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Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an incurable disease that makes the casualty susceptible and is associated with significant morbidity and mortality despite the availability of treatment and care.HIV/AIDS in Nigeria remains a vital public/ community health issue since Nigeria is a base or environment with many people living with HIV unlike other countries worldwide. The Quality of Life (QoL) of HIV/AIDS patient is crucial as well as the disease progression because of their need for adaption to changes in their lives which include financial & societal changes. Therefore, consideration for improving their quality of life is paramount.Compounding the lack of cure for HIV/AIDS, is the fact that PLWHA are still faced with social support issues. It is in the light of these that the researcher carried out this study to explore perceived social support, and socio demographic variables, as correlates of QoL among Human Immunodeficiency Syndrome Patients in a Teaching Hospital Ogun State.
This study employed a descriptive correlational survey design. A total population 160 People living with HIV/AIDS (PLWHA) participated in the study. World Health Organization Quality of Life Brief Instrument (WHOQOLHIV Bref) and Multidimensional scale for perceived social support were used for data collection. The questionnaire was validated and tested for reliability with overall alpha coefficient 0.8. 160copies of the questionnaire was distributed and 149 was returned making 93% return rate. The analysis involved descriptive & inferential statistics.
The findings from the analysis showed that participant disagree to the kind of social support given (mean=3.65, SD=2.11). Quality of life was moderate and participant averagely dissatisfied with them (mean=3.48, SD=1.21).Spirituality domain has the highest mean score and environment has the lowest mean score. The findings showed that gender, occupation, educational level and HIV serostatus does not influence the QoL of PLWHA. The tested hypotheses using PPMC showed that: there is a statistical significant negative relationship between social support and Quality of life (p<0.05), there is a statistical significant negative relationship between educational level and social support (P=0.027), there is no statistical significant relationship between socio-demographic variable and social support.
The study concluded that social support significantly contributes to the QoL of PLWHA. An improvement in the kind of social support will invariably result in a better Quality of life.
Therefore, it is recommended that appropriate intervention programs in the specific area of social support of PLWHA which will in turn improve Quality of life especially environment aspect. Sectors like housing, works environment should be involved in Quality of life improvement. Also the result from this study may assist Policy makers, health workers, and government in planning and improving overall Quality of life.
Keywords: Social support, Socio-demographic variables, People living with HIV/AIDS, and Quality of Life
Word Count: 438
Title page i
Table of Contents vi
List of Tables ix
List of Figures x
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 4
1.4 Research Questions 4
1.5 Hypotheses 4
1.6 Significance of the Study 5
1.7 Scope of the Study 5
1.8 Operational Definition of Terms 5
CHAPTER TWO: REVIEW OF LITERATURE
2.1 Global overview of HIV/AIDS 6
2.2 Basic facts of HIV/AIDS 6
2.3 Disease Staging of HIV/AIDS 6
2.4 Antiretroviral Therapy adherence and Quality of life 8
2.5 Quality of life assessment 9
2.6 Factors that influence Quality of life 10
2.7 Relationship between perceived social support and Quality of life 12
2.8 Relationship between socio-demographic variables and Quality of life 14
2.9 Empirical studies on Quality ofLife 16
2.10 Conceptual Model 17
CHAPTER THREE: METHODOLOGY
3.1 Research Design 21
3.2 Population 21
3.3 Sample size and sampling Technique 21
3.4 Instrumentation 22
3.5 Validity and Reliability of Instrument 22
3.6 Method of Data Collection 23
3.7 Method of Data Analysis 23
