Psychology, University of Southampton, Southampton, UK
Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa.
BMJ Open. 2021 Dec 1;11(12):e047408. doi: 10.1136/bmjopen-2020-047408.
This qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC).
Community setting in Kwa-Zulu Natal, South Africa.
Qualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender.
A couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up.
The transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible.
Many couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors and open discussion of personal barriers to CHTC during couples' counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples' perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs and managing negative emotions.
In-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views.
本定性研究旨在探讨如何优化以夫妇为中心的干预措施，以促进夫妇艾滋病毒检测和咨询（CHTC）。
南非夸祖鲁-纳塔尔省的社区环境。
对 20 对参加以夫妇为中心的干预措施的夫妇和 5 名提供干预措施的工作人员进行了定性访谈。研究人员按照性别对伴侣进行了单独访谈。
先前的研究表明，以夫妇为中心的干预措施包括两个小组会议和四个夫妇咨询会议，可显著提高南非夸祖鲁-纳塔尔省的 CHTC 参与率。然而，在随访期间，超过一半的参与干预措施的夫妇仍选择不一起检测。
使用基于人的方法的变化表分析转录本。与社区小组讨论了拟议的优化措施，以确保干预措施尽可能具有说服力和可接受性。
由于缺乏信任，许多夫妇发现很难与伴侣讨论 CHTC。确定了对干预措施的优化，以增加讨论 CHTC 的准备情况，包括关于血清不一致的教育、由同伴导师进行的 CHTC 讨论以及在夫妇咨询会议期间公开讨论对 CHTC 的个人障碍。为工作人员提供更多关于开放性提问技巧的培训可以帮助他们更舒适地探讨夫妇对 CHTC 的感知障碍，而不是建议夫妇进行检测。开发了一个逻辑模型，以显示预期的机制，通过这些机制，优化后的干预措施将增加对 CHTC 的接受度，包括增加知识、增加对积极结果的信念和管理对 CHTC 的负面情绪。
深入的定性研究为以夫妇为中心的干预措施提供了优化建议，以便在南非进一步评估，以鼓励接受 CHTC。针对在参与者可能不愿意分享负面观点的情况下获得干预体验的开放反馈的最佳方法提出了建议。
