Stigma Consciousness, Coping Strategies And Cd4 Counts Of Persons With Hiv/aids

Another instrument which measured problem coping is Ways of Coping Inventory (Folkman & Lazarus, 1980). The instrument has eight items. The instrument measured problem coping on dimensions of problem focus and problem avoidance. Problem focus has four items and problem avoidance has also four items. Problem focus measures include items, such as I knew what had to be done and worked hard at it; and problem avoidance, I avoided the situation. (see Appendix A, items marked R). The instrument was found reliable r(32)=.62 Cronbach alpha, (see appendix E ).

Finally, the fourth instrument was information coping scale, (Kalichman et al, 2006). The scale measured information seeking and avoidance. Information seeking has three items and information avoidance has two items (items marked R). The items on information seeking were modified to reduce ambiguity. The items include “I feel like knowing what my medical treatment plan is; I can run as many medical tests as required: And, I can look up information for medications. Information avoidance items include, I would do as my doctor said without questions. And, I would do all that I could to block the negative news from my mind. Kalichman et al (2006) reported information – coping scales to be internally consistent ( >.75). The validity is not questionable.

However, following its scant use in this culture (Nigeria), the researcher re-standardized the instrument in another pilot study by administering it to 40 PLWHA. The data collected were subjected to factor analysis, using principal component analysis with Varimax rotation. The result revealed factor loading for the 8 items with eigenvalue of .1 and above for all the 8 items. Also, internal consistency of the items to measure coping strategies was ascertained by subjecting data for analysis using Cronbach alpha method. The results revealed coefficient of .65 alpha, (See Appendix D). The four instruments were scored on 5-point options of strongly agree highest = 5 and strongly disagree lowest = 1. The scorings were based on one progressive direction, indicating that the higher the score, the higher an individual is considered on all the four measures of stigma consciousness, social support, information coping and problem coping. Negative items marked (R) were reversed in scoring.

Procedure

The instruments on stigma consciousness, social support, information coping, and problem coping were used as part of routine evaluations during adherence counseling. Since people living with HIV/AIDS are familiar with adherence counseling as they attend routine antiretroviral therapy, after assurances of confidentiality of responses, there was no objection to respond to the administration of the instruments during data collection. Before administering the questionnaire items, their current CD4 counts, age, and gender were extracted from their respective hospital folders (files containing personal information of patients in and out of hospital).

So, the instruments on stigma consciousness, social support, information coping, problem coping, and provision for information on bio-data (e.g. age and gender) were administered to the participants individually. Besides, information was collected on method of treatment. At the end, the questionnaires were collected back from them on the spot. Data collection lasted for two months simultaneously in all the selected ART sites with the assistance of adherence counsellors attached to the ART sites.

Design/method of data analysis

This is a survey study with complex design and has immune system measured using CD4 count as dependent variable (DV). Archival method, in which measures of the participants’ CD4 counts were collected from ART records, was used in collecting data for the dependent variable. Independent variables (IVs) are stigma consciousness, social support, information coping, and problem coping. The independent variables were manipulated at two levels each (high and low) using independent groups design and were measured using reliable and validated questionnaires. Thus, 2 groups of stigma consciousness (low and high) X 2 groups of social support (low and high) X 2 groups of information coping (information seeking and avoidance) X 2 groups of problem coping (problem focus and avoidance) factorial design resulting to 16 treatment conditions or cells was adopted. Use of drugs for treatment by PLWHA, that is administration of Anti-Retroviral Therapy (ART), can influence immune functioning among PLWHA. ART implies taking anti-retroviral drugs as agreed with the doctor. Thus, treatment was used as a covariate to control for influence of ARV and was measured on two levels thus, using drugs and not using drugs.

The four instruments, stigma consciousness, social support, information coping, and problem coping were scored on 5-point options of strongly agreed (SA), agree (A), undecided (UD), disagree (D), and strongly disagree (SD). The responses were converted to numerical values so that SA = 5, A = 4, UD = 3, D = 2 and SD = 1. Mean and standard deviation scores were computed to determine high and low levels of stigma consciousness and social support, those who seek information and those who avoid information, and those who focus on problem and those who avoid problem. For stigma consciousness measure, the lowest possible score was 10 while the highest possible score should be 50 since the instrument has 10 items scored on 5-point options. Thus, the median score was used to determine high and low levels of stigma consciousness. Those who scored below the median were adjudged low stigma conscious while those who scored above the median were labeled high stigma conscious. So, scores between 10 and 29 were regarded as low stigma consciousness while scores between 30 and 50 were labeled high stigma consciousness.

The same method was applied to low and high levels of social support. The lowest possible score was 15 while the highest possible score was 75 since there were 15 items rated on 1 - 5 continuums. Thus, those who scored between 15 and 45 were adjudged low social support while those who scored between 46 and 75 were labeled high social support.

Also, the same method was further applied to information coping and problem coping. For information coping, the least possible score was 5 and the highest possible score was 25 since the instrument has 5 items scored on 5 – point option. Thus, the median score was used to determine information seeking and avoidance. Scores between 5 and 14 were adjudged as information avoidance while scores between 15 and 25 were labeled information seeking.

The same method was applied to problem coping. Those who scored between 8 and 23 were adjudged problem avoidance while those that scored between 24 and 40 were regarded as being problem focus.