Exploring social ecological pathways from resilience to quality of life among women living with HIV in Canada

被引：15

作者：

Logie, Carmen H. ^{[1
,2
]}

Wang, Ying ^{[1
]}

Kazemi, Mina ^{[2
]}

Hawa, Roula ^{[2
]}

Kaida, Angela ^{[3
]}

Conway, Tracey ^{[2
,8
]}

Webster, Kath ^{[3
,16
]}

de Pokomandy, Alexandra ^{[4
,5
]}

Loutfy, Mona ^{[2
,6
,7
]}

Abdul-Noor, Rahma ^{[8
]}

Anema, Aranka ^{[9
]}

Angel, Jonathan ^{[10
]}

Baril, Jean-Guy ^{[11
]}

Barry, Fatimatou ^{[8
]}

Bauer, Greta ^{[12
]}

Beaver, Kerrigan ^{[8
]}

Becker, Denise ^{[13
]}

Benoit, Anita ^{[8
]}

Brophy, Jason ^{[14
]}

Brotto, Lori ^{[9
]}

Burchell, Ann ^{[15
]}

Cardinal, Claudette ^{[16
]}

Carlson, Allison ^{[8
]}

Carter, Allison ^{[16
,17
]}

Cescon, Angela ^{[17
]}

Cioppa, Lynne ^{[8
]}

Cohen, Jeffrey ^{[18
]}

Colley, Guillaume ^{[17
]}

Conway, Tracey ^{[2
,8
]}

Cooper, Curtis ^{[10
]}

Cotnam, Jasmine ^{[8
]}

Cousineau, Janette ^{[8
]}

Dayle, Janice ^{[19
]}

Desbiens, Marisol ^{[8
]}

Dubinsky, Hania ^{[19
]}

Dubuc, Daniele ^{[19
]}

Duddy, Janice ^{[20
]}

Gagnier, Brenda ^{[8
]}

Gahagan, Jacqueline ^{[21
]}

Gasingirwa, Claudine ^{[8
]}

Gataric, Nada ^{[17
]}

Greene, Saara ^{[22
]}

Hart, Trevor ^{[23
]}

Hankins, Catherine ^{[24
]}

Hogg, Bob ^{[16
,17
]}

Howard, Terry ^{[13
]}

Islam, Shazia ^{[8
]}

Jones, Evin ^{[20
]}

Kaushic, Charu ^{[22
]}

Keating, Alexandria ^{[25
]}

机构：

[1] Univ Toronto, Factor Inwentash Fac Social Work, Toronto, ON, Canada

[2] Womens Coll Hosp, Womens Coll Res Inst, Toronto, ON, Canada

[3] Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada

[4] McGill Univ, Dept Family Med, Montreal, PQ, Canada

[5] McGill Univ, Ctr Hlth, Chron Viral Illness Serv, Montreal, PQ, Canada

[6] Univ Toronto, Dept Med, Toronto, ON, Canada

[7] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[8] Womens Coll Res Inst, Toronto, ON, Canada

[9] Univ British Columbia, Vancouver, BC, Canada

[10] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[11] Clin Quartier Latin, Montreal, PQ, Canada

