Browsing by Author "Wouters, Edwin"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    HIV/AIDS competent households: Interaction between a health-enabling environment and community-based treatment adherence support for people living with HIV/AIDS in South Africa
    (Public Library of Science, 2016) Masquillier, Caroline; Wouters, Edwin; Mortelmans, Dimitri; van Wyk, Brian Eduard; Hausler, Harry; Van Damme, Wim
    In the context of severe human resource shortages in HIV care, task-shifting and especially community-based support are increasingly being cited as potential means of providing durable care to chronic HIV patients. Socio-ecological theory clearly stipulates that–in all social interventions–the interrelatedness and interdependency between individuals and their immediate social contexts should be taken into account. People living with HIV/AIDS (PLWHA) seldom live in isolation, yet community-based interventions for supporting chronic HIV patients have largely ignored the social contexts in which they are implemented. Research is thus required to investigate such community-based support within its context. The aim of this study is to address this research gap by examining the way in which HIV/ AIDS competence in the household hampers or facilitates community-based treatment adherence support. The data was analyzed carefully in accordance with the Grounded Theory procedures, using Nvivo 10. More specifically, we analyzed field notes from participatory observations conducted during 48 community-based treatment adherence support sessions in townships on the outskirts of Cape Town, transcripts of 32 audio-recorded indepth interviews with PLWHA and transcripts of 4 focus group discussions with 36 community health workers (CHWs). Despite the fact that the CHWs try to present themselves as not being openly associated with HIV/AIDS services, results show that the presence of a CHW is often seen as a marker of the disease. Depending on the HIV/AIDS competence in the household, this association can challenge the patient’s hybrid identity management and his/her attempt to regulate the interference of the household in the disease management. The results deepen our understanding of how the degree of HIV/AIDS competence present in a PLWHA’s household affects the manner in which the CHW can perform his or her job and the associated benefits for the patient and his/her household members. In this respect, a household with a high level of HIV/AIDS competence will be more receptive to treatment adherence support, as the patient is more likely to allow interaction between the CHW and the household. In contrast, in a household which exhibits limited characteristics of HIV/ AIDS competence, interaction with the treatment adherence supporter may be difficult in the beginning. In such a situation, visits from the CHW threaten the hybrid identity management. If the CHWhandles this situation cautiously and the patient–acting as a gate keeper– allows interaction, the CHW may be able to help the household develop towards HIV/AIDS competence. This would have a more added value compared to a household which was more HIV/AIDS competent from the outset. This study indicates that pre-existing dynamics in a patient’s social environment, such as the HIV/AIDS competence of the household, should be taken into account when designing community-based treatment adherence programs in order to provide long-term quality care, treatment and support in the context of human resource shortages.
  • Thumbnail Image
    Item
    Households in HIV care: designing an intervention to stimulate HIV competency in households in South Africa
    (Frontiers Media S.A., 2020) Dube, Lorraine Tanyaradzwa; Masquillier, Caroline; Wouters, Edwin
    Despite the Universal Test and Treat program and widespread antiretroviral treatment rollout, South Africa is still facing HIV prevention and treatment challenges, which are aggravated by human resource shortages in the healthcare sector. Individual- and community-level responses to these HIV-related challenges are increasingly being explored, for example, in community and home-based care. The role of the household as a crucial mediating social level has, however, largely been omitted. This paper outlines the design of an intervention to stimulate the involvement of the household in support for people living with HIV in South Africa. The 6SQuID model guided the intervention development process in four phases: (1) formative research, theory formulation, and a review of the existing literature, (2) integration of the results from the formative research into the “Positive Communication Process” (P2CP model) as a mechanism of change, (3) design of a community-health-worker-led intervention as the way to deliver the change mechanism, and (4) testing and revision of the developed intervention material—called Sinako—in a small-scale pilot study.
  • Thumbnail Image
    Item
    On the road to HIV/AIDS competence in the household: Building a health-enabling environment for people living with HIV/AIDS
    (MPDI, 2015) Masquillier, Caroline; Wouters, Edwin; Van Wyk, Brian
    When aiming to provide chronic disease care within the context of human resource shortages, we should not only consider the responsibility of the individual person living with HIV/AIDS (PLWHA) but also the capacity of the social environment to actively encourage a lifestyle that fosters health. In this social environment, extensive efforts are thus required to increase HIV/AIDS knowledge, reduce stigma, stimulate HIV testing, improve health care-seeking behavior, and encourage safe sexual practices—described in the literature as the need for AIDS competence. In accordance with socio-ecological theory, one cannot restrict the research focus to communities, as AIDS competence studies should also incorporate the intermediate household level. In responding to this research need, the aim of this article is to conceptualize an “HIV/AIDS competent household” based on qualitative interviews and focus group discussions conducted in a township on the outskirts of Cape Town, South Africa. Our results show that a household’s supportive response to disclosure allows a patient to live openly as HIV positive in the household concerned.
  • Thumbnail Image
    Item
    Testing a self-determination theory model of healthy eating in a South African township
    (Frontiers Media S.A., 2020) De Man, Jeroen; Wouters, Edwin; Delobelle, Peter; Puoane, Thandi; Daivadanam, Meena; Absetz, Pilvikki; Remmen, Roy; van Olmen, Josefien
    Type 2 diabetes (T2D) is one of the leading causes of death and disability, and its prevalence has been growing rapidly in sub-Saharan Africa (International Diabetes Federation, 2017). In response to this T2D pandemic, engaging in healthy lifestyle activities such as healthy eating, can substantially reduce the risk of T2D onset and complications (International Diabetes Federation, 2017). However, maintaining a healthy diet has been shown challenging and motivation is believed to be a crucial factor, also because the benefits are often not immediately apparent (Kwasnicka et al., 2019).