Abstract
This qualitative study assessed psychosocial concerns that rural women with HIV who had multiple psychosocial vulnerabilities were able to express and communicate during a mobile phone intervention delivered by nurses. The study is part of a pilot randomised controlled trial of an mHealth self-care intervention by nurses for women living with HIV in rural India. For the trial, 60 women were randomised to receive the mHealth intervention. All calls were recorded and call logs were maintained. Call logs of 59 women based on 1186 calls were scanned for psychosocial themes. Audio recordings of 400 calls rich in content were then transcribed and translated for analysis. Themes and subthemes were identified by two independent raters. Majority of the women had low literacy and more than half were widowed. Clinical depression was found in 18.6%. Of the 1186 call logs analysed, 932 calls had a record of at least one psychosocial concern and 493 calls recorded two psychosocial concerns. Some of the major themes that women discussed with nurses included worries about their own and their children’s future; loneliness; stigma; inadvertent disclosure; death and dying; abandonment by partner; financial difficulties; body image; poor social support; emotions such as sadness, guilt, and anger; and need for social services. Almost all expressed appreciation for the intervention. Findings indicate the usefulness of mHealth-based self-care interventions delivered by nurses in hard to reach women in low- and middle-income countries, especially those with multiple psychosocial vulnerabilities.
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Abbreviations
- WLWH:
-
Women living with HIV
- HIV:
-
Human immunodeficiency virus
- ART:
-
Antiretroviral therapy
- LAMI:
-
Low- and middle-income countries
- RCT:
-
Randomised control trial
- mHealth:
-
Mobile health
- MAHILA:
-
Mobile Phone-Based Approach for Health Improvement, Literacy and Adherence
- TAU:
-
Treatment as usual
- CESD:
-
Centre for Epidemiologic Studies Depression Scale
- PSVC:
-
Psychosocial vulnerability checklist
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Acknowledgements
The authors thank the study participants for their contribution to the research, as well as current and past research staff, especially the nursing interventionists Ms. Pushpa L., Ms. Savitha K. S., and Ms. Anto Rashmi, and staff at the ART centre, Dr. Shanta Desai (Senior Medical officer), Dr. Attiq Rehaman (Medical officer), and Ms. Swapna Hulasogi (Counsellor).
Funding
The study was supported by the US National Institutes of Health (R21MH100939), the Indian Council of Medical Research (HIV/INDOUS/152/9/2012-ECD-II), and the ITRA project, funded by DEITy, India (Ref. No. ITRA/15(57)/Mobile/HumanSense/01).
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Contributions
NR, MD, PC, MR, VS, SJ, and PS designed the study. NR and PC are the principal investigators. NR, MD (NIH), PC (ICMR), and PS (DEITy) obtained the funding. SJ provides statistical support, MD and PS provide technological support, and NR, PC, and VS support the intervention and fidelity. NR and LL are the main coordinators of the study in the USA. PC, VS, MV, and MD are the main coordinators of the study in India and conduct and provide on-site oversight. NR, PC, and SP wrote the initial manuscript. All the authors provided comments on the drafts and have read and approved the final version.
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The authors declare that they have no competing interests.
Ethics approval and consent to participate
The protocol was approved by the Institutional Review Boards/Ethics Committees (IRB/ECs) at NIMHANS, Yale University, and the Indian Council of Medical Research (ICMR); each participant provided written informed consent prior to participant enrolment and at each call recording. To ensure that the study minimised risks to the respondents, several safeguards were taken including a detailed consent process that involved explaining risks of having a mobile phone (such as questions from husband and family and inadvertent disclosure). Written standard operating procedures were in place to guide staff on necessary actions if women report suicidality, serious mental health concerns, and/or interpersonal violence during any assessment or during the intervention. A password was provided to the participant to ensure that the phone calls were being attended only by the respondent and the respondent was required to say the password before each telephonic session is initiated. In addition, calls were made only at respondents’ convenience.
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Chandra, P.S., Parameshwaran, S., Satyanarayana, V.A. et al. I have no peace of mind—psychosocial distress expressed by rural women living with HIV in India as part of a mobile health intervention—a qualitative study. Arch Womens Ment Health 21, 525–531 (2018). https://doi.org/10.1007/s00737-018-0827-0
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DOI: https://doi.org/10.1007/s00737-018-0827-0