Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis
Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis
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DOI：
10.7448/ias.19.1.21224
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发表时间：
2016-11-24
影响因子：
6
通讯作者：
Darbes, Lynae A.
中科院分区：
文献类型：
--
作者：
Rogers, Anna Joy;Achiro, Lillian;Darbes, Lynae A.
简介：艾滋病毒感染经常在稳定的伴侣关系中传播。为了防止艾滋病毒阴性夫妇感染艾滋病毒，以及改善艾滋病毒阳性夫妇的应对措施，有人建议，除了解决个人行为问题外，干预措施还应旨在加强夫妇关系。然而，鲜为人知的是，影响关系的因素，影响联合决策有关HIV。方法：我们进行了定性深入访谈，40名孕妇和40名男性合作伙伴在肯尼亚西南部，艾滋病毒高流行地区。从社区应对和健康行为改变的相互依赖模型出发，我们采用主题分析方法在Dedoose软件中分析访谈记录，旨在确定可能有助于发展基于夫妇的干预措施以改善孕妇及其男性伴侣健康结果的关键关系因素。根据相互依赖模型，我们发现，具有更大的关系为中心的动机的夫妇描述共同参与更多的健康促进行为，如夫妇艾滋病毒检测，披露艾滋病毒状况，和合作，以改善药物和诊所预约的遵守。这些夫妇往往有诱发因素，如更强的沟通能力和共同的孩子，不太可能面临潜在的挑战，如一夫多妻制婚姻，妻子继承，分居或经济困难。对于艾滋病毒抗体阴性的夫妇，共同决策有助于他们共同面对感染艾滋病毒的健康威胁。对于艾滋病毒诊断呈阳性的夫妇来说，共同应对有助于降低配偶间传播的风险并改善长期健康前景。相反，参与者认为，以自我为中心的动机导致更多的并发性伙伴关系，降低关系满意度，和不信任。缺乏相互依赖的夫妇更有可能提到经历暴力或关系解散，或难以应付与艾滋病毒相关的stigmos.Conclusions：我们发现，相互依赖理论可能提供关键的见解，通过怀孕夫妇的健康相关的态度和行为。投资于加强关系的干预措施，如怀孕期间的夫妇咨询，可能会改善与艾滋病毒有关的有益健康行为的采用。未来的研究应探讨现有的循证夫妇咨询干预措施，以适应当地的情况，以解决可改变的关系的特点，可以增加相互依存和改善艾滋病毒相关的健康结果。
Introduction: HIV infection is frequently transmitted within stable couple partnerships. In order to prevent HIV acquisition in HIV-negative couples, as well as improve coping in couples with an HIV-positive diagnosis, it has been suggested that interventions be aimed at strengthening couple relationships, in addition to addressing individual behaviours. However, little is known about factors that influence relationships to impact joint decision-making related to HIV.Methods: We conducted qualitative in-depth interviews with 40 pregnant women and 40 male partners in southwestern Kenya, an area of high HIV prevalence. Drawing from the interdependence model of communal coping and health behaviour change, we employed thematic analysis methods to analyze interview transcripts in Dedoose software with the aim of identifying key relationship factors that could contribute to the development of a couples-based intervention to improve health outcomes for pregnant women and their male partners.Results: In accordance with the interdependence model, we found that couples with greater relationship-centred motivations described jointly engaging in more health-enhancing behaviours, such as couples HIV testing, disclosure of HIV status, and cooperation to improve medication and clinic appointment adherence. These couples often had predisposing factors such as stronger communication skills and shared children, and were less likely to face potential challenges such as polygamous marriages, wife inheritance, living separately, or financial difficulties. For HIV-negative couples, joint decision-making helped them face the health threat of acquiring HIV together. For couples with an HIV-positive diagnosis, communal coping helped reduce risk of interspousal transmission and improve long-term health prospects. Conversely, participants felt that self-centred motivations led to more concurrent sexual partnerships, reduced relationship satisfaction, and mistrust. Couples who lacked interdependence were more likely to mention experiencing violence or relationship dissolution, or having difficulty coping with HIV-related stigma.Conclusions: We found that interdependence theory may provide key insights into health-related attitudes and behaviours adopted by pregnant couples. Interventions that invest in strengthening relationships, such as couple counselling during pregnancy, may improve adoption of beneficial HIV-related health behaviours. Future research should explore adaptation of existing evidence-based couple counselling interventions to local contexts, in order to address modifiable relationship characteristics that can increase interdependence and improve HIV-related health outcomes.