Developing, testing and refining of a model for implementation of HIV/AIDS self-management education in a semi-rural area in KwaZulu-Natal, South Africa.
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Date
2011
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Abstract
The purpose of this study was to develop, test and refine a model for implementation of self-management
education for people living with HIV/AIDS (PLWHA) in semi-rural KwaZulu-Natal,
South Africa. The study consists of a purposive sample of 88 men and women over 18 years of age
living with HIV/AIDS. A Quasi-experimental design, incorporating pre-test and post-test
interventions and comparison groups, was used. These groups, equal in number and matched in other
respects at baseline in terms of the recruitment criteria used, were designated Group A and Group B.
Group A received seven weeks of intensive self-management education; Group B received only
traditional health education. Group B, however, received (and its members were informed that they
would do so) self-management education immediately after my intervention had concluded.
Arrangements were made to prevent the two groups from interacting, or even meeting.
A conceptual model derived from the relevant literature on self management, and in particular on
the teaching of self management to PLWHA, was tested using data from participants’ health-related
quality of life, CD4 counts, and viral loads before and after the self-management education
intervention. Testing comprised an investigation into whether or not the outcomes included in the
model adequately reflected those reported in the literature on effective self-management education,
and also whether or not the predicted relationships between intervention and those outcomes existed
in practice.
A priori assessment produced data for preparation and development of the new intervention devised
by the researcher. The assessment process involved the collection of data on participants’
perceptions of health, their difficulties of living with HIV/AIDS, self-management education needs;
preferred methods of learning and perceived barriers to participation in this self-management
education programme. Participants’ health-related quality of life was measured at baseline and at the
twenty-fourth week, using an SF-36 questionnaire. Data on participants’ CD4 cell counts and viral
loads were obtained from the clinic records at baseline and in the twenty-fourth week; comparisons
were made for sample means using the data available on all participants in both groups. In-depth
group interviews were conducted for systematic sampling of the intervention group after intervention
to substantiate the effectiveness of the intervention.
Results indicated a significant trend toward improvement in health-related quality of life. The indepth
group interview results demonstrated that participants showed improvement in their health
status through the acquisition of self-management skills, health practices, and communication with
healthcare providers. Post-intervention results showed that the two groups were statistically
significantly different in terms of their mean scores on physical functioning (t=3.900; df=79;
p<0.0001 < 0.05), vitality (t=3.285; df=79; p=0.002< 0.05) and general health (t=2.107; df=79;
p=0.039 < 0.05), physical health (p=0.001< 0.05) and role limitation due to emotional problems
(p=0.007 < 0.05). No statistically significant difference appeared in terms of their mean scores on
mental health (t=1.422; df=79; p=.158 > 0.05), bodily pain (t=-.138; df=79; p=0.891> 0.05) and
social functioning (p=0.249 > 0.05). Post-intervention, the two groups are statistically different in
terms of their CD4 count mean scores (t=3.741; df=80; p<.0001 <0.05). The mean CD4 cell counts
increased over the period of investigation; paired t-tests for difference between intervention and
comparison groups were statistically significant (p < 0.05) for these variables. However, the
differences between the two groups in terms of their viral load were not statistically significant. This
may be the result of the fact that as researcher, I had no influence over the process by which viral
load data were obtained: both at baseline and after the intervention, they were retrieved from
patients’ records, in which viral load was expressed, for example, as ‘below 25 copies per mil’. This
was of course an approximation; after the intervention, they were expressed similarly as ‘below
detectable limits’, or ‘below 80 copies per mil.’
My conceptual model provides a consistent, reproducible approach to assessment, monitoring, and
evaluation of the key components of self-management education and allows for measurement over
time and the tracking of changes; it has in addition a predictive ability. Overall, the programme
seemed to have a positive impact on the health-related quality of life of PLWHA. The study
confirms the effectiveness of self-management education in improving the health and well-being of
PLWHA, even in a resource-limited semi-rural setting.
Description
Ph. D. University of KwaZulu-Natal, Durban 2011.
Keywords
Self-care, Health--KwaZulu-Natal., Patient self-monitoring--KwaZulu-Natal., HIV-positive persons--Patients--KwaZulu-Natal., AIDS (Disease)--Patients--KwaZulu-Natal., Self-help techniques--KwaZulu-Natal., Theses--Nursing.