Identifying barriers and facilitators to psychosocial care for people living with HIV in Ireland: a mixed methods study

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Abstract

Background

The effectiveness of antiretroviral therapy means that human immunodeficiency virus (HIV) can now be defined as a manageable chronic illness. It is the facilitation of psychosocial care that has increasingly become a priority, as people living with HIV (PLWH) are disproportionately impacted by psychosocial stressors compared to the general population. The aim of this study was to identify barriers and facilitators to psychosocial care for PLWH in Ireland.

Methods

A mixed methods study design was used, employing a national survey of PLWH ( n = 54) via Qualtrics and semi-structured interviews with healthcare professionals that provide clinical support to PLWH across Ireland ( n = 11). Content analysis was used to analyse the interviews.

Results

More than half (59.3%) of survey respondents agreed that living with HIV currently impacts their mental health, with nearly two thirds (64.8%) agreeing that they have experienced stigma as a result of living with HIV. Less than half (40.7%) were comfortable disclosing their status to family, and less than a third (27.8%) to friends. Stigma was identified by healthcare professionals as a barrier to psychosocial care, along with a number of system-level barriers, provider-level or practical barriers, and individual barriers. The value of multidisciplinary care teams and reliance on community support was emphasised, and potential for further integration of support services was highlighted.

Conclusion

Community-based organisations contribute significantly to the facilitation of psychosocial support for PLWH in Ireland, and greater integration of community services could promote a more holistic, patient-centred approach to meeting the diverse needs of this growing cohort. PLWH benefit from multidisciplinary care teams, and the facilitation of safe and effective peer support should be encouraged to afford opportunities to disclose and receive social support. HIV-related stigma remains a barrier to psychosocial care, highlighting the need for stigma reduction interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-21906-1.

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Most cited references 52

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Three approaches to qualitative content analysis.

Hsiu-Fang Hsieh, Sarah Shannon (2016)

Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.

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Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.

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Three studies are described in which measures of perceived social support from friends (PSS-Fr) and from family (PSS-Fa) were developed and validated. The PSS measures were internally consistent and appeared to measure valid constructs that were separate from each other and from network measures. PSS-Fr and PSS-Fa were both inversely related to symptoms of distress and psychopathology but the relationship was stronger for PSS-Fa. PSS-Fr was more closely related to social competence. PSS-Fa was unaffected by either positive or negative mood states (self-statements), but the reporting of PSS-Fr was lowered by negative mood states. High PSS-Fr subjects were significantly lower in trait anxiety and talked about themselves more to friends and sibs than low PSS-Fr subjects. Low PSS-Fa subjects showed marked verbal inhibition with sibs.

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Author and article information

Contributors

Aoife Burke: aoife.burke@ucc.ie

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 20 February 2025

Publication date PMC-release: 20 February 2025

Publication date Collection: 2025

Volume: 25

Electronic Location Identifier: 707

Affiliations

[1 ]School of Public Health, College of Medicine and Health, University College Cork, ( https://ror.org/03265fv13) Cork, Ireland

[2 ]Cork City Council, ( https://ror.org/045wfpr34) City Hall, Anglesea Street, Cork, Ireland

[3 ]National Suicide Research Foundation, ( https://ror.org/03rbjx398) Cork, Ireland

Article

Publisher ID: 21906

DOI: 10.1186/s12889-025-21906-1

PMC ID: 11843745

PubMed ID: 39979953

SO-VID: aa8c9b80-c466-4815-affe-eb7bc9b4eb76

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 5 March 2024

Date accepted : 11 February 2025

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010414, Health Research Board;

Award ID: Health Research Board under SPHeRE-2018-1

Custom metadata

ScienceOpen disciplines: Public health

Keywords: hiv,psychosocial,qualitative,survey,hiv care,ireland

Data availability:

ScienceOpen disciplines: Public health

Keywords: hiv, psychosocial, qualitative, survey, hiv care, ireland

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Identifying barriers and facilitators to psychosocial care for people living with HIV in Ireland: a mixed methods study

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Abstract

Background

Methods

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Supplementary Information

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HIV Self-Testing

Most cited references 52

Three approaches to qualitative content analysis.

Traveling towards disease: transportation barriers to health care access.

Measures of perceived social support from friends and from family: three validation studies.

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