Self-efficacy and social support among 68 people living with HIV/AIDS in Hubei Province*
2011; Wiley; Volume: 3; Issue: 4 Linguagem: Inglês
10.1111/j.1752-9824.2011.01124.x
ISSN1752-9824
Autores Tópico(s)HIV-related health complications and treatments
ResumoJournal of Nursing and Healthcare of Chronic IllnessVolume 3, Issue 4 p. 488-495 ORIGINAL ARTICLEFree Access Self-efficacy and social support among 68 people living with HIV/AIDS in Hubei Province* Jin Na Wang RN, MNurs, Jin Na Wang RN, MNursSearch for more papers by this authorRui Ming Li MPath, Rui Ming Li MPathSearch for more papers by this author Jin Na Wang RN, MNurs, Jin Na Wang RN, MNursSearch for more papers by this authorRui Ming Li MPath, Rui Ming Li MPathSearch for more papers by this author First published: 14 November 2011 https://doi.org/10.1111/j.1752-9824.2011.01124.xCitations: 1 Jin Na Wang Nursing School of Hubei Medical University Shiyan Hubei China Telephone: +86 18986886817 E-mail: xinggui1985@yahoo.com.cn † This work has not been published and is not being considered for publication elsewhere. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract wang jn & li rm (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 488–495 Self-efficacy and social support among 68 people living with HIV/AIDS in Hubei Province Background. Both self-efficacy and social support seem to exert positive influence on health-related variables that might influence the health outcomes; however, there are no findings to explore the level of self-efficacy and social support among people living with HIV/AIDS in China, this deficient understanding will be a negative factor to provide efficient care for these people. Aims and objectives. This study: (i) described demographic characteristics, health status, self-efficacy and social support among people living with HIV/AIDS and (ii) explored the correlations of demographic characteristics, health status, self-efficacy and social support among people living with HIV/AIDS. Results. Participants reported relatively high levels of social support, but low levels of self-efficacy. Spearman's correlation revealed that self-efficacy was positively correlated with social support and negatively associated with symptoms manifested in last month, while social support positively related to self-efficacy, education, income and CD4+ lymphocyte count in the blood checked in the latest time. Conclusions. Healthcare providers may consider further interventions to promote self-efficacy and enhance social support in HIV/AIDS-positive individuals in highly HIV-infected areas of China, as the available social support did not seem to be effective in increasing their self-efficacy. Introduction In the world, close to 60 million men, women and children have been infected with HIV, and nearly 25 million people have died of AIDS (Merson et al. 2008). In 2007, the estimated number of people living with HIV/AIDS (PLWHA) in China was between 0·45–1 million (UNAIDS 2008). Through 31st October 2009, China had reported a total of 319 877 patients with HIV/AIDS, of which 102 323 had AIDS and 49 845 died (Shanghai Channel of Xinhua Net 2009). Although the prevalence of HIV infection in China is about 0·05%, several provinces (including Yunnan, Guangxi, Guangdong, Xinjiang and Henan) have more than 30 000 PLWHA (Zhang et al. 2008). Theoretical framework Social control theory and HIV/AIDS Social control is used for maintaining stability and harmony in society through current social norms (Coreil et al. 2001). Deviance might be positive or negative for society. Deviance includes normative deviance and situational deviance. Normative deviance includes choices and behaviours that are considered as immoral, sinful and breaking the laws (Coreil et al. 2001). The public is inclined to pity, blame and eventually avoid contacting with the deviant individual (Dijker & Koomen 2006). Situational deviance refers to changes that are out of control, unpredicted and overwhelmingly unable to tackle with (Coreil et al. 2001). AIDS is often introduced and talked about as a gay issue, a drug abuser's illness and or prostitution. Because these behaviours are regarded as irresponsible and preventable, AIDS as an illness may be categorised, by the public, as a normative deviance; therefore, patients with AIDS often are stigmatised, discriminated against and blamed for having the disease (Zukoski & Thorburn 2009). The purposes of this research were to (i) identify and describe demographic characteristics, health status, level of self-efficacy and social support of PLWHA in Hubei Province, China; (ii) explore the correlations among demographic characteristics, health status, self-efficacy and social support of PLWHA in Hubei Province, China. Based on the literature review, Bandura (1977) developed the concept of self-efficacy, as a belief of being capable of completing tasks or perusing activities. Schwarzer and Luszczynska (2007) believed that self-efficacy instigates the adoption, initiation and maintenance of