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Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia

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dc.contributor.author Chipimo, Peter Jay
dc.contributor.author Tuba, Mary
dc.contributor.author Fylkesnes, Knut
dc.date.accessioned 2011-08-18T14:19:13Z
dc.date.available 2011-08-18T14:19:13Z
dc.date.issued 2011-01-10
dc.identifier.citation BMC Health Services Research 11(7) en_US
dc.identifier.issn 1472-6963
dc.identifier.uri http://dx.doi.org/10.1186/1472-6963-11-7
dc.identifier.uri http://hdl.handle.net/1956/4885
dc.description.abstract Background: Mental distress is common in primary care and overrepresented among Human Immunodeficiency virus (HIV)-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models (EM) are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual’s perspective on the illness. Although individual variations are important in determining help-seeking and treatment behaviour patterns, the ability to cope with an illness and quality of life, the role of explanatory models in shaping treatment preferences is undervalued. The aim was to identify explanatory models employed by HIV-infected and uninfected individuals and to compare them with those employed by local health care providers. Furthermore, we aimed to build a theoretical model linking the perception of mental distress to treatment preferences and coping mechanisms. Methods: Qualitative investigation nested in a cross-sectional validation study of 28 (male and female) attendees at four primary care clinics in Lusaka, Zambia, between December 2008 and May 2009. Consecutive clinic attendees were sampled on random days and conceptual models of mental distress were examined, using semistructured interviews, in order to develop a taxonomic model in which each category was associated with a unique pattern of symptoms, treatment preferences and coping strategies. Results: Mental distress was expressed primarily as somatic complaints including headaches, perturbed sleep and autonomic symptoms. Economic difficulties and interpersonal relationship problems were the most common causal models among uninfected individuals. Newly diagnosed HIV patients presented with a high degree of hopelessness and did not value seeking help for their symptoms. Patients not receiving anti-retroviral drugs (ARV) questioned their effectiveness and were equivocal about seeking help. Individuals receiving ARV were best adjusted to their status, expressed hope and valued counseling and support groups. Health care providers reported that 40% of mental distress cases were due to HIV infection. Conclusions: Patient models concerning mental distress are critical to treatment-seeking decisions and coping mechanisms. Mental health interventions should be further researched and prioritized for HIV-infected individuals. en_US
dc.language.iso eng en_US
dc.publisher BioMed Central en
dc.rights Copyright 2011 Chipimo et al; licensee BioMed Central en_US
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_US
dc.title Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia en_US
dc.type Journal article en_US
dc.type Peer reviewed en_US
dc.subject.nsi VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Communicable diseases: 776 en_US
dc.rightsHolder Chipimo et al; licensee BioMed Central en_US
dc.type.version publishedVersion en_US


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