Loneliness, Quality of Life, and Health-Related Hardiness among Older HIV+/AIDS Farmers in China

Purpose and Backgrounds:  This study investigates loneliness, quality of life, and health-related hardiness among 64 HIV+ older (49 - 67) farmers in Hubei, China.  HIV infection is a chronic disease that can be managed with evidence-based intervention.  In Central China in the mid-1990s, plasma donation was promoted by collectors among poor rural farmers as an easy way to supplement meager income.  More than 50,000 former plasma donors (FPDs) are now living with HIV+/AIDS in China and mostly in four Provinces, including Hubei, where this study was conducted.  Recently advanced treatment of HIV+/AIDS patients resulted in the pooling of large numbers of older farmers who contracted HIV during the 1970s.  These farmers face not only economic, but social, psychological, and physical problems associated with the aging and HIV+/AIDS processes.  Data have suggested that reducing HIV+/AIDS-related stigma and loneliness may improve the health of HIV+/AIDS patients.  Researchers describe the older HIV+/AIDS p as the “graying” of the HIV epidemic.

In 2006, almost 38% of HIV-positive persons were between the ages of 40–49.  Receiving treatment allows these farmers with HIV+/AIDS to live longer. It is estimated that the number of HIV-positive persons over 50 will increase by 67% in the next decade.  In addition, the association between HIV+/AIDS and depression has been attributed to multiple factors, including poorer cognitive and physical function due to HIV+/AIDS progression or treatment side effects.  Depression and stress are inextricably linked to physical as well as social health outcomes, especially for individuals with HIV+/AIDS.

Design and Methods: A sequential transformative design in mixed methods was used.  Sequential transformative design in mixed methods research is guided by an advocacy lens where the quantitative and qualitative components of the study vary in terms of order and priority weighting.  Mixed methods is where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, concepts or language into a single study (Creswell et al. 2011).

We considered five attributes in designing mixed methods studies, they are: (a) Rationale: Our rationale for mixing methods was to allow participants to respond to objective questionnaires with self-report answers, respond to subjective open ended questions, or share with the research team their thoughts, feelings, and ideas about their IPV experience unencumbered by filling-in or checking space limitations, (b) Data collection and data analysis paradigm: We used phenomenology as a mixed methods paradigm to integrate not only specific quantitative and qualitative data collection and analysis procedures but also the social construction of multiple phenomena understood as valid realities in the mind of the participant, (c) Priority: We gave priority to quantitative data collection and analysis by first collecting and analyzing quantitative data. Qualitative data collection and analysis came second, (d) Concurrent or sequential implementation: We used a sequential implementation and integration plan for data collection and data analysis techniques, and (e) Phase at which time mixing methods were done: Mixing of data collection and data analysis was planned at the proposal stage of the research and implementation occurred first at the data collection phase (combining objective items with subjective open-ended items in one questionnaire) and continued to the data analysis phase (Ponterotto et al. 2013).  A cross-sectional survey using four questionnaires and 1:1 interviews were used to collect quantitative and qualitative data.

Settings:  Four townships located about 5 hours from Wuhan (airport) where the participants lived near the mountains.

Participants:  Sixty four (64) older HIV+/AIDS farmers (age 49 - 64) participate in the study.  They are from four townships located near the mountains in Hubei Province.  The Institutional Review Board (IRB) affiliated with the Wuhan Branch of the Association of Preventive Medicine of China approved the study. 

Data Collection:  A team of 5 researchers along with 5 local health care workers interviewed 64 (male = 36, female = 28) HIV+/AIDS participants for qualitative data.  Four questionnaires: (a) demographic, (b) loneliness, (c) quality of life, and (d) health-related hardiness were used to collect quantitative data.

Results: A total of 64 HIV+/AIDS older farmers, from four townships participated in the study.  Their ages ranged from 49 to 67; 36 males and 28 female in total.  Forty eight (48) are married, 5 are single (never married) and 11 are divorced or separated.  As to education received, thirty two (32) have primary school education and 16 have middle school education, one has a high school education and 14 have no education at all.  Only one has a college education.  The infectious routes for 43 HIV+/AIDS farmers are mostly through blood selling; 15 via blood transfusion (not blood selling), 4 through sexual contacts and 2 did not know how they contracted with the HIV virus.  Average yearly income ranged from 0 to 40,000 Chinese Yen.  Forty six (n = 46, 71%) stated that they have family members who care for them or live with them, thus, family members care for them as they cope with their HIV+/AIDS illness. 

Participants residing in more developed areas showed higher quality of life (mean = 80.7, p < 0.01) and higher health-related hardiness (mean: 134.9, p < 0.00.  Those with higher education showed significant higher hardiness than those who have no education (mean = 134.5, p < 0.008).  Married participants showed less loneliness (77.08, p < 0.018) and higher hardiness (mean = 125.1, P< 0.038).  Variables such as higher income were related to higher quality of life (mean = 77.0, p < 0.013) and having family members care for them are related to less loneliness (mean = 77. 02, p < 0.012).  The qualitative data was collected via 1:1 interview with a researcher and a participant.  A brief report of the qualitative data collection and analysis will be included in this presentation. 

Conclusions:  Participants in the study need evidence-based intervention and social support in understanding HIV+/AIDS as a chronic disease.  Nursing care that integrates cultural diversity, evidence-based practice specifically in the area of hardiness and resilience is needed to understand the uniqueness of each participant’s response to their HIV+/AIDS status.  The Chinese philosophy that says “It is better to have a ‘difficult’ life than a ‘good’ death” exemplifies the concepts and ingredients in hardiness and resilience.  Chinese philosophers taught the Chinese to be hardy and resilient.  Resilient individuals are capable of adjusting and coping successfully in the face of adversity and successfully use social support systems to prevent the escalation of such adversity.  Resilient individuals in various life spans possess the capacity to assert control and decision making processes in de-escalating or preventing adversity.  Petros et al. (2013) and Bowes et al. (2013) discuss resilience as an important attribute in overcoming stress, depression, adversity, or enduring environmental and social risks and challenges into opportunities.

Furthermore, studies show resilience is a protective factor and that it could be developed in individuals; however, it can also be depleted through repeated unabated or unresolved stress, anxiety, or assault and lack of social support.  We plan to develop, optimize and implement a “Hardiness, Resilience, and Social Support” care to a larger group of HIV+/AIDS farmers in our future study.

References:

Bowes, L, Jaffe, SR (2013). Biology, genes, and resilience: Toward a multidisciplinary approach. Trauma, Violence, & Abuse, 14(3) 195-208.

Creswell, JW, Klassen, AC, Clark, VLP, Smith, KC (2011). Best practices for mixed methods research in health sciences, NIH, OBSSR, http://www.nih.gov/icd/od/ Retrieved on September 23, 2011.

Petros, N, Opacka-Juffry, J, Huber, JH (2013). Psychometric and neurobiological assessment of resilience in a non-clinical sample of adults. Psychoneuroindocrinology 28, 2099-2108.

Ponterotto, JG, Matthew, JT & Raughley, B (2013). The value of mixed methods designs to social justice research in counseling and psychology. Journal of Social Action in Counseling and Psychology 5(2): 42-68.