Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Debbie L. Humphries

Abstract

Background: By 2015, 50% of all HIV/AIDS cases in the United States will be persons 50-plus years of age. Very little, if any, research has examined resilience in older people living with HIV/AIDS (PLWHA). This research explored the conceptual construct of resilience and investigated the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in PLWHA over fifty.

Methods: Data from a sample of 299 PLWHA over 50 was analyzed using structural equation modeling (SEM) to define a hypothesized Resilience construct (represented by Coping Self-Efficacy, Active Coping, Hope/Optimism and Social Support) and to assess meditating effects of Resilience between Life Stress and three facets of HRQoL (Physical Well-Being, Emotional Well-Being, and Functional and Global Well-Being). In addition, the mediation model was further analyzed to examine moderating effects of demographic variables on the magnitude of mediating effects.

Results: The SEM results showed satisfactory model fit for the Resilience construct, χ2 (18, N = 299) = 41.2, p = .001, and comparative fit index (CFI) = .98, incremental fit index (IFI) = .98, Tucker-Lewis coefficient (TLI) = .96, root mean square error of approximation (RMSEA) =0.066 (95% CI: [.039, .092]), with all factor loading ranging from 0.61 to 0.86. The mediational model demonstrated adequate fit (χ2 (96, N = 299) = 226.9, p < .0001, CFI = .96, IFI = .96, TLI = .95, RMSEA = .068 (95% CI: [.056, .079]) and revealed a full mediating effect of Resilience between Life Stress and Functional and Global Well-Being, as well as partial mediating effects on the relationship between Life Stress and Physical and Emotional Well-Being. What's more, the study found that race and study sites moderated the mediating effects of Resilience, suggesting that Resilience may present differently across race/ethnicity, cultures, and other factors.

Conclusion: The model indicated a well-defined Resilience construct and suggested that resilience may reduce the negative influence of life stress on physical, emotional, functional and global well-being. Findings suggest that the development of culturally-sensitive interventions that build personal capacity and environmental support may contribute to better management of HIV/AIDS and may be more efficacious in increasing HRQoL in older adult PLWHA.

Comments

This is an Open Access Thesis.

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