Stressors and coping behaviours of caregivers and children across the pediatric HIV-disclosure stages in resource-limited settings
The stressful nature of pediatric HIV disclosure has contributed to the less than optimal disclosure rates in many resource-limited settings. This study examined the presence of disclosure stressors and coping behaviours used by South African caregivers and children during the disclosure phases to promote a healthy disclosure process. Disclosure experiences of 54 caregivers and 27 children (not-dyads) attending HIV-groups in Khyletisha were assessed using the directed approach to content analysis method to identify stressors and coping use. Data from six FGDs and eight IDIs were coded using predetermined coping batteries. 10 disclosure stressors and 12 coping behaviours were identified. Transcripts revealed that the common barriers reported in the literature, like HIV-stigma and caregiver unpreparedness, functioned as stressors influencing the use of coping mechanisms. Identified Adaptive coping strategies included: Social Support, Restraint Coping, Selective Disclosure, Active Coping/Problem Solving, Positive Thinking/Cognitive Restructuring, Religious Coping, Acceptance, and Information seeking, which often encouraged full disclosure, brought resolution to stressful situations, maintained positive self-esteem, or encouraged adherence to ART. Maladaptive coping behaviours included: Behavioural Disengagement, Confrontive Coping, Escape-Avoidance/Tension Reduction, and Suicidal. Throughout the disclosure stages, coping behaviours dynamically changed to perceived consequences/stressors (i.e potential stigmatization) and changing situational dynamics. Coping use and recommendations for disclosure interventions were discussed. Coaching of healthy coping strategies to caregivers and children is essential in combating the stressful nature of disclosure and critical in promoting adequate disclosure processes, outcomes, and timely disclosure.
child disclosure, coping, stressors, HIV, disclosure barriers
Networked Digital Library of Theses and Dissertations
Department of Public Health and Family Medicine