health-promoting behaviours. Scores of researchers had suggested that self-efficacy was positively influenced behavioural intent (Peltzer et al. 2000, Warren et al. 2007, Lee et al. 2009), adherence of medicine and physical functioning (Luszczynska et al. 2007), voluntary counselling and testing uptake (Vermeer et al. 2009) and increases in CD4 and decreases in viral load (Ironson et al. 2005). Moss (1973) defined social support as the subjective feeling of belonging, of being accepted, loved, esteemed, valued and needed for oneself, not for what one can do for others (Moss 1973). Nausheen et al. (2009) had deemed that social support was composed by structural and functional aspects. The structural aspects of social support included the quantitative properties of the social network, and the functional support referred to the quality or function served by the structural support components. Prior research had been conducted regarding the influence of social support on PLWHA and had been testified that favourable social support was positively correlated with adjustment (Turner-Cobb et al. 2002) coping strategies (Dillon & Brassard 1999, Heckman et al. 2000), improved medical adherence (Edwards 2006), avoidance of high-risk sexual behaviour (Reilly & Woo 2004), reduced HIV-related health symptoms (Ashton et al. 2005), decreased depression (Ingram et al. 2001, Lee et al. 2007, Vyavaharkar et al. 2007) and positive outcomes(Waller 2001, Sun et al. 2009). On the contrast, unsatisfactory social support was proved to be positively correlated with increased depression (Ingram et al. 2001) and an increased progression to AIDS (Leserman et al. 2000). According to the literature, both self-efficacy and social support were meaningful in AIDS prevention; however, self-efficacy and social support among PLWHA in China have not been well described or investigated. An inadequate understanding of self-efficacy and social support among PLWHA may negatively impact the quality of care they receive. Research framework Based on literature review, it appears that (i) one's social demographic characteristics may correlate with social support, self-efficacy and health status; (ii) Both self-efficacy and social support might correlate with the health status; (iii) social support and self-efficacy may correlate with each other among PLWHA. These assumptions and model were developed to guide this research. Therefore, the research framework was formulated as shown (Fig. 1). Figure 1Open in figure viewerPowerPoint Relationship among demographic characteristics, health status, social support and self-efficacy of people living with HIV/AIDS. Materials and methods Participants A convenience sampling of 68 participants were joined in this study. Individuals were diagnosed by local control and preventions (CDCs) as having HIV/AIDS and aged above at least 16 years were included, while those who had severe mental illness or cognitive impairment were excluded. This information was provided by the doctors in Centers for Disease Control and Prevention. Every HIV-positive participant was a client of the local CDCs, who came regularly to receive free antiretroviral medicines from CDC. One author worked with faculties of the local CDCs for about 2 months. After the patients obtained their medicine, they were invited to join in the study. If they accepted, they needed to complete an anonymous questionnaire (demographic data) and two scales (General Self-efficacy Scale and Multidimensional Scale of Perceived Social Support) for about 30 minutes. For participants who were literate, they wrote the questionnaires and scales on their own, while for the other illiterate participants, the author read each item in the questionnaires and scales for them. Prior to data being collected, the researcher received approval to conduct the study from HOPE School of Nursing, Wuhan University and the Centers for Disease Control and Prevention (CDC) in the two cities (in Hubei Province, China). Before interviewing the participants, the interviewer informed the patients and obtained written permission to participate in this study. The patients were told they had the right to refuse to be interviewed at any stage. If they accept, they were told that they would not receive any benefits. Study design Based on the questionnaires, the author described the demographic characteristics, treatment PLWHA received, health status, and the levels of self-efficacy and social support of 68 PLWHA in Hubei Province, China. Additionally, Spearman's correlation was used to explore relations among self-efficacy, social support, demographic characteristics and health status. Instruments Social demographic characteristics A social demographic questionnaire developed by the author sought information regarding each subject's: gender, age, educational background, family size, living status and income level. Health status and treatment The questionnaire sought information regarding each subject's: date of diagnosis, mode of transmission, the