Browsing by Subject "Individual & family studies"

Background: South African adolescents living with HIV (ALWH) experience elevated risk for poor HIV-related outcomes due to challenges associated with HIV disease management. While previous research suggests that social support may mitigate poor HIV-related outcomes, we know little about the specific types of family social support that help ALWH achieve better health outcomes or how this support might be better facilitated. This study aimed to address this gap by characterizing the types of social support provided by family members to assist ALWH in their HIV care management.Methods: We conducted fifty-nine in-depth, semi-structured interviews with ALWH (n=20), their caregivers (n=19), and community stakeholders (n=20) in Cape Town, South Africa. Using deductive and then inductive thematic methods, we triangulated data from these three groups in NVivo to qualitatively analyze family social support. Results: We identified four types of family social support: instrumental support, appraisal support, emotional support, and informational support. Families provided crucial instrumental support through treatment reminders and attending clinic appointments with ALWH. Families also acted as strong sources of appraisal support to help ALWH reflect upon the importance of medication adherence by promoting future orientation and HIV normalization. Similarly, families facilitated adherence through emotional support, such as motivating ALWH and demonstrating interest in their health. Lastly, families offered informational assistance to educate adolescents about managing HIV treatment challenges, such as side effects. Conclusion: In characterizing family social support, our findings highlight sources of struggle and possible solutions to the challenges that ALWH face in their HIV care. Our results suggest that ALWH and providers rely heavily on families to distribute these four types of support in HIV care, emphasizing the importance of exploring how to better facilitate and replicate this support. Understanding these types of social support is a crucial step to identifying potential gaps in care and possible intervention strategies. As such, future research should inquire about the efficacy of incorporating these types of social support into interventions to assist ALWH in their HIV care management.

Household-level decisions such as whether to marry or whether to move for a career opportunity are often thought to be driven by the financial position of the man within a heterosexual couple, rather than the woman. Historically, men’s greater relative income and labor market participation within a household provided a gender-neutral explanation of his influence over such decisions. However, as the gaps between couples’ relative education and earnings narrow over time, it appears that women’s economic gains have led to little change in this pattern, raising skepticism about whether a gender-neutral, resource-based explanation can account for household bargaining outcomes. This dissertation research explores why this unequal pattern persists; what prevents men’s and women’s economic resources, such as income and educational attainment, from being equally predictive of their respective bargaining power in household decisions?

I focus specifically on the way gender norms, such as expectations of women’s primary caregiver roles or men’s responsibilities as financial breadwinner, shape how couples make decisions. Using a mix of quantitative and qualitative methods in three studies, I explore these dynamics in couples across a range of socioeconomic statuses. Through 1) a unique experimental survey design and 2) in-depth interviews, I collect original data that evaluate how men and women in dual-career couples decide which partner’s career should be prioritized during a household move. These two studies focus on medical student couples applying to residency, an early-career decision with important implications for future career investments among highly-skilled workers. Using 3) a longitudinal dataset of low-income unmarried parents sponsored by the Administration on Children and Families, I evaluate how the relative and overall resources of each parent predict changes in the couples’ relationship status and reported relationship quality. Together, this collection of three studies examines the extent to which women’s improved economic position, relative to their male partners and to their peers, translates into greater agency over their career and family goals.

Overall, results suggest that, while women on average have lower economic resources than their partners, these resources are equally predictive of household decision-making. Women’s disproportionate caregiving duties, however, remain an important barrier to women’s career achievement. Supportive partners who advocate for an egalitarian division of work and childcare, and effective policy that facilitates women’s financial and educational success, can ensure men’s and women’s preferences are equally weighed in household decisions.