Date of Award
Open Access Dissertation
Health Promotion, Education and Behavior
With prolonged lives thanks to antiretroviral therapy, parents living with HIV (PLH) face challenges regarding telling their HIV-positive status to children (i.e., parental HIV disclosure). With aims to assist PLH in making a well-planned and developmentally appropriate HIV disclosure to their uninfected children, a theory-driven intervention was conducted among 791 PLH with children aged between 6-15 years in Guangxi, China.
Guided by the stage model of the Health Action Process Approach (HAPA), three critical disclosure stages were defined: 1) the pre-intention stage, in which people have not yet decided to disclose; 2) the intention stage, in which people have decided to disclose but have not yet started action; 3) the action stage, in which individuals make actual disclosure event. Accordingly, people at the three stages were defined as pre- intenders, intenders, and actors.
Using secondary data from the baseline (W1) and the first two follow-ups (W2 at 6-month and W3 at 12-month) data, this dissertation evaluated the intervention effect on parental HIV disclosure stages and examined the roles disclosure-related psychosocial factors play in the process. Three major research questions were addressed: 1) is there any intervention effect on HIV disclosure stage transition between W2 and W3? 2) is there any intervention effect on disclosure-related psychosocial factors from W1 to W2 and from W2 to W3? 3) do disclosure-related psychosocial factors at W2 yield stage- specific predictive effects on disclosure stage transition from W2 to W3?
To address the first question, a multigroup first-order manifest Markov Chain method was conducted to assess intervention effect on disclosure stage transitions between W2 and W3. Among pre-intenders at the first follow-up, those in the intervention group were more likely to progress to the action stage rather than being static (OR = 3.43, 95% CI 1.17, 10.01). However, no statistically significant intervention effect was detected in promoting progression from pre-intention to intention (OR = 1.02, 95% CI 0.47, 2.20). Among intenders at the first follow-up, no statistically significant intervention effect was detected in preventing backward transition to pre-intention (OR = 0.71, 95% CI 0.35, 1.43) or promoting forward transition to action (OR = 2.01, 95% CI 0.84, 4.79).
To address the rest two questions, a proportional latent change score (LCS) method was used to assess intervention effect on disclosure-related psychosocial factors including knowledge, outcome expectancy (perceived costs and rewards), self-efficacy, and planning. Predictive effects of these psychosocial factors on disclosure stage transitions were examined by treating these factors as covariate in the Markov chain. At the first follow-up, statistically significant intervention effect was detected for disclosure knowledge, action self-efficacy, and action planning but not for disclosure outcome expectancy. Stage-specific predictive effects of action self-efficacy and action planning on HIV disclosure stage transitions were detected.
Findings from the dissertation have significant implications for future studies.
First, the 3-stage HAPA model can be applied to the evaluation of HIV disclosure interventions. Second, the identification of stage-specific psychosocial predictors of stage transition allows the development of stage-matched interventions tailored to their needs.
Da, W.(2019). Applying the Health Action Process Approach (HAPA) in Program Evaluation of a Theory-Based Parental HIV Disclosure Intervention Among Parents Living With HIV (PLH) in China. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/5508