CD4+ lymphocyte count in their blood, if given ART-therapy and any discomforts experienced in the last month. General Self-efficacy Scale The General Self-efficacy Scale (GSE) contains 10 items that are used to evaluate self-efficacy when faced with challenging events in life. Each item is scored from 1–4. Higher scores show greater in self-efficacy and vice versa. The GSE has been translated into 28 languages and widely used and repeatedly tested its high reliability, stability and construct validity (Cronbach's α ranges from 0·75–0·94) (Scholz et al. 2002, Luszczynska et al. 2005b, Siu et al. 2007). In this study, the Chinese GSE was used to measure the level of general self-efficacy among the PLWHA recruited, and the Cronbach's α in this sample was 0·92. The multidimensional scale of perceived social support The multidimensional scale of perceived social support provides assessment of three sources of support: family (FA), friends (FR) and significant others (SO). It has 12 items: 4 for FA, 4 FR and 4 SO. Items are measured on a 7-point scale from 1 'strongly disagree' to 7 'strongly agree' (Zimet et al. 1988). Research manifested that MSPSS was a psychometrically sound instrument with strong factorial validity and test–retest reliability. (Zimet et al. 1988, Chou 2000, Wang et al. 2001, Clara et al. 2003). In this study, the Chinese MSPSS was used to measure the social support of PLWHA and the Cronbach's α of this sample was 0·88. Results Of the 68 participants (32 women, 36 men, Mage = 42 years, age range: 17–75 years), 14 (21%) individuals lived in urban areas and 54 (79%) in rural districts. Most (n = 61, 90%) of PLWHA in this study lived with their family or relatives (Mfamily size = 4, family size range: 1–12). Twenty-nine (43%) of the subjects received less than 6 years education. Although all participants received the basic cost of living allowances from the local government, most PLWHA, as well as their families, were impoverished in comparison with the poverty line of $1·25, a day announced by the World Bank in 2008 (Shah 2010). Until December 2009, the mean time since diagnosis with HIV/AIDS of participants was 5 years and 4 months. The majority (n = 47, 69%) of the participants were infected by blood transmission either from selling blood (n = 32, 47%) or blood infusion (n = 15, 22%) in hospitals, 94% (n = 64) experiencing symptoms in last month and 63% had an insufficient CD4+ lymphocyte count before the interviews (n = 43). In this study, self-efficacy, age, family size, and social support, family support, friends support and significant other's support were continuous variables. The categorical variables were gender (classification 1–2), education (classification 1–5), income (classification 1–5), the number of CD4+ lymphocyte count (classification 1–3), symptoms showed in last month (classification 1–4) and length of time since diagnosis (classification 1–3). The author coded the data based on literature review and the advice of doctors and nurses from two local Centers for Disease Control and Prevention. The mean of self-efficacy among the participants was 22·7 (SD = 7·8; see Table 1). The mean of MSPSS among participants was 4·6 (SD = 1·2; see Table 2). Spearman's correlation revealed that self-efficacy was positively correlated with social support and negatively associated with symptoms manifested in last month, while social support positively related to self-efficacy, education, income, CD4+ lymphocyte count checked in the latest time and friends support (see Table 3). Table 1. Self-efficacy of PLWHA Content Mean SD Item 3 It is easy for me to stick to my aims and accomplish my goals 2·01 0·970 Item 5 Thanks to my resourcefulness, I know how to handle unforeseen situations 2·13 1·064 Item 8 When I am confronted with a problem, I can usually find several solutions 2·13 0·991 Item 10 I can usually handle whatever comes my way 2·13 1·035 Item 4 I am confident that I could deal efficiently with unexpected events 2·16 1·074 Item 2 If someone opposes me, I can find the means and ways to get what I want 2·34 1·031 Item 6 I can solve most problems if I invest the necessary effort 2·4 0·964 Item 7 I can remain calm when facing difficulties because I can rely on my coping abilities 2·4 1·010 Item 9 If I am in trouble, I can usually think of a solution 2·47 0·938 Item 1 I can always manage to solve difficult problems if I try hard enough 2·49 1·000 Total 22·66 7·77 PLWHA, people living with HIV/AIDS. There were 10 items in total, the score of each item ranged from 1–4: 1, not at all true; 2, hardly true; 3, moderately true; 4, exactly true; and the total scores ranged from 10–40. Higher scores indicated better self-efficacy. Table 2. Social support from family, significant others and friends Dimension Minimum Maximum Mean SD Family 1·5 7 4·94 1·22 Friends 1 7 4·21 1·66 Significant others 1 6·75 4·75 1·35 Total 1 7 4·63 1·19 The MSPSS contained 12 items, each scored from 1–7 and the total score ranged from 12–84. It had three dimensions, support