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British Journal of Healthcare and Medical Research - Vol. 10, No. 6
Publication Date: December 25, 2023
DOI:10.14738/bjhmr.106.15955.
Sianchapa, B. N., Katowa-Mukwato, P., & Ngoma, C. M. (2023). Stress Levels and Coping Strategies Among Women Diagnosed with
HIV During Pregnancy at Selected Health Facilities in Lusaka District, Zambia. British Journal of Healthcare and Medical Research,
Vol - 10(6). 103-117.
Services for Science and Education – United Kingdom
Stress Levels and Coping Strategies Among Women Diagnosed
with HIV During Pregnancy at Selected Health Facilities in Lusaka
District, Zambia
Brenda Nambala Sianchapa
The University of Zambia, School of Nursing Sciences,
Department of Midwifery, Women’s and Child Health, Lusaka, Zambia
Patricia Katowa-Mukwato
The University of Zambia, School of Nursing Sciences,
Department of Basic and Clinical Nursing Sciences, Lusaka, Zambia
Catherine M. Ngoma
The University of Zambia, School of Nursing Sciences,
Department of Midwifery, Women’s, and Child Health, Lusaka, Zambia
ABSTRACT
Background: In an effort to eliminate mother-to-child transmission of HIV, pregnant
women undergo HIV testing during antenatal care. A diagnosis of HIV adds to the
stress of pregnancy. When mothers diagnosed HIV positive during pregnancy utilize
effective coping strategies, the stress levels decrease. Aim: To measure the levels of
stress and categorise the coping strategies among women diagnosed with HIV
during pregnancy. Methodology: An analytical longitudinal study design was used.
Panel studies were used to collect data in 3 stages. Census sampling was done in
selecting 110 study participants. The levels of stress were measured using the
Perceived Stress scale adapted from Cohen, 1983, and the coping strategies were
categorised using the Coping Strategy Indicator adapted from Armikhan, 1990. The
Statistical Package for Social Sciences Version 26 was used to analyse data. Major
findings: Majority of participants (57.3%, 65.6%, and 37.5%) had moderate levels
of stress at stages 1, 2 and 3 of the study respectively. Majority utilised Problem
focused (problem solving) coping (54.4 and 62.5%) at stages 2 and 3 of the study
respectively. Kruskal-Wallis test indicated significant difference between the
coping strategy used and the stress levels at stage 2 of the study [χ2 (2) = 23.708, p
= .001]. Conclusion: The study recommends the use of the Perceived Stress Scale
and Coping Strategy Indicator at every antenatal and postnatal visit for women
diagnosed HIV positive during pregnancy, to identify those who are stressed and
those who use maladaptive coping in order to assist them to cope.
Keywords: stress, HIV diagnosis during pregnancy, coping strategy
INTRODUCTION
The Human Immuno-Deficiency Virus (HIV) is a blood-borne virus that is spread, largely,
through unprotected sexual intercourse, and to a child from an infected mother. The virus seeks
and destroys CD4+ cells, a type of T-lymphocyte which is critical to the immune system and is
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 6, December- 2023
Services for Science and Education – United Kingdom
responsible for warding off infections and diseases. [1]. Individuals who would like to know
their HIV status usually undergo Voluntary Counselling and Testing (VCT), and may postpone
the VCT to a time when they are more prepared for the test and results. However, in an effort
to eliminate mother-to-child transmission (eMTCT) of HIV, pregnant women undergo HIV
testing during antenatal care. Pregnancy is a sensitive and stressful state as the pregnant
woman is in a specific stage of her biological, psychological, and social development, and her
body is adjusting in order to maintain the pregnancy and prepare for labour and delivery; and
the puerperium [2]. As pregnant women undergo HIV testing, a diagnosis of HIV infection may
be made during a routine antenatal care visit, when the woman may not have prepared
adequately for the test and results, and receiving the diagnosis can lead to stress and other
effects [3, 4].
The stress of an HIV positive diagnosis during pregnancy can be made bearable when the
affected woman is assisted to cope with her condition. All antenatal clinics are equipped to offer
post-test counselling to women who have tested positive for HIV during pregnancy where they
are informed of the HIV resources available to them and are usually enrolled in HIV care. When
a mother diagnosed with HIV infection during pregnancy utilizes effective coping strategies,
their internalized stigma and depression decrease, and self-esteem increases [3]. Those who
employ negative ways of coping may resort to harmful behaviours, like substance abuse, or
simply denying that they have the virus [5].
