应用社会生态学模型解析HIV感染妇女告知子女感染状态的心理行为研究

Extensive studies have shown that disclosing maternal HIV status to children by HIV-infected mothers could improve the quality of life effectively. It is a cost-effective way to reduce the impact of AIDS on children. However, there is uncertainty about the status quo and the demand of disclosure between HIV-infected mothers and their children. Meanwhile, it is important to explore on how and the extent which various levels of factors, such as individual, social networks and social environment would be associated with disclosure. .The study would combine qualitative and quantitative methods in identifying the process and factors associated with disclosure. Longitudinal research would be developed and factors related to background information, psychological and emotional aspects, social networks, and health services utilization of HIV-infected mothers would be explored. The research would also examine willingness to disclose, disclosure behaviour, and need. Multi-level regression equation would be adopted to explore the impact and strength of different factors towards disclosure of maternal HIV status to children. Structural equation model will be tested and multi-level social ecological model would be built to explain and analyse the disclosure mechanism in depth. The study provides an in-depth understanding on the need and factors associated with disclosure of HIV-infected mothers, which has a great potential to serve as a scientific base to the health promotion strategies in HIV disclosure. The study will explore and supplement the new growth points in public health disciplines such as maternal and child health and disease prevention.

HIV感染妇女对子女告知感染状况，可有效提高其生活质量，对降低艾滋病对儿童的影响具有明显的成本效益。但HIV感染母亲对子女的告知现状及需求尚不明确；同时，个体、人际网络和社会环境等不同纬度因素对告知的影响及强度值得探索。. 本研究拟采用定性与定量研究相结合的方法。通过队列随访研究，收集HIV感染母亲的背景信息、心理、情绪、社会关系、卫生服务利用等；同时了解其告知意愿、行为与需求。选择多水平回归方程，系统评估不同因素对HIV感染母亲告知子女的影响及强度；筛选变量入选结构方程模型，构建多层次社会生态学理论解释模型，深入剖析告知的机制。研究关注HIV感染母亲的深度需求，前瞻性的探索建立告知心理行为与妇幼保健策略之间的模型，为国际这一研究领域提供重要的中国科学数据，探索和补充了妇幼保健和疾病预防等公共卫生学科新的生长点。

HIV感染妇女对子女告知感染状况，可有效提高其生活质量，对降低艾滋病对儿童的影响具有明显的成本效益。但HIV感染母亲对子女的告知现状及需求尚不明确；同时，个体、人际网络和社会环境等不同纬度因素对告知的影响及强度值得探索。本研究拟采用定性与定量研究相结合的方法。通过队列随访研究，收集HIV感染母亲的背景信息、心理、情绪、社会关系、卫生服务利用等；同时了解其告知意愿、行为与需求。338名研究对象中，有69名受访者在基线前已向至少一名年龄>5岁的子女告知了他们的HIV感染状态(20.4%)。56.2%和50.4%的参与者分别表现出至少轻度或以上的抑郁和焦虑症状。研究成功构建社会生态学模型，家庭功能与自我效能呈负相关（β=-0.25），而护理专业人员的同理心与正面预期（β=-0.15）和自我效能（β=-0.12）呈负相关。此外，负面预期负面预测告知意愿（β=-0.14），而正面预期(β=0.17）和自我效能感（β=0.39）正面预测第三次的艾滋病告知意愿。该研究关注HIV感染母亲的深度需求，前瞻性的探索建立了告知心理行为与妇幼保健策略之间的模型，为国际这一研究领域提供重要的中国科学数据，探索和补充了妇幼保健和疾病预防等公共卫生学科新的生长点。