Caiola Courtney, Barroso Julie, Docherty Sharron L
Courtney Caiola, PhD, MPH, RN, was a Doctoral Student, Duke University School of Nursing, at the time the research was completed. She is now Assistant Professor, Family and Community Nursing, School of Nursing, University of North Carolina at Greensboro. Julie Barroso, PhD, ANP-BC, RN, FAAN, is Professor and Chair, Department of Nursing, Medical University of South Carolina, St. Charleston. Sharron L. Docherty, PhD, PNP-BC, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina.
Nurs Res. 2017 May/Jun;66(3):209-221. doi: 10.1097/NNR.0000000000000213.
The disparate health outcomes of African American mothers living with HIV are considerable. Multidimensional approaches are needed to address the complex social and economic conditions of their lives, collectively known as the social determinants of health.
The purpose of this study was to explore the social determinants of health for African American mothers living with HIV by examining how mothers describe their social location at the intersection of gender, race, and class inequality; HIV-related stigma; and motherhood. How they frame the impact of their social location on their health experiences is explored.
This exploratory study included in-depth, semistructured interviews with 18 African American mothers living with HIV at three time points. We used an intersectional framework and frame analysis to explore the meaning of these constructs for participants.
Findings from 48 interviews include a description of the intersecting social determinants functioning as systems of inequality and the heterogeneous social locations. Three frames of social location were used to organize and explain how African American mothers living with HIV may understand their social determinants of health: (a) an emancipatory frame, marked by attempts to transcend the negative social connotations associated with HIV and socially constructed identities of race, gender, and class; (b) a maternal frame, marked by a desire to maintain a positive maternal identity and maternal-child relations; and (c) an internalized frame, marked by an emphasis on the deleterious and stigmatizing effects of HIV, racial, gender, and class inequality.
The findings offer knowledge about the heterogeneity in how demographically similar individuals frame their social location as well as how the intersections of social determinants influence participant's health experiences. Potential health implications and interventions are suggested for the three frames of social location used to describe intersecting social determinants of health. The study offers an analytic approach for capturing the complexity inherent in intersectional methodologies examining the role of social determinants in producing health inequities.
感染艾滋病毒的非裔美国母亲的健康状况差异很大。需要采取多维度方法来应对她们生活中复杂的社会和经济状况，这些状况统称为健康的社会决定因素。
本研究的目的是通过考察感染艾滋病毒的非裔美国母亲如何描述她们在性别、种族和阶级不平等交叉点上的社会位置、与艾滋病毒相关的耻辱感以及母亲身份，来探索她们健康的社会决定因素。探讨她们如何构建其社会位置对健康体验的影响。
这项探索性研究包括在三个时间点对18名感染艾滋病毒的非裔美国母亲进行深入的半结构化访谈。我们使用交叉性框架和框架分析来探讨这些结构对参与者的意义。
48次访谈的结果包括对作为不平等系统发挥作用的交叉社会决定因素以及异质社会位置的描述。社会位置的三个框架被用来组织和解释感染艾滋病毒的非裔美国母亲如何理解她们健康的社会决定因素：(a) 解放框架，其特征是试图超越与艾滋病毒相关的负面社会内涵以及种族、性别和阶级的社会建构身份；(b) 母亲框架，其特征是渴望维持积极的母亲身份和母婴关系；(c) 内化框架，其特征是强调艾滋病毒、种族、性别和阶级不平等的有害和污名化影响。
研究结果提供了关于人口统计学上相似的个体如何构建其社会位置的异质性，以及社会决定因素的交叉如何影响参与者健康体验的知识。针对用于描述健康交叉社会决定因素的社会位置的三个框架，提出了潜在的健康影响和干预措施。该研究提供了一种分析方法，用于捕捉交叉性方法中固有的复杂性，该方法考察社会决定因素在产生健康不平等方面的作用。
