Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings
Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings
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DOI：
10.1177/1363461519858446
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发表时间：
2020-02-01
影响因子：
2.5
通讯作者：
Weiser, Sheri D.
中科院分区：
文献类型：
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作者：
Hatcher, Abigail M.;Lemus Hufstedler, Emiliano;Weiser, Sheri D.
虽然粮食不安全和贫困使艾滋病毒/艾滋病患者的心理健康状况恶化，但很少有干预研究将贫困和粮食不安全作为改善心理健康的一种方式。在艾滋病毒阳性患者中，解决这些上游决定因素可能被证明是确保更好的精神健康和艾滋病毒临床结果的关键。我们将纵向、定性的研究整合到一项民生干预的随机试验中，以了解干预可能如何影响感染艾滋病毒的肯尼亚成年人的心理健康的过程和机制。在两个时间点(干预开始后和干预结束时)对干预者(n=45)和对照组(n=9)进行深入访谈。访谈(n=85)被翻译、双重编码，并使用归纳-演绎团队的方法进行主题分析。参与者报告了干预后的许多心理健康改善，包括减少了压力，减少了焦虑症状，改善了情绪，降低了抑郁症状，减少了重复和沉思的想法，以及对未来更有希望。精神健康的改善似乎是通过几种机制实现的，包括：1)更好的食品安全和收入；2)增加体力活动和围绕农活创造富有成效的日常生活的能力；以及3)提高作为社区积极成员的自我意识。定性的纵向访谈可能有助于确定改善心理健康的干预机制，但还需要进一步的研究来证实心理健康变化的自我报告。这些发现表明，生活干预可能会以多方面的方式改善心理健康，并帮助PLHIV更好地融入他们的社区。
While food insecurity and poverty worsen mental health outcomes among people living with HIV/AIDS (PLHIV), few intervention studies have targeted poverty and food insecurity as a way to improve mental health. Among HIV-positive patients, addressing such upstream determinants may prove crucial to ensure better mental health and HIV clinical outcomes. We integrated longitudinal, qualitative research into a randomized trial of a livelihood intervention to understand processes and mechanisms for how the intervention may affect mental health among HIV-infected Kenyan adults. In-depth interviews were conducted with intervention participants (n = 45) and control participants (n = 9) at two time-points (after intervention start and upon intervention end). Interviews (n = 85) were translated, double-coded, and analyzed thematically using an inductive-deductive team approach. Participants reported numerous mental health improvements post-intervention including reduced stress, fewer symptoms of anxiety, improved mood, lower depressive symptoms, fewer repetitive and ruminating thoughts, and more hopefulness for the future. Improvements in mental health appear to occur via several mechanisms including: 1) better food security and income; 2) increased physical activity and ability to create fruitful routines around farm work; and, 3) improved sense of self as an active member of the community. Qualitative, longitudinal interviews may help identify intervention mechanisms for improved mental health, but additional research is required to confirm self-reports of mental health changes. These findings suggest that livelihood interventions may improve mental health in multi-faceted ways, and help PLHIV better integrate with their communities.Trial registered at ClinicalTrials.gov: NCT01548599