3.8 Ethical Consideration 23
CHAPTER FOUR: DATA ANALYSIS, RESULTS
AND DISCUSSION OF FINDINGS
4.0. Introduction 25
4.1 Presentation of Results: Socio-demographic information of respondent 24
4.2 Analysis of Research Questions 26
4.3 Hypothses Testing 32
4.4 Discussion of Findings 34
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.0 Introduction 39
5.1 Summary 39
5.2 Conclusion 40
5.3 Recommendations 41
5.4 Contribution to Knowledge 42
5.5 Limitation of the Study 42
5.6 Suggestion for Further Studies 42
LIST OF TABLES
4.1 Respondent’s Demographic characteristics 25
4.2 Perceived social support of PLWHA 26
4.3 Quality of life of People living with HIV/AIDS 28
4.4a Model Summary for the influence of Gender on Quality of life of PLWHA 30
4.4b Simple linear Regression showing influence of Gender on Quality of life 30
4.5a Model Summary for the influence of educational level on Quality of life of PLWHA 31
4.5b Simple linear Regression showing influence of educational level on Quality of life 31
4.6a Model Summary for the influence of occupation on Quality of life of PLWHA 31
4.6b Simple linear Regression showing influence of occupation on Quality of life 31
4.7a Model Summary for the influence of HIV serostatus on Quality of life of PLWHA 32
4.7b Simple linear Regression showing the influence of Gender on Quality of life 32
4.8 Pearson Product Moment Correlation (PPMC) showing relationship between social
support and quality of life 33
4.9 PPMC showing relationship between Quality of life and socio-demographic variables 33
4.10PPMC showing relationship between social support and socio-demographic variables 34
LIST OF FIGURES
2.1 Adapted Conceptual model of Quality of life among People Living with HIV/AIDS 19
AIDS Acquired Immune Deficiency Syndrome
HIV/AIDS Human Immunodeficiency Virus
NACA National Action Committee on AIDS
OOUTH Olabisi Onabanjo University Teaching Hospital
PLWHA People Living with HIV/AIDS
QoL Quality of Life
WHO World Health Organisation
WHOQoL-HIV World Health Organisation Quality of life for HIV
1.1 Background to the study
Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) is a pandemic disease in which the body’s defense mechanism is weak and this makes the body unable to get rid of infection (NACA, 2001). HIV/AIDS is an incurable diseases that makes the casualty susceptible (Rajeev, 2012), and is associated with significant morbidity and mortality despite the availability of treatment and care. (Smeltzer, Bare, Hinkle & Cheever, 2010).
As at the end of 2015 – 36.7 million people probably were living with the virus, 2.1 million people were nearly infected; 1.1 million people died from the disease; and 18.2 million people were accessing ART as June 2016. Since the beginning of the epidemic, over 78 million people have become infected; and 3.5 million have died from AIDS related diseases thus challenging improvements to world health today (UNAIDS, 2016). In sub Saharan Africa about 21 million people are living with HIV/AIDS and 32% of this population are presently on ART as at 2012 (UNAIDS, 2013). Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to about 3.5 million people from about 141 million of the total population (UNAIDS, 2016).
Nigeria is Africa most populous country with 140,4311,790 population figure as at the last census, and is also rated as tenth largest country in the world with the approximate estimation of 55% literate and 70% poor in the population (UNAIDS, WHO & Nigerian Population Comission 2009). Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to about 2.6 million people from about 141 million of the total population (UNAIDS, 2008). Another report from NACA (2009) statistics shows average 4.6% prevalence HIV rate among Nigerians (NACA, 2009). HIV/AIDS in Nigeria remains a vital public/ community health issue since Nigeria is a base or environment with many people living with HIV with South Africa prevalence 19.2% as at the end of 2015 (UNAIDS, 2016). The widespread of this disease has negative effect on the psychosocial, cultural, and developmental aspects of life, which makes the diseases a critical public health issue (UNAIDS, 2008).
