Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial.

Objective: To examine the effectiveness of a family-based program for post-stroke patients and their families. Methods: A cluster randomized controlled trial design was used. Participants were randomly selected in the experimental group (3 districts) and the comparison group (3 districts), with 62 families recruited. Sixty-two persons with new stroke and families (family caregivers and family members) who met the inclusion criteria were assigned to two groups, 31 in each group. Using the Neuman System Model as a framework, we implemented the stressors assessment and family-based intervention into the program. Participants in the comparison group received usual care, and those in the experimental group underwent a stressors assessment and received the family-based program. Measurement of functional status, depression, and complications in post-stroke patients and family function in family caregivers and family members, as well as caregiver burden and caregiver stress in family caregivers, were assessed at baseline, 4 weeks, and 12 weeks after enrollment. Data analysis included descriptive statistics, the chi-square test, Bonferroni test, and repeated measures analysis of variance. Results: After participating in a 12-week family-based program, post-stroke patients in the experimental group showed statistically significant improvements in their functional status and decreased depression compared to the comparison group (P < 0.05). The family function of the experimental group was significantly improved, and caregivers' burden and stress were decreased compared to the comparison group (P < 0.05). Three patients in the experimental group and seven in the comparison group experienced complications. Conclusions: The study findings suggest that the present family-based program improved family function in family caregivers and family members and decreased caregiver burden and stress in family caregivers. The program also improved functional status and reduced depression in post-stroke patients. It is suggested the duration of the program be extended to assess its sustainable effectiveness.

The life experiences of Thai women and smoking: a phenomenological study.

OBJECTIVE: Exploring and understanding the live experiences of women smokers as well as the conditions and the family/social context of Thai society. MATERIAL AND METHOD: A phenomenological approach was used and conducted from July 2011 to April 2012. The informants were 25 Thai women smokers in Bangkok and peripheral areas. Data were collected from focus group discussions and indepth interviews and was analyzed using Diekelmann and Love thematic analysis. RESULTS: The informants ranged in age from 14 to 66 years. The highest education level was a Vocational Certificate and the lowest level was a primary education (Grade 4). The youngest began smoking at 12 years. The average duration of smoking behavior was 22.3 years; the longest of smoking duration was 52 years. They smoked 2.4 packs of cigarettes per day on average, 6 packs per day at the maximum. Within a family setting, the highest number of people smoking and living in the same household was 13 persons. Five themes were identified as follows: 1) the starting point of smoking:-the family environment triggers smoking; 2) the meaning of smoking:-smoking means 'cigarettes are like friends ', 3) femininity and smoking.:-smoking is an individual right and is not illegal; 4) smoking and health:-smoking-health linkage is not an immediate issue as the informants did not suffer from any serious illness; and 5) view on/intention to stop smoking:-the permanent cessation of smoking was not possible due to the current environment in which their friends or family members still smoked, and because some also chose to reduce their stress by smoking. CONCLUSION: Family environment and peer group influenced the informants smoking behavior Children see their grandmother mother or elder sister smoke, so smoking is perceived as normal behavior among women as well. Most of them had chosen cigarette smoking as a way to relieve themselves from stressful environments.

Suffering and hope, the lived experiences of Thai HIV positive pregnant women: a phenomenological approach.

OBJECTIVE: To understand the meaning and interpret descriptions about the lived experiences of Thai pregnant women with HIV positive and to discover essential themes in the context of Thai socio-economic and health care service system. MATERIAL AND METHOD: A phenomenological approach was used. Sixteen HIV positive pregnant women volunteered to participate from June 2005 to June 2006. Data were collected through unstructured multiple in-depth individual interviews, observation, field-note, tape recorded and transcribed, and analyzed thematically. RESULTS: Two patterns emerged: first was a pattern of suffering, secondly, was a pattern of hope. Suffering was caused by fear of condemnation from their spouses, and by fear of disappointing their larger families. Moreover; the suffering was exacerbated by feelings of uncertainty for the sickness in the future, worry about the discrimination and stigmatization of their children, self-blaming and a feeling desperation. Within the pattern of hope, these women hoped for their unborn babies to be healthy and free from HIV infection. Furthermore, they hoped to live as long as possible in order to care for their children, and they hoped that someday they would be accepted by the community and be able to live in harmony. CONCLUSION: This study formed 2 patterns of the lived experiences among Thai HIV positive pregnant women. Interventions through health promotion programs to encourage the development of skills for positive coping and therapeutic self-care to help them endure suffering and support women's hopes to live longer for their children by changing to healthy patterns of behavior.

Sexual behaviors during antiretroviral therapy among HIV-infected patients, Thailand.

An increasing trend in sexual risk behavior has occurred in the era of antiretroviral therapy (ART) in Thailand. This study was conducted to identify sexual risk behavior and examine relationships between unprotected sex and CD4 levels among HIV-infected patients receiving ART in the National Antiretroviral Program. A cross-sectional survey was conducted in 460 HIV-infected patients age 18-49 years who visited the out-patient clinic of Bamrasnaradura Infectious Diseases Institute in February 2006 by using a standardized self-administered questionnaire. The results show that 60.4% of participants were men. The median most recent CD4 cell count during the prior 6 months was 261 cells/mm3. Twenty-three percent of the participants who had no sexual activity after they knew their HIV positive status started having sex again after receiving ART with a 12-week median duration period from starting ART to having first sex. There was a significant difference between the number of those having sexual activity before and after starting ART (p-value=0.013). Fifty-six percent of participants had sex during the previous 6 months. Of these, 26.5% had sex with commercial partners and 28.4% with non-regular partners. Inconsistent condom use, with commercial partners or non-regular partners, in females (35.3-36.8%) was higher than in males (7.8-11.1%). Participants with a known HIV-negative regular partner were 0.25 times more likely to have unprotected sex than those with a known HIV-positive regular partner (adjusted OR, 0.25; 95%CI, 0.09-0.73). No association between unprotected sex and CD4 levels was found. The findings support the need for reinforcing risk reduction programs among HIV-infected persons, particularly couple counseling, and promoting awareness of risk of acquirring sexually transmitted infections and drug-resistant strains of HIV.