Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence.

This pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.

Self-awareness as the key to successful adherence to antiretroviral therapy among people living with HIV in Indonesia: A grounded theory study.

Background: Adherence to antiretroviral therapy (ART) continues to pose a significant challenge for people living with HIV (PLWH). Non-adherence to ART can have far-reaching implications for patient well-being, particularly in increasing the risk of opportunistic infections when medication is not taken as prescribed. Objective: This study aimed to develop a theoretical model that explains how PLWH in Indonesia adhere to their ART regimen and the strategies they follow to maintain adherence. Methods: The study used a grounded theory approach. Data were collected through face-to-face in-depth interviews with 21 PLWH who had been taking ART for six months or more at a non-governmental organization (NGO) in Jakarta, Indonesia, between July 2019 and November 2019. Theoretical sampling was used, and the data analysis method of Corbin and Strauss was utilized, including open coding, axis coding, and selective coding. Results: Three stages were identified as a process of adherence to the ART regimen: 1) initiating ART, 2) missing the connection, and 3) taking control. Self-awareness was identified as the central core theme describing the ART adherence process. Conclusion: Having adequate self-awareness to take ART regularly is crucial to improving adherence to ART. Moreover, social support from one's spouse and family members can help patients maintain adherence. Therefore, self-awareness and support systems should be included as components in nursing interventions when starting ART therapy. In addition, nurses can help identify potential support persons and provide information related to ART therapy.

Classifying stigma experience of women living with HIV in Indonesia through the social ecological model.

Little is known how stigma theories apply to women living with HIV (WLWH). To apply stigma theories to WLWH, and locate within the dimensions of the Social-Ecological Model (SEM). Using a literature review and a theoretical subtraction to apply stigma forms to the SEM dimensions. WLWH begin to self-stigmatize, receive stigma based on fear from the family and community. Healthcare providers and society stigmatize WLWH by ascribing character flaws to them. The SEM allowed us to locate the dimensions of stigma and identify areas for future interventions for WLWH in Indonesia and other countries.

Gaining a "normal life": HIV-positive Indonesian female injection drug users in drug recovery.

The number of female injection drug users in Indonesia is rapidly increasing. This study explores the experiences of women living with HIV in recovery from heroin injection. Using a ground theory approach, 22 women former drug users in Jakarta participated in this study. Six themes emerged: the challenges of quitting, the role of self-motivation, the utility of methadone treatment, the importance of partner and family support, the transformation of "self" and situation, and the rewards of a normal life if successful. These women's accounts point to the personal and cultural challenges that they faced as women, wives, and mothers.

A Content Analysis Study: Concerns of Indonesian Women Infected With HIV by Husbands Who Used Intravenous Drugs.

Few international studies document the concerns of women living with HIV (WLWH) who were infected by their intravenous drug-using husbands. Our content analysis described the concerns of this population by analyzing 12 interviews with WLWH. Three main concerns were discussed by the women: dealing with anger and being a dedicated wife, going home to one's parents as the only place to go, and being strong and staying alive for the children. Dealing with their own emotional responses to the HIV diagnosis, lacking financial resources after the husband's death, and remaining focused on staying healthy were major issues in their stories. Indonesia needs large-scale public HIV education campaigns about the risks women encounter as wives to husbands who use intravenous drugs as well as campaigns to educate husbands about their risks. Nurses need to encourage women to get tested during prenatal care to prevent infecting their children.

Feasibility of an iPad application for studying menopause-related symptom clusters and women's heuristics.

PURPOSE: To evaluate feasibility, including usability and utility, of the Computerized Symptom Capture Tool for Menopause (C-SCAT-M), a symptom heuristics application (app) for the iPad, with midlife women. METHODS: Thirty midlife women aged 40-60 and experiencing symptoms they associated with menopause were recruited through flyers posted on a university campus, primary care and women's health clinics. The C-SCAT-M guided participants to identify symptoms they experienced, draw temporal and causal relationships between symptoms and identify symptom clusters. Women were encouraged to think aloud as they encountered questions or problems and their comments were audio recorded. After completing the C-SCAT-M, they completed a 22-item acceptability survey and a demographic survey. Data were downloaded from catalyst website and analyzed using SPSS. RESULTS: Women completed the C-SCAT-M with minimal difficulty, with most indicating that using the app was very/extremely easy and most (57%) preferred using the iPad app to paper. Most women stated that the final diagrams were very/extremely accurate depictions of their symptom clusters and relationships (77%). CONCLUSION: The C-SCAT-M demonstrated initial feasibility, including usability and utility, for collecting data about symptom clusters experienced by midlife women.