Many studies have been conducted on HIV, leading to a lot of discoveries and successes in
handling HIV infected individuals. However, even if there have been important medical
advances in the management of HIV, there are still psychosocial problems that can be as hard
to deal with as the illness itself. For many people, it is a stigmatizing condition which makes the
burden of illness more difficult to bear leading to stress. There was a dearth of knowledge on
levels of stress experienced by women diagnosed with HIV during pregnancy, and the coping
strategies that they use in Lusaka district.
This study therefore aimed to measure the levels of stress in women diagnosed HIV positive
during pregnancy, and categorise the coping strategies that they use, in order to provide
guidelines for caring for them, including their families, in view of their stressful diagnosis in a
stressful state.
Specific Objectives
The specific objectives of this study were to;
1. Measure the levels of stress in women diagnosed with HIV infection during pregnancy
at selected Health facilities in Lusaka district.
2. Categorise the coping strategies used by women diagnosed with HIV during pregnancy
at selected Health facilities in Lusaka district.
Hypotheses
The following hypotheses were tested;
1. Null hypothesis: There is no association between coping mechanisms used by women
diagnosed with HIV during pregnancy and their stress levels.
2. Null hypothesis: There is no association between the levels of stress and the
participants’ demographic variables.
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Sianchapa, B. N., Katowa-Mukwato, P., & Ngoma, C. M. (2023). Stress Levels and Coping Strategies Among Women Diagnosed with HIV During
Pregnancy at Selected Health Facilities in Lusaka District, Zambia. British Journal of Healthcare and Medical Research, Vol - 10(6). 103-117.
URL: http://dx.doi.org/10.14738/bjhmr.106.15955.
MATERIALS AND METHODS
Design and Setting
Panel studies were conducted in three stages using an analytical longitudinal study design [6].
Stage 1 was recruitment and measuring the stress levels in women coming for antenatal revisits
who had been diagnosed HIV positive during their booking visit. The stress levels were
measured again at stages 2 and 3 of the study which were conducted at 32 to 36 weeks’
pregnancy and at 6 weeks post-delivery respectively. The coping strategies were categorised at
stages 2 and 3 of the study. The study was conducted at selected urban Health facilities of
Lusaka district, which included Chilenje level 1 hospital, Kanyama level 1 hospital and George
Health centre. All the three facilities offer Maternal and Child Health services on a daily basis.
Data were collected in private rooms that were provided by each of the health facilities.
Sampling Technique
The health facilities were purposively selected. The Census Sampling method was used to select
110 women seeking 2nd visit antenatal care services, who tested HIV positive for the first time
during their antenatal booking visit and these were also followed up at Stage 2 and 3 of the
study.
Participants
Women were included in the study if they were pregnant and tested HIV positive for the first
time at the booking visit during their current pregnancy and were willing to take part in the
study. Women who were suffering from other complications or medical conditions during
pregnancy, or experiencing any pregnancy danger sign during their second antenatal visit were
excluded from the study.
Procedures
Data Collection Tool:
The Perceived Stress Scale (PSS) adapted from Sheldon Cohen (1983) was used to collect data
during all stages of the study and measured the stress levels that women were experiencing at
different stages of their pregnancy and after delivery. The tool, which has 5 scales of
measurement was adapted by adding the phrase, ‘HIV diagnosis during pregnancy’ on a number
of its items. The Coping Strategy Indicator (CSI) adapted from Amirkhan, 1990 was used to
categorise the coping strategies during stage 2 and 3 of the study. It is a 33 item 3-point self- report rating scale designed to assess 3 basic modes of coping (Problem solving, seeking social
support and Avoidance) and indicates how people cope with stressful situations in life. In this
study, seeking social support was categorized under Problem focused coping in relation to the
theoretical model. The tool was adapted by adding the phrase, ‘keeping HIV diagnosis in mind’
in the opening sentence.
Data Collection Technique:
Data were collected in eleven months, from March, 2022 to January, 2023. The data collection
instruments were always administered after all the examinations for the particular visit had
been conducted. The participants were identified by the Midwife conducting the examinations,
and thereafter escorted to the interview room by the same midwife. Stickers were put on the
participants’ antenatal card at enrolment into the study, for easy identification during the
subsequent visits. The researcher began by introducing self and explaining the purpose of the
study to each woman diagnosed HIV positive during their current pregnancy. If they agreed to