HIV diagnosis during pregnancy: stress, coping strategies and experiences of women at selected health facilities in Lusaka district, Zambia.
| dc.contributor.author | Sianchapa, Brenda Nambala | |
| dc.date.accessioned | 2025-06-27T14:19:18Z | |
| dc.date.available | 2025-06-27T14:19:18Z | |
| dc.date.issued | 2024 | |
| dc.description | Thesis of Doctor of Philosophy in Midwifery. | |
| dc.description.abstract | Background: A diagnosis of HIV usually causes stress in the affected individual because of its lack of cure. In an effort to eliminate mother-to-child transmission (eMTCT) of HIV, pregnant women have to undergo HIV testing during antenatal care. Pregnancy is a sensitive and stressful state as the body of the pregnant woman has to make adjustments throughout in order to maintain the pregnancy and prepare for labour and delivery; and the puerperium. A diagnosis of HIV during pregnancy therefore adds on to this stress. A pregnant woman who is diagnosed HIV positive requires assistance in order to cope positively with the HIV diagnosis and its effects. When positive coping strategies are used, the levels of stress begin to dissipate. Study aim: The study aimed to ascertain the stress levels, coping strategies and experiences of women diagnosed HIV positive during pregnancy at selected Health facilities in Lusaka district, Zambia Methods: A longitudinal mixed methods design was used to collect panel data in 3 stages. Stage 1 of the study was done during the participants’s second antenatal visit at around 14-20 weeks gestation, stage 2 was done at around 28-32 weeks’gestation and stage 3 was done at six weeks postdelivery. The quantitative arm used a longitudinal analytical design, while the qualitative arm used a descriptive cross-sectional design. The study population were pregnant women who tested HIV positive for the first time during their current pregnancy, and 100% enumeration was used to select 110 participants for the quantitative data, and out of these, purposive sampling was employed to select 17 participants, for the qualitative data collection. The Perceived Stress Scale (PSS) and Coping Strategy Indicator (CSI) were used to collect quantitative data on the levels of stress and the coping strategies used respectively. The stress levels were measured during all the 3 stages of the study and the coping strategies were categorised during stage 2 and 3 of the study. Stress levels were categorised into high, moderate or low, while coping strategies were either problem focused or emotion focused. The problem focused coping was subdivided into problem focused (problem solving) and problem focused (seeking social support). Quantitative data analysis was conducted using the Statistical Package for Social Sciences (SPSS) Version 26. Descriptive statistics were used to report participants’ demographic characteristics as well as the levels of stress and coping strategies that they used at each assessment period. A Wilcoxon matched pairs signed rank test tested for differences in stress levels at Stages 1 and 2 of the study, and Kruskal-Wallis test determined the relationship between the coping strategy used and the stress levels. Post hoc comparisons were conducted using Mann-Whitney tests to compare the differences in stress levels among the coping strategies that were used. Qualitative data were collected using a semi structured interview schedule during stage 3 of the study and were analysed manually, using the Braun and Clarke 6-phase coding framework for thematic analysis, which included; familiarisation, coding, generating themes, reviewing themes, defining and naming themes, and writing up. Findings: The major findings revealed that 57.3%, 65.6%, and 37.5% of the participants had moderate levels of stress at stages 1, 2 and 3 of the study respectively. This was followed by those who had high levels of stress (26.4%, 14.4 and 12.5%) at stages 1, 2 and 3 of the study respectively. Over half (54.5 and 62.5%) of participants utilised problem focused (problem solving) coping strategy at stages 2 and 3 of the study respectively. There was a statistically significant median difference between the perceived stress scale (stage 1) and perceived stress scale (stage 2). We therefore rejected the null hypothesis and concluded that the difference between the rank totals of 34.91 (A), 30.71 (B) and 46.43 (C) were significant, H (2, n=73(=6.75, p=.034. There was a statistically significant association between the coping strategy and the levels of stress at stage 2 of the study (p=.001). Post hoc comparisons were conducted using Mann- Whitney tests with a Bonferroni adjusted alpha level of .016 (0.05/3). The difference between the Problem solving group and the seeking social support group was statistically significant (z=-21.252, p=.002), Problem solving group and Emotion focused group (z=-33.327, p=.001). Kruskal Wallis test revealed a statistically significant association between stress levels and Health facility at Stage 1 (p=.038). Post hoc comparisons using Mann Whitney tests with a Bonferroni adjusted alpha level of .016 (0.05/3) were conducted and revealed a statistically significant difference between the Kanyama and the George group (z=24.638, p=.038). There was also a statistically significant association between participant’s age and stress levels at both stage 1 and 2 of the study (U=627.000, p=.012 at stage 1 and U=498.500, p=.015 at stage 2). Thematic analysis was conducted on qualitative data and 8 themes emerged which explained the participants’ experiences. Among them were; stress of an HIV diagnosis, ART adherence, disclosure of an HIV diagnosis, staff behaviour, mother baby interaction, and resilience and moving on. Conclusion: The study revealed that women who are diagnosed with HIV during pregnancy experience stress, and the coping strategy that they utilise determines the increase or reduction of the stress levels. The study recommends the use of the Perceived Stress Scale, and Coping Strategy Indicator at every antenatal and postnatal visit for women diagnosed HIV positive during pregnancy. This will help to identify those who are stressed and enable individualised care to help them to cope; and those using maladaptive coping, to help them employ coping strategies that can help them deal with the stress. Key words: stress, HIV diagnosis in pregnancy, coping strategy, mother-baby bonding | |
| dc.identifier.uri | https://dspace.unza.zm/handle/123456789/9230 | |
| dc.language.iso | en | |
| dc.publisher | The University of Zambia | |
| dc.title | HIV diagnosis during pregnancy: stress, coping strategies and experiences of women at selected health facilities in Lusaka district, Zambia. | |
| dc.type | Thesis |