One of the variables to be measured in this study is social support which has been associated to better Quality of Life among PLWHA in different studies (Khumaseen, Aoup-por & Thammachak, 2012). Social support is defined as “the view or experience that one is loved and cared for by others, esteemed and valued, and part of a social network of mutual assistance and obligations” (Taylor, 2007, p. 145). Social support assistance, user fees friendly, good patient – health workers relationship can help to curb non-adherence. An in-depth knowledge of the multifaceted interrelationship of the biological sociological factors is required to understand non-adherence, and Quality of life thus creating avenue for more effective non-adherence intervention programs (Olowookere, et al, 2012). Also, Adedimeji & Odutolu (2007) in a quantitative research to determine the extent to which certain factors contribute to improvement in QoL of PLWHA reported that availability of care and social support from spouse friends and family members yielded good QoL with 93%. Social support services is limited and lacking in this country and this makes evaluation of the wellbeing and longetivity of PLWHA important as to how individual perceive their own health using different instrument such as WHOQOL HIV BREF version instrument. (Folasire, Irabor & Folasire 2013).
The incurable and pandemic nature of HIV/AIDS calls for mobilization of resources such as human, money & material resources to improve quality of life among PLWHA. HIVAIDS is a serious humanitarian problem that could affect the physical, psychological, social status of PLWHA. The Quality of Life (QoL) of HIV/AIDS patient is crucial as well as the disease progression because of their need for adaption to changes in their lives which include financial & societal changes. Therefore, consideration for improving their quality of life is paramount (Fan, Kuo, Kao, Morisky & Chen 2011). According to World Health Organization (2005) quality of life is described as individual’s perceptions of their position in the life in the context of culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns.
The indicator of physical, mental, social, and spiritual, wellbeing is Health Related Quality of life and this could serve as means of measuring the total wellbeing of PLWHA which include their functions and perceptions based on life experiences (Malucclo, Palemo, Kadliyala, & Rawat, 2015). However, the HRQOL is regarded as non-medical aspect of living example psychosocial, socio economic aspect etc (Trana, Ohinmaaa, Nguyen, Nguyen & Nguyen, 2011). Advances in the management of HIV/AIDS makes it a chronic condition thereby causing reduction in morbidity and mortality thus improves QoL (Millard, Elliott, Slavin, McDonald, Rowell, & Girdler 2014). As HIV treatment and care worldwide is moving from emergency to longer term strategies management, there are structural and contextual factors that influence the outcome of this intervention. The factors include individual, facility based, environmental/cultural etc (Aidala, Wilson, Shubert, Gogolishvili, Globerman, Rueda, et al, 2016).
The changes that result from HIV care and Management conote that individual with the diseases should take responsibility for themselves since it is now a chronic condition. Thus this will help to prevent disability and improve QoL (Millard et al, 2014). In the care and management of HIV/AIDS wholistic approach is needed to promptly address issues since it remains a chronic diseases. The stress and fear that accompany the diseases has been reduced since it has been addressed in relation to other aspects of life. Focus should now be shifted or adjusted to how individual adjusts to symptoms (Buseh, Kelber, Stevens, & Park, 2008), and Health related QOL which is a determinant of overall personal health (Krause, Butler, & May, 2013).
According to United States Department of Health and Human Services (HHS) (2011), The two overarching goals of Healthy people 2020 include (1.) Improving the overall quality of life (2.) Improving the health of all groups. The QoL of PLWHA can be traced to the increase in life span of infected individuals due to availability and access to ART. Socio economic conditions of individuals with HI/AIDS can alter QoL thereby affecting health-seeking behaviours (Mawar, Katendra, Bagul,.Bembalker, Vedamurthachar, Tripathy, et al., 2015). Another variable of interest in this study is demographic factors which have been proven to improve quality of life and are seen as determinant of quality of life. Socio demographic charasteristics like income level, Marital status, educational level, occupation when investigated among PLWHA in China was found to influence quality of life which means people with higher income and are married tend to show positive quality of life.( Rajeev etal.., 2012). The explanation for this could be as a result of the knowledge gained from the exposure in the workplace which could impact quality of life. Also employment among other demographic factors like gender, higher income, and gender are associated with improved quality of life as seen among PLWHA in India (Basavaraj etal.., 2010). The reason for the employment may be a source of income, care and social support to the individual that are affected which means having a good job may directly or indirectly improve QoL.
