The development of an instrument to measure adolescent HIV self-management in the context of the Western Cape, South Africa
| dc.contributor.advisor | Skinner, Donald | en_ZA |
| dc.contributor.advisor | Van der Merwe, Anita S. | en_ZA |
| dc.contributor.author | Crowley, Talitha | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery. | en_ZA |
| dc.date.accessioned | 2018-02-23T13:53:17Z | |
| dc.date.accessioned | 2018-04-09T06:59:20Z | |
| dc.date.available | 2018-02-23T13:53:17Z | |
| dc.date.available | 2018-04-09T06:59:20Z | |
| dc.date.issued | 2018-03 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2018. | en_ZA |
| dc.description.abstract | 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. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Agtergrond en rasionaal: Suid Afrika huisves 20% van die wêreldwye menslike immunogebreksvirus (MIV)-geïnfekteerde adolessente populasie van 1.8 miljoen. Die kliniese MIV bestuur van adolessente mag uitdagend wees en word vererger deur die fisieke en psigologiese veranderinge wat gedurende adolessensie plaasvind. Met die koms van en toegang tot antiretrovirale terapie, word MIV soos ʼn kroniese siekte behandel en het aspekte soos self-bestuur ʼn belangrike komponent van sorg geword. Navorsing het tot op hede nie op adolessente MIV self-bestuur en die meet daarvan gefokus nie. Doel: Om ʼn instrument wat adolessente MIV self bestuur in die konteks van die Wes Kaap, Suid Afrika meet, te ontwikkel. Metodes: ʼn Gemengde-metode verkennende sekwensiële ontwerp was gebruik. Die studie omgewing het geselekteerde gesondheidsorgfasiliteite in die Kaapse Metropool van die Weskaap ingesluit. Adolessente tussen die ouderdom van 13 en 18 wat MIV dienste gebruik, hulle versorgers, gesondheidsorgwerkers/akademici met ondervinding in adolessente MIV sorg en navorsing, was die teiken populasie groepe. Eerstens was individuele onderhoude met ses adolessente, ses versorgers en ses gesondheidsorgwerkers gevoer en daarna is vyf fokusgroepe met adolessente gehou. Interpretatiewe fenomenologie was gebruik om die ervaringe van die deelnemers binne hulle sosiale en kulturele konteks te plaas. In die tweede fase van die studie is items, gebaseer op die deelnemers se ervaringe, die teoretiese raamwerk van die studie en die literatuur induktief ontwikkel. Derdens het adolessente en versorgers die ontwikkelde items se resonansie met hulle ervaringe geëvalueer in fokusgroepe waar kognitiewe onderhoudsvoering gebruik is. Hierna is ʼn groep kenners gevra om die inhoudgeldigheid en duidelikheid van elke item te evalueer en die inisiële lys van 65 items is na 44 hoogs relevante items verminder. Deelnemers was doelgerig geselekteer vir hierdie kwalitatiewe komponente. Laastens, in die vierde fase van die studie, om geldigheid en betroubaarheid te bepaal, is ʼn deursnit ontwerp gebruik en is die self-toegediende vraelys deur 385 adolessente voltooi wat van 11 gesondheidsorgfasiliteite in volgorde geselekteer was. Bevindinge: Vyf komponente van adolessente MIV self-bestuur is deur verkennende faktor analise geïdentifiseer: Glo en weet; Doelwitte en fasilitering; Deelname; MIV biomediese bestuur; en Hantering en selfregulering. Hierdie komponente het betekenisvol met die teoretiese raamwerk en kwalitatiewe data ooreengestem. Die finale Adolessente MIV Selfbestuur (AdMIVSB) meetinstrument het uit 35 items bestaan. Die AdMIVSB-35 se betroubaarheid en stabiliteit was aanvaarbaar. Die sub-skale het aanvaarbare betroubaarheid gehad, maar sekere sub-skale se stabiliteit en konvergente geldigheid was ontoereikend. Bevestigende faktor analise wat toegepas was op die instrumentstruktuur wat deur verkennende faktor analise ontwikkel is, het ʼn goeie modelpassing aangedui, wat die geldigheid van die struktuur bevestig het. Die studie verskaf bewyse dat deelnemers met hoër self-bestuur beter MIV-verwante en algemene gesondheid resultate gehad het, wat die maatstaf- en konvergente geldigheid van die geïdentifiseerde komponente bevestig. Slotsom: ʼn Fokus op adolessente MIV self-bestuur in die kliniese MIV bestuur van adolessente het die potensiaal het om adolessente se getrouheid tot hulle behandelingsplan, virus onderdrukkingsvlakke en gesondheidsverwante kwaliteit van lewe te verbeter. | af_ZA |
| dc.description.sponsorship | National Research Foundation (NRF) | en_ZA |
| dc.format.extent | xix, 377 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/103521 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | UCTD | |
| dc.subject | AIDS (Disease) in adolescence | en_ZA |
| dc.subject | HIV infections -- Nursing | en_ZA |
| dc.subject | HIV infections -- Treatment | en_ZA |
| dc.subject | Self-management (Psychology) for teenagers | en_ZA |
| dc.subject | Self medication -- Measurement | en_ZA |
| dc.subject | Self-care, Health | en_ZA |
| dc.title | The development of an instrument to measure adolescent HIV self-management in the context of the Western Cape, South Africa | en_ZA |
| dc.type | Thesis | en_ZA |