Ghose Toorjo, Ali Samira, Shubert Virginia, Stanton Megan, Walker Lynn, Chaudhuri Sambuddha
J Health Care Poor Underserved. 2019;30(1):182-201. doi: 10.1353/hpu.2019.0015.
A high prevalence of homelessness among women with HIV released from incarceration (WHRI) poses significant challenges to antiretroviral therapy. This research examines the pathways through which housing shapes adherence for previously homeless WHRI. In-depth semi-structured interviews were conducted with 43 WHRI in a supportive transitional housing program. Interviews were analyzed using grounded theory. Housing triggered subjective and material processes that increased adherence. Subjectively, housing increased empowerment, boosted cognitive and emotional re-engagement with post-carceral life, and established health-seeking behavior norms. Materially, housing increased reintegration into community life, reduced exposure to chaos and risk, and increased access to services. Our results suggest how a modified Theory of Planned Behavior (TPB) framework explains adherence by exploring subjective and material facets of TPB. Attitudes were described by subjective re-engagement and material reintegration; norms were established through subjective meaning-making and engagement in services; self-efficacy improved through subjective empowerment and reduction in the material risk environment.
从监狱获释的感染艾滋病毒女性（WHRI）中无家可归现象普遍存在，这给抗逆转录病毒疗法带来了重大挑战。本研究探讨了住房状况影响既往无家可归的WHRI坚持治疗的途径。对参与支持性过渡住房项目的43名WHRI进行了深入的半结构化访谈。采用扎根理论对访谈进行分析。住房引发了主观和物质层面的过程，从而提高了治疗依从性。主观上，住房增强了权能，促进了对出狱后生活的认知和情感重新投入，并确立了寻求健康行为的规范。物质层面上，住房增加了重新融入社区生活的机会，减少了接触混乱和风险的机会，并增加了获得服务的机会。我们的研究结果表明，一个经过修改的计划行为理论（TPB）框架如何通过探索TPB的主观和物质层面来解释治疗依从性。态度通过主观重新投入和物质重新融入来描述；规范通过主观意义构建和参与服务来确立；自我效能通过主观赋权和物质风险环境的降低而提高。