from family, friends and significant others; each dimension included four items. Table 3. Relationships between demographic characteristics, health status (symptoms in last month, CD4 cells count before interview, length of time diagnosed as HIV positive), self-efficacy and social support 1 2 3 4 5 6 7 8 9 10 11 12 13 Spearman's correlation 1. Gender 2. Age −0·084 3. Education −0·256* −0·212 4. Family size 0·199 −0·118 −0·042 5. Income 0·073 −0·041 0·261* −0·288* 6. CD4+ cells count 0·178 0·051 −0·074 0·115 0·250* 7. Symptoms in last month 0·109 −0·047 −0·133 0·062 −0·160 −0·09 8. Length of time diagnosed 0·197 0·279* −0·269* 0·286* −0·144 0·280* −0·027 9. Social support 0·051 0·065 0·308* 0·118 0·248* 0·304* −0·099 0·118 10. Family support 0·118 0·194 0·000 −0·210 0·341** 0·212 −0·053 −0·012 0·129 11. Friends support 0·074 0·044 0·094 −0·033 0·273* 0·339** −0·012 0·097 0·239* 0·492*** 12. Significant others' support 0·108 0·073 0·079 −0·159 0·362** 0·069 −0·086 −0·051 0·111 0·607*** 0·609*** 13. Self-efficacy −0·144 0·071 0·211 −0·016 0·019 −0·091 −0·312** −0·009 0·375** −0·046 −0·150 −0·011 *p < 0·05, **p < 0·01, ***p < 0·001. Discussion Self-efficacy of PLWHA in this study was relatively low in comparison with prior research (see Table 4), which was prone to be negative for participants to adopt efficient strategies for fighting with HIV/AIDS and eventually accelerating AIDS progression (Wang et al. 2001, Luszczynska et al. 2005a, Schwarzer 2009). Ironson et al. (2005) had supported that increases in AIDS self-efficacy over the 3-month period were significantly related to increases in CD4 and decreases in viral load, which were positive sighs for slowing down the pace of AIDS progression, which suggested that self-efficacy was a positive predictor on AIDS prevention. Table 4. Comparison of the self-efficacy Self-efficacy Sample size Mean SD PLWHA in central China 68 22·66 7·77 Students in China (male) 127 26·9 5·7 Students in China (Female) 273 25·5 5·3 Norms of German Heterogeneous Adult Population 1660 29·28 High school students 3494 29·60 4·0 Norms of American Adult population 1594 29·48 5·13 PLWHA, people living with HIV/AIDS. Spearman's correlations showed that self-efficacy was negatively associated with symptoms PLWHA experienced in last month. Shin et al. (2001), Hellström et al. (2009) had suggested that people with chronic disease and patients with previous falling had lower self-efficacy. A percentage of 84% of participants had experienced some symptoms in the last month (see Table 5), which indicates a declining health status. Being sick constantly, the participants were liable to doubt their own abilities to deal with problems and hold lower self-efficacy than those who had no symptoms. Table 5. Symptoms of PLWHA (n = 68) Items Number of the subjects % of the subjects Symptoms of the last month Sleeping disorder 17 25 Headache 24 35 Fatigue 19 28 Cough, gasping, chest pain or dyspnoea 17 25 Fever, chill or sweating 17 25 Nausea, vomiting, diarrhoea or feeling pain in abdomen 13 19 Lack of appetite, losing weight 12 18 Influenza 5 7 Itchy skin or infection of the skin 4 6 Impaired vision 1 1 Osteoporosis 1 1 Backache 1 1 None 11 16 PLWHA, people living with HIV/AIDS. Additionally, self-efficacy was relevant to social support positively at a moderate level; it is similar with the results obtained by Harrison-Genus (2009). In addition, McKellar et al. (2008) found that for participants with alcohol addiction, social support from friends was a positive predictor of alcohol-related self-efficacy at 1 year. Contradictively, the social support among these participants were relatively positive, which inferred that although social support might be a beneficial factor for self-efficacy, raising social support alone was not enough for improving self-efficacy of PLWHA. Moreover, most participants live in remote rural area of China, and they, as well as the other residents, were not capable of receiving higher education. These residents might have deficient or incorrect information about AIDS transmission (Zhu et al. 2007), the fear of being infected made some of them avoid contacting with PLWHA, which might increase AIDS-related isolation, and harm the level of self-efficacy of PLWHA. Meanwhile, PLWHA in this study scored moderately on social support (Msocial support = 55·6), while family support scored highest. Based on demographic data, 90% of participants lived with their family members or relatives; this was a positive predictor for positive social support. In a family-centred country, people gain major support from family. In addition, 79% of this sample lived in remote rural area of China, where residents mainly led a life by farming and had a big family. Simple life style makes these residents enthusiastic, honest, simple and industrious. The local residents had many interactions with families, relatives and neighbours; thus, they construct certain amount of social networks and receive much social support. Moreover, it is Chinese