The HSRC is collaborating with the University of Southampton and the University of Cape Town to develop behaviour change strategies aimed at encouraging couples to manage their health. At a recent HSRC seminar, the researchers explained how earlier couples-focused work around HIV testing will be expanded to include other health conditions, such as diabetes. By Antoinette Oosthuizen
Studies have shown that two people in a relationship are more likely to behave in similar ways. This may be because people are often attracted to those who are similar to them; or individuals in a relationship may develop similar behaviour over time due to a shared lifestyle. When it comes to health, similar behaviours may lead to a couple sharing a disease risk.
Prof Nuala McGrath, a professor of epidemiology and sexual health from the University of Southampton in the United Kingdom, talked about the Couples Health Research and Intervention Studies (CHERISH) programme, which builds on the earlier Uthando Lwethu couples-focused intervention at the HSRC’s Sweetwaters site in KwaZulu-Natal.
UNAIDS estimates that 25.5 million people are living with HIV in Sub-Saharan Africa and more than 60% of these people are in stable relationships. The Uthando Lwethu intervention aimed to increase HIV testing and counselling, but the researchers now want to expand it to other chronic conditions, such as diabetes, which is the second leading underlying cause of premature adult death in South Africa. Recognising the impact of the disease, the National Department of Health has also set a target to increase diabetes control.
“In the first strand of the CHERISH programme, we would like to increase the uptake of couples’ HIV testing and counselling at Sweetwaters toward broader reproductive health promotion and STI testing,” said McGrath.
In a second strand of this five-year programme, the researchers plan to extend this approach to develop a couple-focused intervention for diabetes control in clinic settings. In the third strand, they will establish a future couples-based agenda beyond HIV and diabetes to focus on other health conditions.
The Uthando Lwethu intervention
KwaZulu-Natal has a 29% adult HIV prevalence and low rates of marriage, but many people live in stable relationships. Many national campaigns have focused on individual HIV testing, but it is difficult to get individuals to repeat test. Some are not able to disclose their HIV status to their partners and many have no knowledge of their partners’ status.
During the Uthando Lwethu intervention (conducted from 2012), researchers followed 332 couples for 9 months: 168 in an intervention group and 164 in a control group. The intervention focused on problem-solving and communications skills for couples, including speaker-listener techniques for more effective communication, for example, to prevent arguments from escalating.
The idea was to shift the partners’ focus from an individually-centred perspective to believing their health as a couple was important. The researchers held group sessions, each couple had meetings with their counsellor to talk their specific problems and there were also individual sessions for confidential sharing.
The outcome was that 42% of couples in the intervention arm decided to test for HIV. In the control group, it was only 12%.
Moving on to diabetes
One of the aims of the new work on the CHERISH programme is to increase public involvement, said McGrath, who distinguished between research “involvement” and “participation”.
Involvement is more than participating in a study, she said. “We have recruited a community working group to help us develop the intervention, giving input on how to recruit participants and how to design the evaluation. They will continue to work with researchers throughout entire research process.” Two members of the working group will be invited to join the monthly meetings held by the researchers.
At the seminar, Dr Kate Morton, a senior research fellow based in the School of Primary Care, Population Sciences and Medical Education at the University of Southampton, provided an overview of how the researchers used a person-based approach to optimise the Uthando Lwethu intervention.
“The idea is to develop an understanding of the perspectives of people who will use the intervention to improve uptake adherence and outcomes.”
As part of an intervention planning phase of a type-2 diabetes intervention, the researchers conducted interviews with 20 of the couples who had participated in the Sweetwaters research.
They asked them about their experiences of group sessions, couples counselling and perspectives about HIV testing. The data collected will help researchers to identify key issues from the users’ perspectives.
The seminar concluded with Dr Frank Feng from the University of Southampton illustrating how multilevel modelling can be used to analyse individual, community and national determinants of health behaviours.