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      The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

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          Abstract

          The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders.

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          Most cited references30

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          If it changes it must be a process: study of emotion and coping during three stages of a college examination.

          This natural experiment provides substantial evidence for the following major themes, which are based on a cognitively oriented, process-centered theory of stress and coping: First, a stressful encounter should be viewed as a dynamic, unfolding process, not as a static, unitary event. Emotion and coping (including the use of social support) were assessed at three stages of a midterm examination: the anticipation stage before the exam, the waiting stage after the exam and before grades were announced, and after grades were posted. For the group as a whole there were significant changes in emotions and coping (including the use of social support) across the three stages. Second, people experience seemingly contradictory emotions and states of mind during every stage of an encounter. In this study, for example, subjects experienced both threat emotions and challege emotions. The complexity of emotions and their cognitive appraisals reflects ambiguity regarding the multifaceted nature of the exam and its meanings, especially during the anticipation stage. Third, coping is a complex process. On the average, subjects used combinations of most of the available forms of problem-focused coping and emotion-focused coping at every stage of the exam. Different forms of coping were salient during the anticipation and waiting stages. Problem-focused coping and emphasizing the positive were more prominent during the former, and distancing more prominent during the latter. Finally, despite normatively shared emotional reactions at each stage, substantial individual differences remained. Using selected appraisal and coping variables, and taking grade point averages (GPA) into account, approximately 48% of the variances in threat and challenge emotions at the anticipation stage was explained. Controlling for variance due to the grade received, appraisal, and coping variables accounted for 28% of the variance in positive and negative emotions at the outcome stage. Including grade, 57% of the variance in positive emotions at outcome and 61% of the negative emotions at outcome were explained.
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            The theory of planned behavior: a review of its applications to health-related behaviors.

            To review applications of Ajzen's theory of planned behavior in the domain of health and to verify the efficiency of the theory to explain and predict health-related behaviors. Most material has been drawn from Current Contents (Social and Behavioral Sciences and Clinical Medicine) from 1985 to date, together with all peer-reviewed articles cited in the publications thus identified. The results indicated that the theory performs very well for the explanation of intention; an averaged R2 of .41 was observed. Attitude toward the action and perceived behavioral control were most often the significant variables responsible for this explained variation in intention. The prediction of behavior yielded an averaged R2 of .34. Intention remained the most important predictor, but in half of the studies reviewed perceived behavioral control significantly added to the prediction. The efficiency of the model seems to be quite good for explaining intention, perceived behavioral control being as important as attitude across health-related behavior categories. The efficiency of the theory, however, varies between health-related behavior categories.
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              Psychiatric illness in family practice.

              One hundred twenty patients from each of 6 family practices were surveyed to determine the prevalence of symptom-based psychiatric illness (emotional distress) in family practice. Assessments of presence or absence of emotional distress and the severity of this distress were made using ratings made by the treating physician and by the patient. Nineteen percent of the surveyed patients were designated by their physicians as having "high distress," and 21% by the patient-completed abbreviated Hopkins Symptom Checklist (HSCL-25). High concordance (86.7%) existed between the "case" assessment by the physician and the patient's own rating of distress. For the majority of "high distress" patients, pharmacotherapy was considered the treatment of choice by physicians.
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                Author and article information

                Contributors
                +31-43-3882414 , +31-43-3884211 , hermien.boon@maastrichtuniversity.nl
                Journal
                J Cross Cult Gerontol
                Journal of Cross-Cultural Gerontology
                Springer US (Boston )
                0169-3816
                1573-0719
                8 October 2009
                December 2009
                : 24
                : 4
                : 373-389
                Affiliations
                [1 ]Health Promotion Research and Development Unit, Medical Research Council, Cape Town, South Africa
                [2 ]Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
                [3 ]Department of Health Promotion and Health Education, Maastricht University, Maastricht, The Netherlands
                [4 ]Horizons, Population Council, Johannesburg, South Africa
                [5 ]Department of Work & Social Psychology, Faculty of Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
                Article
                9101
                10.1007/s10823-009-9101-2
                2784496
                19813083
                661930d6-868c-48d6-80e3-f45d1cea4631
                © The Author(s) 2009
                History
                Categories
                Original Article
                Custom metadata
                © Springer Science+Business Media, LLC 2009

                Geriatric medicine
                south africa,hiv,older people,aids,care-giving
                Geriatric medicine
                south africa, hiv, older people, aids, care-giving

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