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A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV



Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH.


Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory.


Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05).

Conclusions/practice implications

Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.

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This study was supported by grants from the National Institutes of Health (R01 DA019413 and R34 DA034314). The lead author was partially supported by the HIV Prevention Trials Network Domestic Scholars Program. This research was also supported by the University of North Carolina at Chapel Hill Center for AIDS Research (P30-AI050410-22).

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Correspondence to Allysha C. Maragh-Bass.

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Research involving human participants and/or animals

The present research included human subjects only. The research detailed in the manuscript was conducted in accordance with Institutional Review Board ethical standards regarding the treatment of human subjects. All work described was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.

Informed consent

Data were collected between March and October of 2014, at our research center located off-campus near Johns Hopkins Hospital. Written consent was obtained from all participants for interviews and focus groups. The principal investigator and three trained research team members conducted interviews and focus groups. Participants completed computer-assisted personal interview with a trained interviewer, and completed separate written informed consent, even if they had participated in previous interviews and/or focus groups. All study procedures and materials were fully approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

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Maragh-Bass, A.C., Sloan, D.H., Alghanim, F. et al. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res 30, 507–519 (2021).

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  • Advanced care planning
  • African Americans
  • Quality of life
  • Healthcare mandates
  • Urban health
  • Health disparities