Midlife women's symptom cluster heuristics: evaluation of an iPad application for data collection.

OBJECTIVE: This study aims to elicit midlife women's heuristics about symptom clusters they were experiencing, as identified by the Computerized Symptom Capture Tool for Menopause (C-SCAT M). METHODS: Women aged 40 to 60 years who were experiencing symptoms that they associated with menopause were recruited through flyers posted on campus and in clinics. Women completed the C-SCAT M application (app), using an iPad, by identifying and drawing symptom clusters they experienced during the last 24 hours, indicating relationships among symptoms, prioritizing the clusters and symptoms within them, making causal attributions, and identifying exacerbating and ameliorating factors. They were asked to prioritize the clusters and a symptom within each cluster. While women were completing the app, they were asked to "think aloud" about their experience using the app. Data generated from the C-SCAT M app were transmitted securely to an Amazon Web Services account and saved as screen images and Excel files to preserve both graphical images and text elicited from the app. Qualitative data were saved in verbatim phrases. Conventional content analysis was used to analyze qualitative data. RESULTS: Thirty women completed the app. Most women (77%) stated that the final diagrams were very/extremely accurate in depicting their symptoms and their connections. Women reported between 1 and 22 symptoms (median, 11). Hot flashes, waking up during the night, night sweats, and early morning awakening were the most commonly reported symptoms. Women rated hot flashes as their most bothersome symptom, followed by waking up during the night and fatigue. They reported more than 300 different bivariate relationships between their symptoms and more than 150 unique causal paths. They believed that hot flashes caused several symptoms, especially sleep disruption, and most could describe the time order of their symptoms. Women reported clusters consisting of 2 to 18 symptoms. Women also named each cluster based on their response to their symptoms ("really annoying"), time of occurrence ("night problem"), and symptoms included in the cluster ("hot flash"). They attributed their clusters to menopause, life demands, and other symptoms, among other causes. Management strategies that women used included over-the-counter preparations, sleep, rest, and other lifestyle changes. Some women requested for a copy of their final symptom cluster diagram to discuss with their healthcare providers. CONCLUSIONS: Use of the C-SCAT M affords women an opportunity to depict their symptoms and clusters and the relationships between them and to provide narrative data about their heuristics. Women's unsolicited comments about using the cluster diagram to facilitate conversations (about their symptoms) with their healthcare providers suggest the potential value of modifying the C-SCAT M and evaluating its use in a healthcare setting.

Effects of isoflavones and amino acid therapies for hot flashes and co-occurring symptoms during the menopausal transition and early postmenopause: a systematic review.

AIMS: Review controlled clinical trials of isoflavones and amino acid preparation effects on hot flashes and at least one other symptom including mood, sleep, pain, and cognitive function that women report during the menopausal transition and early postmenopause. METHODS: An experienced reference librarian searched PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for English-language randomized controlled trials between 2004 and July 2011. Seventeen trials of isoflavones and amino acid effects on hot flashes and one additional symptom were identified. RESULTS: In five trials of soy isoflavone preparations, two (6g soy germ extract and 25 g soy protein in soy nuts) significantly decreased hot flashes, but no other symptoms. In the seven trials of other isoflavones, six significantly reduced hot flashes; in addition, red clover (80 mg) significantly reduced mood symptoms; Rexflavone (350 mg) for women with Kupperman Index>20 significantly reduced sleep symptoms; two trials had significant reductions for pain: isoflavone powder (90 mg) and red clover (80 mg). The only trial in this systematic review that significantly reduced cognitive symptoms was red clover (80 mg). In one trial, red clover isoflavone (80 mg/day) significantly relieved hot flashes, mood, pain, and cognitive symptoms. Amino acids yielded no significant results. Equol supplements of 30 mg/day for non-Equol producing women significantly reduced mood symptoms in one trial. The magnolia bark extract combination significantly reduced hot flashes, mood, and sleep symptoms. CONCLUSIONS: Isoflavone trials yielded significant reductions on hot flashes and co-occurring symptoms during the menopausal transition and postmenopause, but studies require replication with larger sample sizes and attention to measurement of outcomes.