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An HIV Self-Care Symptom Management Intervention for African American Mothers

Miles, Margaret Shandor; Holditch-Davis, Diane; Eron, Joseph; Black, Beth Perry; Pedersen, Cort; Harris, Donna A.

Features

Background Human immunodeficiency virus (HIV) infection has become a serious health problem for low-income African American women in their childbearing years. Interventions that help them cope with feelings about having HIV and increase their understanding of HIV as a chronic disease in which self-care practices, regular health visits, and medications can improve the quality of life can lead to better health outcomes.

Objective This study aimed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV.

Method Women caregivers of young children were randomly assigned to self-care symptom management intervention or usual care. The intervention, based on a conceptual model related to HIV in African American women, involved six home visits by registered nurses. A baseline pretest and two posttests were conducted with the mothers in both groups. Emotional distress was assessed as depressive symptoms, affective state, stigma, and worry about HIV. Health, self-reported by the mothers, included the number of infections and aspects of health-related quality of life (i.e., perception of health, physical function, energy, health distress, and role function).

Results Regarding emotional distress, the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group. Outcome assessments of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers. Within group analysis over time showed a reduction in negative affective state (depression/dejection and tension/anxiety) and stigma as well as infections in the intervention group mothers, whereas a decline in physical and role function was found in the control group.

Conclusions The HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics.

Margaret Shandor Miles, PhD, RN, FAAN, is Professor, School of Nursing, University of North Carolina at Chapel Hill.

Diane Holdich-Davis, PhD, RN, FAAN, is Professor, School of Nursing, University of North Carolina at Chapel Hill.

Joseph Eron, MD, is Associate Professor, Department of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill.

Beth Perry Black, RN, MSN, is Clinical Associate Professor, School of Nursing, University of North Carolina at Chapel Hill.

Cort Pedersen, MD, is Professor, Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill.

Donna A. Harris, BSN, is Social Research Assistant, School of Nursing, University of North Carolina at Chapel Hill.

Accepted for publication July 14, 2003.

The authors received partial support from the following grants: R01 NR 04416, P30 NR 03962, P30 HD27360, GCRC RR0046, and R01 MH 51019. John Preisser, PhD, provided statistical consultation, and Lynda L. Bell, RN, ANP, provided clinical consultation. Other members of the research team included Mardi Clayton, MSN, Mary Foster Dillard, MSN, Senyene Eyo, BSN, Jenise V. Gillespie, PhD, RN, Joann Haggerty, MSW, Valerie Lunsford, MSN, and Yaoshi Wu.

Corresponding author: Margaret S. Miles, RN, PhD, School of Nursing, Carrington Hall, CB7460, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 (e-mail: Mmiles@email.unc.edu).

© 2003 Lippincott Williams & Wilkins, Inc.