The Hope Initiative Research Findings in a Sub-Analysis of HIV Positive Women
The Covid-19 pandemic has taught us that even the most thoughtfully designed, evidence-based primary healthcare delivery systems are dependent upon the ability of local health systems to build trust among their community members that facilitate early and ongoing engagement in care and adoption of health recommendations. Hope – characterized by interconnectedness, readiness for change, and future-oriented mindset – plays a critical role in effective primary care delivery by facilitating strong relationships between frontline health workers that motivate frontline health workers to provide high-quality care in a way that inspires trust and engagement of community members. On this World AIDS Day, it is especially important to understand the factors that influence hope among our most vulnerable community members.
Hope influences one’s intrinsic motivation for change, and is critical to sustaining short term behavior change. Sustaining short term gains requires attention to factors that inspire ownership of health outcomes and influence health care workers’ ability to maintain high quality care and health care recipients’ ability to maintain short term health improvements. Hope can be influenced.
TIP developed the Hope Initiative to better understand the influence of health system design on hope among nurses and mothers in rural health centers of Rwanda and the impact of hope among this same population on sustainable improvements in health outcomes. We will use the Hope Index to determine if influencing these factors can increase hope and improve health outcomes. Research shows that hope can be fostered by strengthening interpersonal relationships, providing visual evidence that change is possible, and learning to control one’s symptoms. In the next phase of our work we will assess personal and system factors that influence hope.
TIP conducted a sub-analysis of interviews with HIV-positive women to identify potential variance in the influencers of hopefulness among sub-populations. While themes found were consistent with the findings from the general population across all psychometric properties, some key subthemes were noted more frequently within each factor – interconnectedness, readiness for change, and future orientation.
HIV-positive women highlighted personal relationships and social inclusion as strong facilitators of trust required for interconnectedness. The importance of trust as a facilitator of interconnectedness extended to both other HIV-positive women in the program and the healthcare workers who provide HIV-related services. The healthcare workers who provide HIV services commonly describe mutual respect as a key facilitator of both trust and passion for a role that strengthens their sense of connection with the HIV-positive women they serve.
The HIV-positive women who participated in the research emphasized a healthcare worker’s communication style as a strong facilitator of the trust needed to support readiness for change. Healthcare workers inspire trust by describing the benefit of the recommended change and facilitating problem-solving to overcome barriers. Several healthcare workers who provide HIV services describe the need for space and time to support problem-solving with the women they serve.
Women who are HIV-positive also described prior positive experiences as strong facilitators of one’s ability to set and act upon future goals, and that prior trauma limits one’s ability to set and act upon future goals. This is particularly true regarding their interactions with healthcare workers, where there is great opportunity to address prior trauma and to provide positive experiences that facilitate future orientation.
“Sometimes, when you are sick and you come here, the way [the health worker] welcomes you and treats you only increases your strength or mood and though I am sick and am not feeling well, I will get better just because of how the health worker welcomed me.” – Lydia*, HIV positive woman
Additional sub-analyses in this study include evaluation of responses by socioeconomic strata, geographic location, local infrastructure, and level of external support at the individual and system levels for both frontline health workers and pregnant and breastfeeding mothers. A comparative analysis between primary and secondary respondents is also underway.
The TIP Hope Initiative is dedicated to deeply researching the influence of hope on health outcomes to promote healthy choices, strong health systems, and thriving communities. Combined with TIP’s other solutions, E-Heza Data Solutions and Aheza Fortified Foods, TIP creates innovations of scale that create hope for frontline health workers and the patients they serve each day, leaving no one behind as we create hopeful healthcare systems.
*Name has been changed to protect the participant’s identity
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