College of Behavioral & Social Sciences
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Item Patient and provider perceptions of a peer-delivered intervention (‘Khanya’) to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis(Cambridge University Press, 2022-08-26) Rose, Alexandra L.; Belus, Jennifer M.; Hines, Abigail C.; Barrie, Issmatu; Regenauer, Kristen S.; Andersen, Lena S.; Joska, John A.; Ciya, Nonceba; Ndamase, Sibabalwe; Myers, Bronwyn; Safren, Steven A.; Magidson, Jessica F.Background. Despite a high prevalence of problematic substance use among people living with HIV in South Africa, there remains limited access to substance use services within the HIV care system. To address this gap, our team previously developed and adapted a six-session, peer-delivered problem-solving and behavioral activation-based intervention (Khanya) to improve HIV medication adherence and reduce substance use in Cape Town. This study evaluated patient and provider perspectives on the intervention to inform implementation and future adaptation. Methods. Following intervention completion, we conducted semi-structured individual interviews with patients (n = 23) and providers (n = 9) to understand perspectives on the feasibility, acceptability, and appropriateness of Khanya and its implementation by a peer. Patients also quantitatively ranked the usefulness of individual intervention components (problem solving for medication adherence ‘Life-Steps’, behavioral activation, mindfulness training, and relapse prevention) at post-treatment and six months follow-up, which we triangulated with qualitative feedback to examine convergence and divergence across methods. Results. Patients and providers reported high overall acceptability, feasibility, and appropriateness of Khanya, although there were several feasibility challenges. Mindfulness and Life-Steps were identified as particularly acceptable, feasible, and appropriate components by patients across methods, whereas relapse prevention strategies were less salient. Behavioral activation results were less consistent across methods. Conclusions. Findings underscore the importance of examining patients’ perspectives on specific intervention components within intervention packages. While mindfulness training and peer delivery models were positively perceived by consumers, they are rarely used within taskshared behavioral interventions in low- and middle-income countries.Item Attachment Security, Mindfulness, and Psychotherapy: Testing a Mediational Model(2008-07-31) Ma, Yueher; Gelso, Charles J.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Previous research shows theoretical and/or empirical support for the relation between attachment security and adaptive functioning, between mindfulness and adaptive functioning, as well as between attachment security and mindfulness. Besides, mindfulness is considered to be theoretically similar to several constructs that has been identified as significant mediators in the relation between attachment security and positive life adaptations (e.g., reflective functioning, affect regulation strategies). The present study mainly examined whether mindfulness mediated the relation between attachment security and adaptive functioning in a clinical sample that consisted of students from a large mid-Atlantic university (N = 90, M (age)= 20.96, SD = 3.15). According to the participants' retrospective pre-therapy and current post-therapy self-report ratings, significant associations were discovered between attachment security and adaptive functioning, between mindfulness and adaptive functioning, as well as between attachment security and mindfulness before and after therapy. Also, the results supported the mediating role of mindfulness in the link between attachment security and adaptive functioning both prior and subsequent to therapy. Limitations of this study, directions for future research, and implications for clinical practice were discussed.