Cross-cultural applicability of the episodic disability framework with adults living with HIV in Ireland: a qualitative study

Abstract

Purpose: To explore the cross-cultural applicability of the Episodic Disability Framework with people living with HIV in Ireland.

Methods: We conducted a qualitative descriptive study using semi-structured interviews. We recruited adults with HIV from a hospital clinic and community-based organization in Dublin, Ireland. We asked participants to describe their health-related challenges, the extent to which these challenges were episodic in nature, and the impact on their overall health. We analyzed data using content analytical techniques.

Results: Of the 12 participants (9 men; 3 women), with a median time since HIV diagnosis of 12 years, 83% had an undetectable viral load. Participants described multi-dimensional and episodic health challenges that spanned disability dimensions in the Episodic Disability Framework including: physical, cognitive, and mental-emotional symptoms and impairments, challenges to social inclusion, and uncertainty or worrying about future health with HIV. Contextual factors that exacerbated disability included stigma and fear of HIV disclosure whereas living strategies (lifestyle, positive outlook, resiliency) and social support (family, friends, health services and providers) mitigated disability.

Conclusions: The Episodic Disability Framework is pertinent to adults living with HIV in Ireland. Contextual factors are critical for understanding cross-cultural distinctions of the disability experience across varying political, economic, socio-cultural, and environmental contexts and should be considered by rehabilitation professionals to address disability for people with HIV.

Implications for rehabilitation

• The Episodic Disability Framework, originally derived and validated from perspectives of adults living with HIV in Canada, is pertinent to people living with HIV in Ireland.

• The Episodic Disability Framework can be used to describe disability experienced by people living with HIV, and to better understand the contextual factors that may exacerbate or alleviate dimensions of disability over time.

• Contextual factors are critical for understanding cross-cultural distinctions of the disability experience across varying political, economic, sociocultural, and environmental contexts, and should be considered by rehabilitation professionals to better address disability for people with HIV.

Keywords:

• Disability evaluation
• HIV
• rehabilitation
• resilience
• psychological
• social stigma

Acknowledgements

The authors thank the adults living with HIV in Dublin, Ireland who participated in the interviews for this study. They also gratefully acknowledge the GUIDE Clinic at St. James’s Hospital and Open Heart House, Dublin, Ireland for their support with recruitment and provision of space to conduct the interviews.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This research was supported by a Dobbin Scholarship from the Ireland Canada University Foundation (ICUF). KKO was supported by a CIHR New Investigator Award at the time of this study. KKO is currently supported by a Canada Research Chair in Episodic Disability and Rehabilitation. The views expressed in this article are those of the authors, and no official endorsement by supporting agencies is intended or should be inferred.