Relationships Between Dimensions of Disability Experienced by Adults Living with HIV: A Structural Equation Model Analysis

O’Brien, Kelly K; Davis, Aileen M.; Gardner, Sandra; Bayoumi, Ahmed M.; Rueda, Sergio; Hart, Trevor A.; Cooper, Curtis; Solomon, Patricia; Rourke, Sean B.; Hanna, Steven

doi:10.1007/s10461-012-0363-2

Cited by 12 publications

(16 citation statements)

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“…Incorporating health into the priority reflected the transition of HIV into a chronic disease, and the need to adopt a more health-oriented approach and promote self-management strategies. Evidence has explored the experience of episodic disability and relationships between dimensions of disability [ 10 ],[ 42 ], however the episodic nature of disability has not been examined longitudinally. Evidence on the barriers and facilitators to employment, and importance of employment as it relates to physical and mental health, has articulated the need for rehabilitation interventions, programs and policies to enhance the ability to recruit and retain people living with HIV in the employment sector [ 43 ]-[ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation

et al. 2014

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BackgroundHIV increasingly is experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed ‘disability’. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation.MethodsWe convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques.ResultsNinety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy.ConclusionsThese priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0724-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation

et al. 2014

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“…The exploratory factor analysis in this study supports the notion that HIV-related stigma comprises three latent structures for adults living with HIV in Florida. [16][17][18][19][20][21][22][23][24][25] to inform the development of the 10-item scale, the scale has not been psychometrically evaluated in samples of adults living with HIV. Our work suggests that adult PLWH in Florida may report the experience of stigma differently than youth.…”

Section: Exploratory Factor Analysismentioning

confidence: 99%

“…The experience of overall HIV-related stigma was significantly associated with persons living with disability and depression. There is a small amount of work examining persons with disability and HIV-related stigma [21][22][23], which identified that stigma may exacerbate or alleviate episodes of disability. This may be because people with disabilities face significant barriers to HIV programming and services, including lack of access to health care services, sexual, or reproductive education, poverty, and challenges to social inclusion compared to those who are not disabled [24].…”

Section: Overall Stigmamentioning

confidence: 99%

The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015–2016

et al. 2020

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Background: Human Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma. Methods: We analyzed secondary data from the 2015-2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale. Results: Multivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38-7.13) and persons with disability (OR: 1.64; CI: 1.03-2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15-3.56) depression (OR: 2.81; CI: 1.38-5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31-0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20-7.65), severe depression (OR: 2.87; CI: 1.38-5.98), identified as Black (OR: 0.60; CI: 0.37-0.98), non-injection drug use (OR: 0.55; CI: 0.33-0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09-0.82). Personalized stigma was not associated with any of the variables examined. Conclusions: The implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.

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“…We examined relationships between components of disability using data from the Ontario HIV Treatment Network Cohort Study (OCS) using variables that resembled dimensions of disability within the Episodic Disability Framework, such as scores from symptom and quality of life questionnaires [18]. Results from this analysis indicated that physical and mental health challenges and difficulties carrying out daily activities either directly or indirectly predicted having challenges with social participation.…”

Section: Introductionmentioning

confidence: 99%

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

et al. 2019

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Background People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as ‘disability’. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. Methods We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2–0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. Results Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). Conclusions Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions. Electronic supplementary material The online version of this article (10.1186/s12879-019-4203-0) contains supplementary material, which is available to authorized users.

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Relationships Between Dimensions of Disability Experienced by Adults Living with HIV: A Structural Equation Model Analysis

Cited by 12 publications

References 58 publications

Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation

Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation

The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015–2016

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

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