Influence of Psychosocial Factors on Optimal Dietary Intake of Immuno-Suppressed Women of Kakamega County

Research Article

Austin J HIV/AIDS Res. 2015; 2(2): 1017.

Influence of Psychosocial Factors on Optimal Dietary Intake of Immuno-Suppressed Women of Kakamega County

Mutuli LA*, Mwani C, Wepukulu M and Walingo M

Community Nutrition and Development Program, Maseno University, Kenya

*Corresponding author: Mutuli LA, Community Nutrition and Development Program, Maseno University, P.O. Box 113, Kakamega, Kenya

Received: October 21, 2015; Accepted: November 23, 2015; Published: November 25, 2015

Abstract

The study focused on assessing the predictive power of psychosocial factors influencing optimal dietary intake of immune-suppressed women. This crosssectional study was conducted from August to November, 2014 in Kakamega County within 3 Comprehensive Care Clinics that were purposively sampled. Proportionate stratified sampling was utilized to obtain 220 respondents. A structured questionnaire was used to collect quantitative data where exploratory factor analysis tested dimensionality of questions, while skewness and kurtosis assessed normality of data. Structural equation modeling determined predictive power of latent variables. The model fitted data acceptably well, 2= 156, P<0.001, Tucker Lewis index =0.93, comparative fit index =0.95, root mean square error of approximation =0.090, Hoelter critical N (0.01=220), with regard to dietary behavior. Regression weights showed predictive power for women’s attitude (β=0.42, P<0.01), subjective norm (β=0.36, P<0.05), perceived behavioral control (β=0.48, P<0.05), and intention (β=0.95 P<0.001). This study provides data on a good approach for promoting optimal dietary intake that will improve the food frequency and nutrient intake of immune-suppressed women.

Keywords: Immuno-Suppressed; HIV/AIDS; Dietary Intake

Introduction

The global distribution of HIV/AIDS and its prevalence varies widely, with more men being infected and dying from the pandemic than women except in sub-Saharan Africa where women are dying more than men [1]. The prevalence of HIV/AIDS among women in Kenya is very high (40 percent) compared to men (33 percent) [2]. Several factors including socioeconomic, political, legal and cultural practices as well as biological factors make women more vulnerable to HIV infection than men [3]. Yet they are also the main caretakers for everyone who becomes ill with AIDS. In Kenya, HIV epidemic is superimposed on a pre-existing and longstanding background of extensive malnutrition. Weight loss is the AIDS-defining diagnosis for about 20 percent of people with AIDS [4] and ultimately occurs among a majority of people living with AIDS. Loss of the muscle tissue is one of the most debilitating and relentless complications of HIV/AIDS [5]. There is a critical level of body cell mass below which survival is impossible. It is indicated that death occurs for those with wasting syndrome either when their body weight approaches 66 percent of their ideal body mass or when body cell mass approaches 54 percent of normal [4]. Whereas the prevalence of HIV/AIDS is high (45 percent) in Kakamega County, a household ability to produce and buy food is reduced, and as a coping strategy dietary intake is reduced. This coping strategy is commonly practiced by women since they are the care takers of homes. Women living with HIV/ AIDS are the worst affected since their immune status is lowered as a consequence of sub-optimal dietary intake behavior. The woman’s intention to initiate sub-optimal dietary intake is triggered by her attitude, subjective norm and perceived behavioral control (Somerset et al., 2004). Optimal dietary intake intention is a significant predictor of optimal dietary intake influencing food frequency and nutrient intake. Studies have described many factors associated with dietary intake of immune suppressed people [6]. These factors include education level, economic status, nutrition knowledge, attitude towards food, and social support network. Understanding factors associated with optimal dietary intake enables health professionals to plan and evaluate appropriate interventions to improve food frequency and nutrient intake of immune-suppressed women. Since sub-optimal dietary intake increases the risk of HIV infection and the progression of the disease which exacerbates malnutrition [7]. Malnutrition is initiated from reduced dietary intake, nutrient malabsorption and increased utilization as well as increased excretion of proteins and micronutrients in response to the invading pathogens (HIV) [8]. The aim of this study was to assess the predictive power of psychosocial factors that include attitude, subjective norm, perceived behavioral control and intention on optimal dietary intake of immune-suppressed women and develop a strategy for improving their food frequency thus nutrient intake.

Study Framework

This study adapted Ajzen’s TPB model (Figure 1) to fit psychosocial factors that influence optimal dietary intake of immune suppressed women. The TPB model works on the basis that the approach to target behavior intention, which in turn is seen to be operation of 4 exogenous variables: attitude, subjective norm, perceived behavioral control and intention. In this context attitude was the certainty about the likely outcomes of optimal dietary intake multiplied by evaluation of these outcomes (behavioral beliefs). Subjective norm was the belief of the respondent over important people in her life that may or may not have influenced her optimal dietary intake (normative beliefs). Perceived behavioral control was viewed as control factors to promote or inhibit the respondent’s optimal dietary intake multiplied by the power she had over those factors (control beliefs). Perceived behavioral control was measured both directly and indirectly since dietary intake is not under completely volitional control. Therefore, attitude and subjective norm were posited to have influenced optimal dietary intake indirectly through dietary intention. While perceived behavioral control both directly and indirectly manipulated optimal dietary intake, the immediate antecedent of intention, which was described as a behavioral tendency that captured the motivational factors that had an impact on optimal dietary intake as a behavior. The latent variables can also be endogenous since they depend on observed variables to be measured, whereas observed variables can be exogenous since they are independent variables. When a variable is believed to “cause” another variable, the relationship between variables is shown as directed arrow, from cause to effect. Whether one variable “causes” another is an assumption that the researcher makes and only data can reveal. Co variation between 2 variables is shown as a 2 headed arrow connecting the variables. As a framework of competency, psychosocial factors influencing optimal dietary intake describes improving food frequency and nutrient intake are determined primarily by a respondent’s cognitive judgment and expectation concerning her ability to practice optimal dietary intake. To comprehend optimal dietary intake using the TPB model, an elicitation study was initially conducted prior to the current study to elicit salient beliefs on which exogenous variable are based. This was then employed to construct a questionnaire, which was pretested and used to assess the influence of these psychosocial factors on optimal dietary intake (Figure 1). Four specific objectives were intended to be achieved. Based on the above literature the objectives generated for the study are shown in (Figure 1).