tradition to take responsibility for families, so it is not surprisingly that when one family member was sick, the other families tended to offer support and accept reality. Furthermore, as the majority of PLWHA in this study was infected by blood transmission either from illegal blood selling for improving deficient home finance or blood infusion in hospitals, they might feel less stigmatised by their family members. According to social control theory, their infection was unpredicted and out of control, which could be categorised as situational deviance (Coreil et al. 2001). Naturally, they were inclined to be much more acceptable by the public as well as their family members and to accept tangible social support much easier. However, PLWHA in this study scored a slightly lower on social support than that in the study by Sun et al. (2007) (Msocial-support = 62·5), who also implemented research with the same social support scale in Central China, with 103 individuals with HIV/AIDS registered at the 'Warm Homestead' healthcare centre. It is a institution which provided comprehensive care for PLWHA in the area (those unable to come to the facility were visited at home), except the government aids, mutual help among patients also included, which may greatly increase the perceived social support to the PLWHA. The comparison indicated that mutual help among patients was a beneficial factor for raising the level of social support of PLWHA. Except self-efficacy, social support of PLWHA was also positively correlated with education and income. If PLWHA had received higher education and better house finance, they were inclined to know more about the disease, faced the disease easier and talked about it more openly with family members and friends, which might be efficient to reduce the level of stigma of caregivers and supporters, and then the participants with higher education might gain better social support than those with lower education. Chen et al. (2007) had suggested that stigmatisation of PLWHA was strongly associated with community-level HIV knowledge and fear. In addition, people who had better household finances may experience less family conflicts and access medical services easier and therefore demonstrate more satisfaction with the social support. This result is supported by a study by Schulz et al. (2006), which concluded that higher household income may help strengthening social support. Additionally, social support of participants was relevant to CD4 cells positively, which indicated that PLWHA who were satisfied with their social support were likely to maintain a moderate level of CD4+ cells count. Persson et al. (2002) implied social network factors might prevent the decline of the CD4 lymphocyte level. While Fekete et al. (2009) supported that non-Hispanic White men who were receiving high family support had a lower viral load and higher CD4+ cell count, and Latino men who were receiving low family support had a higher viral load. These results indicated that social support of PLWHA is a favourable factor on declining the progress of AIDS. Several limitations of this study should be noted. The patient sample was from only two local CDCs in Hubei Province, where the primary transmission of HIV/AIDS was via blood transmission. Thus, the findings may not be representative of PLWHA in other countries or of those infected through another route of transmission. Also, the low education level of the participants and the character of the disease (sex related) allow the possibility that some of them may not have understood the questions and/or may not have responded accurately; the researcher had to assume that the respondents were truthful and fully understood the questions being asked. Further studies are necessary to determine the predictors of the self-efficacy and social support among PLWHA in China. Such data will permit us to assess various methods for increasing the level of self-efficacy and social support, and eventually decreasing progression of AIDS for PLWHA. Relevance to clinical practice The results of this study indicated that (i) AIDS professionals and public health personnel should work with residents and community health workers to increase a more harmony community, which includes spread of proper AIDS-related information, mutual interaction between PLWHA, and multiple communication among PLWHA, their supporter and the public; (ii) available medical services should be more humane and convenient for their consideration, such as adding AIDS clinics to tackle with opportunistic infections; (iii) programmes aimed to decrease poverty and increase the educational level of the local area are needed to plan and develop. Acknowledgement To finish this research, Dr Mari Kondo Sato provided guidance and revisions of this paper. In addition, the faculties in HOPE Foundation, HOPE Nursing School of Wuhan University, faculties in two local CDCs have provided much assistance in data collection. 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