Sense of Coherence and HIV in Southeastern North Carolina
Purpose: Nationally, the rate of HIV diagnoses have stabilized, improved treatment methods have led to a decrease in the mortality rate and an increase in the number of people living with HIV (Centers for Disease Control & Prevention, 2011). An estimated 25,074 people are living with HIV in North Carolina (North Carolina, 2010, p. v). Though they represent 22% of the state’s population, Blacks account for 66% of people living with HIV/AIDs in North Carolina. Sense of coherence is the ability to comprehend, manage and find meaning in the face of chronic illness (Antonovsky, 1987). In terms of living with HIV, sense of coherence facilitates an individual’s quality of life, increases social capital, and lessens psychological stress. The authors examined the contribution of quality of life, social capital, stressful life events, engagement with health care providers, and race, to a sense of coherence in clients who have HIV.
Methods: This cross-sectional study used a purposive sample of people living with HIV (n= 100) in southeastern North Carolina. The sample included 70 Blacks, 29 Non-Blacks, 64 males, 36 females; and the median age was 48 years. They reported similar income (low) and no significant difference in insurance. The composite variables were examined for the assumptions of regression and the reliability estimates ranged from .84 - .96. The analysis included bivariate correlations, multiple regression with an interaction analysis and collinearity diagnostics. While controlling for income and insurance, sense of coherence was regressed on quality of life, social capital, stressful life events, engagement with health provider, race and the interaction, race by engagement.
Results: The model was significant and accounted for 69% of the variance in sense of coherence, F(9, 78) = 19.177, p < .000; R2 = .689; Adj-R2 = .653; SER = .7291, and no multicollinearity was present. The interaction showed that Non-Black clients had a higher sense of coherence facilitated by their engagement with their health care provider than Black clients (β = .151; p = .068, note: Marginal significance is acceptable with interaction terms (Tabachnick & Fidell, 2007)). Quality of life accounted for 48% of the variance in sense of coherence (β = .479; p < .000); trailed by social capital at 27% (β = .272; p= .002). Insurance accounted for 14% of the variance (β = .138; p = .045). Income and stressful life events were not significant.
Implications: Health care provider bias attenuated a sense of coherence in Black clients; and as a consequence, left Black clients more vulnerable to stressful disease experiences than Non-Black clients. An important contextual factor, the health care teams were all White Americans. This study suggested the need for cultural competence training for unintentional expressions of racial bias by health care teams as well as institutional support for increasing the number of Black social work and medical staff working within HIV/AIDs interdisciplinary teams.