Adjustment to chronic illness among HIV-infected women

Purpose: To identify factors that influence adjustment to chronic illness among HIV-infected women, using the cognitive appraisal model of stress and coping. Design: Cross-sectional descriptive survey of 101 HIV-infected women living in the Northeastern United States, from December 1996 to December 1997. Methods: During face-to-face interviews, the Meaning, of Illness Questionnaire, Duke UNC Functional Social Support Questionnaire, HIV Symptom Experience Inventory and Medical Outcomes Study (MOS) Short Form Survey were used to measure appraisal of illness, social support, HIV symptom severity and adjustment to chronic illness. Hierarchical linear regression, path analysis, and procedures to test for mediation were performed. Findings: The model variables explained 70% of the variance in adjustment to chronic illness. Symptom experience accounted for the greatest percentage of variance in adjustment (28%). Two of the three predicted relationships were supported as hypothesized: adjustment to chronic illness was directly influenced by appraisal of illness and by HIV-symptom experience. Social support was not found to have a direct effect on adjustment. Instead, appraisal of illness mediated the effect of social support on adjustment and symptom experience. HIV illness stage was not a significant predictor of adjustment. Conclusions: The cognitive appraisal model of stress and coping was useful for building knowledge on adjustment to chronic illness, among HIV infected women. Interventions aimed at reframing negative appraisals have the potential to affect adjustment.