[12] Univ Western Ontario, London, ON, Canada

[13] Posit Living Soc British Columbia, Vancouver, BC, Canada

[14] Childrens Hosp Eastern Ontario, Ottawa, ON, Canada

[15] Ontario HIV Treatment Network, Toronto, ON, Canada

[16] Simon Fraser Univ, Vancouver, BC, Canada

[17] British Columbia Ctr Excellence HIV AIDS, Vancouver, BC, Canada

[18] Windsor Reg Hosp, Windsor, ON, Canada

[19] McGill Univ, Hlth Ctr, Montreal, PQ, Canada

[20] Pacific AIDS Network, Vancouver, BC, Canada

[21] Dalhousie Univ, Halifax, NS, Canada

[22] McMaster Univ, Hamilton, ON, Canada

[23] Ryerson Univ, Toronto, ON, Canada

[24] UNAIDS, Geneva, Switzerland

[25] ViVA & Southern Gulf Islands AIDS Soc, Victoria, BC, Canada

[26] BC Womens Hosp & Hlth Ctr, Oak Tree Clin, Vancouver, BC, Canada

[27] CIHR Canadian HIV Trials Network, Vancouver, BC, Canada

[28] Univ Ottawa, Ottawa, ON, Canada

[29] Providence Hlth Care, Vancouver, BC, Canada

[30] Univ Toronto, Toronto, ON, Canada

[31] Native Womens Shelter Montreal, Montreal, PQ, Canada

[32] Canadian Aboriginal AIDS Network, Vancouver, BC, Canada

[33] Univ Quebec, Montreal, PQ, Canada

[34] Posit Womens Network, Chennai, Tamil Nadu, India

[35] Womens Hlth Womens Hands, Toronto, ON, Canada

[36] McGill Univ, Toronto, ON, Canada

[37] British Columbia Ctr Dis Control, Vancouver, BC, Canada

[38] Publ Hlth Agcy Canada, Ottawa, ON, Canada

[39] Toronto East Gen Hosp, Toronto, ON, Canada

[40] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[41] St Josephs Hlth Care, London, England

[42] Univ Victoria, Victoria, BC, Canada

[43] Ctr Hosp Univ Montreal, Montreal, PQ, Canada

[44] Ctr Addict & Met Hlth, Toronto, ON, Canada

[45] Haven Clin, Sudbury, ON, Canada

[46] Clin lActuel, Montreal, PQ, Canada

[47] Toronto Gen Res Inst, Toronto, ON, Canada

[48] Kingston Univ, Kingston, ON, Canada

[49] Native Youth Sexual Hlth Network, Toronto, ON, Canada

[50] St Michaels Hosp, Toronto, ON, Canada

来源：

AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV | 2018年 / 30卷

基金：

加拿大健康研究院;

关键词：

Resilience; women; HIV; social support; stigma; DISCLOSURE CONCERNS; FOOD INSECURITY; POSITIVE WOMEN; HEALTH; SUPPORT; STIGMA; VALIDATION; ASSOCIATION; INSTRUMENT; DEPRESSION;

D O I：

10.1080/09540121.2018.1488031

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Resilience, positive growth in contexts of stress and adversity, is shaped by social ecological factors. Among people living with HIV, resilience is associated with myriad positive health benefits and improved health-related quality of life (HR-QoL). Identifying contextual factors associated with resilience among women living with HIV (WLWH) is particularly important as this population experiences many stressors and inequalities. We examined social-ecological factors associated with resilience and its relationship with HR-QoL among WLWH. We utilized baseline survey data from a national cohort of WLWH (n=1424) in Canada. We conducted structural equation modelling using maximum likelihood estimation methods to test the direct effects of social support and women-centred HIV care (WCHC) on resilience, and the direct effects of resilience on mental and physical HR-QoL. We also tested the indirect effects of resilience on HR-QoL via HIV disclosure concerns and economic insecurity. Participant median age was 43 years (IQR=35-50); most participants were women of colour (29% Black; 22% Indigenous; 7% other ethnicities; 41% Caucasian). Social support and WCHC were associated with increased resilience. The direct path from resilience to mental HR-QoL was significant, accounting for the mediation effects of economic insecurity and social support. The direct path from resilience to physical HR-QoL was significant, accounting for the mediation effects of economic insecurity. Economic insecurity partially mediated the relationship between resilience and mental HR-QoL and physical HR-QoL. HIV disclosure concerns partially mediated the relationship between resilience and mental-HR-QoL. Model fit indices suggested that the model fit the data well (2[14]=160.378, P<0.001; CFI=0.987; RMSE=0.048 [90% CI:0.042-0.080]; SRMR=0.036). Findings suggest social (social support) and structural (WCHC) factors increase resilience. While resilience is associated with improved HR-QoL, social (HIV disclosure concerns) and structural (economic insecurity) factors partially mediate these associations and threaten HR-QoL. Multi-level interventions can address social ecological contexts to advance resilience and HR-QoL among WLWH.

引用

页码：S67 / S75

页数：9

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