Maybe, maybe not: Deciding to disclose HIV to family

也许，也许不是：决定向家人透露艾滋病毒

• 批准号: 8702236
• 负责人: JULIANNE M SEROVICH
• 金额: $ 63.98万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-16 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8702236
• 关键词: Age; Anxiety; Attention; Characteristics; Communication; Conflict (Psychology); Control Groups; Decision Making; Development; Disclosure; Disease Management; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Evaluation; Evidence based intervention; Family; Family member; Feeling; Gender; Goals; HIV; HIV Seropositivity; Health; Health Services Accessibility; Intervention; Lead; Learning; Life; Link; Loneliness; Mediating; Mental Depression; Mental Health; Nuclear Family; Outcome; Outcome Measure; Participant; Persons; Physical Function; Pilot Projects; Positioning Attribute; Preparation; Problem Solving; Process; Randomized Controlled Trials; Regrets; Relative (related person); Reporting; Research; Rewards; Risk; Self Efficacy; Sex Orientation; Social support; Staging; Stress; Testing; Time; Work; base; cost; demographics; evidence base; expectation; experience; follow-up; group intervention; high risk sexual behavior; improved; innovation; intervention effect; medication compliance; physical conditioning; post intervention; primary outcome; public health relevance; satisfaction; secondary outcome; self esteem; skills; theories; therapy design; tool; transmission process; treatment effect

DESCRIPTION (provided by applicant): The decision to disclose one's serostatus to family members creates considerable emotional strain for people living with HIV (PLWH), regardless of gender and sexual orientation. While disclosure to family members has been linked to positive outcomes including increased social support, improved physical and mental health outcomes, reduced loneliness and stress, and improved HIV disease management, the decision not to disclose can also lead to positive outcomes. To date, most research about serostatus disclosure has focused on the act of disclosing - the who, what, where, and when of disclosing - rather than the decision process involved. Based on lessons learned during the pilot study of this intervention, disclosure decision-making is a lifelong process and PLWH can benefit from an intervention which helps them clarify their disclosure-related goals, weigh the costs and rewards of disclosure and non-disclosure, identify strategies that will minimize potential costs - and even helps them come to terms with the decision not to disclose. Our long-range goal is to further refine and evaluate an intervention designed to enhance HIV disclosure decision-making among PLWH. To reach this goal, we are proposing a course of study with the following specific aims: Specific Aim 1: Conduct a randomized, controlled trial (n=450) of the piloted intervention, and assess the effectiveness of the intervention relative to an attention- control condition on a variety of primary outcomes related to disclosure and health. Specific Aim 2: Examine the effects of the intervention over time. Specific Aim 3: Explore potential moderating effects of participant demographics, relationship characteristics, and contextual variables related to family on intervention effectiveness. Specific Aim 4: Evaluate the effects of treatment engagement, retention, and expectations on outcomes. The central hypothesis of this proposal is based on the Consequences Theory of Disclosure. According to the theory, positive persons weigh the rewards and costs of disclosing their status to family. Whenever the rewards outweigh the costs, disclosure occurs. We have adapted our theory and intervention to incorporate fundamental processes of decision making such as clarifying antecedent goals, decision making, and decision evaluation. This proposal is highly innovative in two very important ways. First, to date, no evidence-based intervention has been developed to assist PLWH in making decisions about disclosure to family. Second, the focus of this intervention is on the disclosure decision-making process and comfort/acceptance with the disclosure decision. As such, skills learned through the intervention can be applied to the lifelong process of serostatus disclosure.

描述(由申请人提供)：向家庭成员披露自己的血清状况的决定给艾滋病毒携带者(PLWH)带来了相当大的情感压力，无论性别和性取向如何。虽然向家庭成员披露信息与积极的结果有关，包括增加社会支持、改善身心健康状况、减少孤独和压力以及改善艾滋病毒疾病管理，但不披露的决定也可能带来积极的结果。到目前为止，大多数关于血清状态披露的研究都集中在披露的行为上--披露的人、内容、地点和时间--而不是涉及的决策过程。根据在这种干预的试点研究中学到的经验教训，披露决策是一个终生的过程，公共卫生部门可以从干预中受益，这有助于他们澄清与披露相关的目标，权衡披露和不披露的成本和回报，确定将潜在成本降至最低的战略--甚至 帮助他们接受不披露的决定。我们的长期目标是进一步完善和评估旨在加强公共卫生部门艾滋病毒披露决策的干预措施。为了实现这一目标，我们提出了一个具有以下具体目标的研究过程：具体目标1：对试点干预进行一项随机对照试验(n=450)，并根据与信息披露和健康相关的各种主要结果评估干预相对于注意力控制条件的有效性。具体目标2：检查干预措施随时间推移的效果。具体目标3：探讨受试者人口统计、人际关系特征以及与家庭相关的情境变量对干预效果的潜在调节作用。具体目标4：评估治疗参与度、保留率和期望值对结果的影响。这一提议的核心假设是基于披露后果理论。根据这一理论，积极的人会权衡向家人透露自己的身份的回报和成本。当回报超过成本时，就会发生披露。我们已经调整了我们的理论和干预措施，以纳入决策的基本过程，如澄清先前目标、决策制定和决策评估。这项提议在两个非常重要的方面具有很高的创新性。首先，迄今为止， 还没有开发出基于证据的干预措施来帮助公共卫生部门做出关于向家人披露信息的决定。其次，这种干预的重点是披露决策过程和对披露决定的安慰/接受。因此，通过干预学到的技能可以应用于血清状态披露的终生过程。