1.2 Statement of the Problem
In Nigeria, Joint United Program on HIV/AIDS (2014) reported estimated National HIV prevalence of 4.6% and Nigeria is said to be the 2nd in Africa in terms of People Living with HIV/AIDS (PLWHA) Africa with over 3.2 million (UNAIDS, 2014). Compounding the lack of cure for HIV/AIDS is the fact that PLWHA are still faced with social support issues even being a predictor of QoL. PLWHA are also faced with Poor Quality of Life which has been attributed to certain socio demographic variables like lack of social support system or dissatisfaction with the perceived social support given. Kehinde, Fatiregun, & Osagbemi (2013) reported that certain sociodemographic/ economic factors like occupation, income, educational level have been proven to impact QoL where low income and low educational level brings about poor QoL among the HIV/AIDS patient in Kogii state of Nigeria (Kehinde, Fatiregun & Osagbemi, 2013). Also, gender difference has been documented to influence QoL being a major predictor of QoL where statistical result revealed lower score of QoL among men (Sanyang, 2011). People still struggle with coping with AIDS and related diseases in the recent times and this called for evaluating QoL among PLWHA (Oliveira, Moura, Araujo, & Andrade, 2015). Moreover, limited information about QoL is a major problem in African setting even with ART in place for PLWHA. Little or no information on QoL has been documented in Ogun state despite the high prevalence of 6.1 % which is believed to be one of the highest in the south west Geopolitical zone in Nigeria (NACA, 2014).
It is in the light of these that the researcher is carrying out this study to explore perceived social support, and socio demographic variables as correlates of Quality of life among Human Immunodeficiency Syndrome patients in a teaching hospital, Ogun State.
1.3 Objective of the Study
The main objective of this study is to explore perceived social support, and socio demographic variables as correlates of Quality of life among Human Immunodeficiency Syndrome patients in a teaching hospital, Ogun State.
The specific objectives are to:
1.4 Research Questions
1.6 Significance of the Study
The findings of this study could contribute to what is known and create an avenue for future research especially in settings with high prevalence rate. To inform healthcare practitioner on the importance of quality of life assessment and ways for improvement. Also, findings from this study should guide in practice especially in developing sustainable intervention program that would improve Quality of Life of PLWHA. This study would help to combat HIV pandemic and its associated problem by exploring perceived social support, socio demographic variables as correlates of Quality of life among Human Immunodeficiency Syndrome Patients. Also, the results of this study would provide more information to healthcare practitioners and the general public about the physical & total wellbeing / overall functionality of PLWHA and provide more evidence regarding the use of the WHO HIV Quality of Life Brief version tool in the study setting.
1.7 Scope of the Study
This study is looking into People living with HIV/AIDS (PLWHA) and to accomplish the objective stated above the Researcher’s consideration is based on quality of life and associated factors. The study tends to cover Quality of life, factors that influence or impact the QOL among PLWHA.
It is only limited to HIV positive patient in Olabisi Onabanjo University Teaching Hospital excluding children.
1.8 Operational Definition of Terms
Social Support: Any direct or indirect support or assistance gotten from family, friends or significant orders like colleagues, healthcare workers etc. for example someone that provide help when the person is in need.
Socio demographic Variables: They are socio economic characteristics like gender, educational level, occupation, marital staus and income
Quality of Life (QOL): Perceived quality assessment of individual wellbeing that includes all emotional, social, physical aspects of life. OR degree to which individual enjoys important possibities of his /her life OR is the product of interplay among social health economic and environmental conditions which affect human and social development.
Human immunodeficiency syndrome Patient: They are individuals male and female that are diagnosed of HIV/Acquired Immune deficiency Syndrome excluding children also PLWHA.
A Teaching Hospital: This is Olabisi Onabanjo University Teaching Hospital Sagamu Ogun State. Precisely the virology clinic set aside for treating and addressing the needs of HIV positive patients