reducing the initial 65 items to 44 highly relevant items. Participants were purposefully selected for the more qualitative components. Finally, in the fourth phase of the study, in order to establish validity and reliability, a cross-sectional design was used and the self-administered questionnaire was completed by 385 adolescents who were sampled serially from 11 healthcare facilities in the Cape Metropole. Findings: Five components of adolescent HIV self-management were identified though exploratory factor analysis: Believing and knowing; Goals and facilitation; Participation; HIV biomedical management; and Coping and self-regulation. These components were meaningful and could be related to the theoretical framework for the study and the qualitative data. The final Adolescent HIV Self-Management (AdHIVSM) measure consisted of 35 items. The developed AdHIVSM-35 had acceptable reliability and stability. The sub-scales had acceptable reliability, but some of the sub-scales had undesirable stability and questionable convergent validity. Confirmatory factor analysis on the structure developed through exploratory factor analysis indicated a good model-fit that supported its structural validity. The study provides evidence that participants who have higher self-management had better HIV-related and general health outcomes, which supports the criterion- and convergent validity of the identified components. Conclusion: Targeting adolescent HIV self-management in the clinical HIV management setting has the potential to improve adolescents’ adherence to treatment, viral suppression rates and their health-related quality of life.