Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa.
Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa.
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DOI：
10.1016/j.socscimed.2016.10.031
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Bland RM
中科院分区：
文献类型：
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作者：
Rochat TJ;Mitchell J;Lubbe AM;Stein A;Tomlinson M;Bland RM
对流行地区儿童对艾滋病毒和死亡的了解研究不足。我们调查了母亲艾滋病毒披露后儿童死亡相关的问题。次要目的是研究与死亡相关的问题和儿童心理健康后果相关的特征。艾滋病毒感染的母亲（N = 281），支持披露自己的艾滋病毒状况，他们的孩子（6-10岁）在一个不受控制的干预前后评估。通过母亲报告收集儿童的问题后，披露后1-2周。61/281名儿童询问了88个与死亡有关的问题，并对这些问题进行了定性分析。Logistic回归分析研究了与死亡相关问题相关的特征。使用父母报告的儿童行为检查表（CBCL），线性回归分析研究了各组儿童行为检查表问题的差异，控制基线。儿童的问题分为三个主题：“威胁”、“影响”和“警告”。儿童最关心的是死亡的威胁、母亲的生存和以前的家庭死亡。在多变量分析中，与询问死亡相关问题显著相关的变量包括没有定期汇款给母亲（AOR 0.25 [CI 0.10，0.59] p = 0.002），母亲报告孩子对披露的最初反应是“害怕”（AOR 6.57 [CI 2.75，15.70] p=<0.001）和向儿童披露的水平（完全/部分）（AOR 2.55 [CI 1.28，5.06] p = 0.008）。控制显著变量和基线，所有儿童的CBCL在干预后均有改善;干预后总问题评分无显著差异（β -0.096 SE 1.366 t = -0.07 p = 0.944）。儿童在披露后所问问题的内容表明，他们对艾滋病毒有一定的了解，而且几乎三分之一的儿童了解艾滋病毒对父母死亡的潜在后果。产妇披露的程度和对家庭的经济支持的稳定性可能会促进或抑制关于死亡后披露的讨论。根据母亲的报告，关于死亡的沟通没有对儿童行为产生直接的负面影响。在撒哈拉以南非洲，由于儿童在幼年时就面临死亡，满足儿童的信息需求可以提高他们的复原力。生活在艾滋病毒流行社区的儿童在年幼时就面临死亡。小学学龄儿童了解有关艾滋病毒、疾病和死亡的信息。干预训练成功地使母亲们做好了沟通死亡的准备。关于死亡的沟通并没有增加儿童的心理健康问题。艾滋病毒的披露创造了与儿童沟通和安抚儿童的机会。
Children's understanding of HIV and death in epidemic regions is under-researched. We investigated children's death-related questions post maternal HIV-disclosure. Secondary aims examined characteristics associated with death-related questions and consequences for children's mental health. HIV-infected mothers (N = 281) were supported to disclose their HIV status to their children (6–10 years) in an uncontrolled pre-post intervention evaluation. Children's questions post-disclosure were collected by maternal report, 1–2 weeks post-disclosure. 61/281 children asked 88 death-related questions, which were analysed qualitatively. Logistic regression analyses examined characteristics associated with death-related questions. Using the parent-report Child Behaviour Checklist (CBCL), linear regression analysis examined differences in total CBCL problems by group, controlling for baseline. Children's questions were grouped into three themes: ‘threats’; ‘implications’ and ‘clarifications’. Children were most concerned about the threat of death, mother's survival, and prior family deaths. In multivariate analysis variables significantly associated with asking death-related questions included an absence of regular remittance to the mother (AOR 0.25 [CI 0.10, 0.59] p = 0.002), mother reporting the child's initial reaction to disclosure being “frightened” (AOR 6.57 [CI 2.75, 15.70] p=<0.001) and level of disclosure (full/partial) to the child (AOR 2.55 [CI 1.28, 5.06] p = 0.008). Controlling for significant variables and baseline, all children showed improvements on the CBCL post-intervention; with no significant differences on total problems scores post-intervention (β -0.096 SE1.366 t = -0.07 p = 0.944). The content of questions children asked following disclosure indicate some understanding of HIV and, for almost a third of children, its potential consequence for parental death. Level of maternal disclosure and stability of financial support to the family may facilitate or inhibit discussions about death post-disclosure. Communication about death did not have immediate negative consequences on child behaviour according to maternal report. In sub-Saharan Africa, given exposure to death at young ages, meeting children's informational needs could increase their resilience. Children living in HIV epidemic communities are exposed to death at young ages. Primary-school aged children understand information on HIV, illness and death. Intervention training successfully prepared mothers to communicate about death. Communication about death did not increase children’s mental health problems. HIV disclosure creates opportunities to communicate with and reassure children.