Development of the theoretical framework for psychological resilience interventions in people living with HIV/AIDS: a realist synthesis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Yue ¹ , XU Lei ¹ , YANG Zhongfang ¹ , CHEN Ben ¹ , ZHANG Lin ² , GONG Beibei ³ ,  HU Yan ¹

1. School of Nursing, Fudan University, Shanghai 200032, P. R. China;
2. Department of Nursing, Shanghai Public Health Clinical Center of Fudan University, Shanghai 200083, P. R. China;
3. Department of Nursing, the Fourth People's Hospital of Nanning, Nanning 530013, P. R. China;

Corresponding?author：

HU Yan, Email: huyan254@126.com

Keywords：

People living with HIV; Psychological resilience; Realist synthesis; Context-mechanism-outcome configuration; Nursing intervention

DOI：

10.7507/1672-2531.202509119

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective This study applies a realist synthesis approach to analyze the context-mechanism-outcome (CMO) configurations of psychological resilience interventions for people living with HIV/AIDS. This study aims to explore the applicability and activation pathways of interventions across different contexts, and to construct an actionable theoretical framework to guide personalized intervention design. Methods According to the RAMESES reporting guidelines, a five-stage realist synthesis approach was adopted. The PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CBM, WanFang Data, VIP, and CNKI databases were electronically searched from the inception to July 1, 2025. Two researchers independently screened studies and assessed quality by relevance and rigor. Intervention elements were extracted to build and refine CMO configurations through stakeholder feedback, forming the final theory. Results A total of 32 studies were included. Four key intervention mechanisms were identified: cognitive-behavioral approaches, social support, self-efficacy enhancement, and strength-based positive psychology. The findings highlight that intervention effectiveness depends on context alignment and mechanism activation. Single mechanisms may be less effective in resource-limited or high-stress settings. Conclusion Psychological resilience interventions for HIV/AIDS patients should be context-specific, combining mechanisms in tailored ways to improve relevance and impact

1.	Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet, 2013, 382(9903): 1525-1533.
2.	Rueda S, Mitra S, Chen S, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open, 2016, 6(7): e011453.
3.	孟美琪, 李學靖, 張小艷, 等. 現實主義綜述用于復雜護理干預評估的范圍綜述. 護理學雜志, 2023, 38(16): 119-124.
4.	Wong G, Greenhalgh T, Westhorp G, et al. RAMESES publication standards: realist syntheses. J Adv Nurs, 2013, 69(5): 1005-1022.
5.	Pawson R, Greenhalgh T, Harvey G, et al. Realist review-a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy, 2005, 10(Suppl 1): 21-34.
6.	Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol, 2001, 56(3): 218-226.
7.	Cohen S, Wills T A. Stress, social support, and the buffering hypothesis. Psychol Bull, 1985, 98(2): 310-357.
8.	Padesky C A, Mooney K A. Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Clin Psychol Psychother, 2012, 19(4): 283-290.
9.	Lee TY, Cheung CK, Kwong WM. Resilience as a positive youth development construct: a conceptual review. ScientificWorldJournal, 2012, 2012: 390450.
10.	趙俊強. 現實主義綜述: 現實主義哲學視角下理論驅動的復雜干預系統綜述方法. 醫學新知, 2020, 30(4): 291-301.
11.	Wong G, Greenhalgh T, Westhorp G, et al. Health services and delivery research. Southampton (UK): NIHR Journals Library, 2014.
12.	Greenhalgh T, Wong G, Westhorp G, et al. Protocol-realist and meta-narrative evidence synthesis: evolving standards (RAMESES). BMC Med Res Methodol, 2011, 11: 115.
13.	Yu X, Lau JT, Mak WW, et al. A pilot theory-based intervention to improve resilience, psychosocial well-being, and quality of life among people living with HIV in rural China. J Sex Marital Ther, 2014, 40(1): 1-16.
14.	Psaros C, Stanton A M, Goodman G R, et al. Adapting, testing, and refining a resilience intervention for older women with HIV: an open pilot study. J Women Aging, 2023, 35(4): 395-415.
15.	Psaros C, Stanton AM, Goodman GR, et al. A resiliency intervention adapted for older women with HIV: results from a pilot randomized controlled trial in the northeastern US. J Health Psychol, 2025, 30(3): 434-450.
16.	Fazeli PL, Hopkins CN, Wells A, et al. Examining the acceptability of a resilience building intervention among adults aging with HIV. J Assoc Nurses AIDS Care, 2022, 33(2): 155-167.
17.	Hosaka KRJ, Mmbaga BT, Gallis JA, et al. Feasibility and acceptability of a peer youth led curriculum to improve HIV knowledge in Northern Tanzania: resilience and intervention experience from the perspective of peer leaders. BMC Public Health, 2021, 21(1): 1925.
18.	Ronen K, Mugo C, Kaggiah A, et al. Facilitated WhatsApp support groups for youth living with HIV in Nairobi, Kenya: single-arm pilot intervention study. JMIR Form Res, 2023, 7: e49174.
19.	Young A. Instrumental case study: the process of catalyzing resilience in an individual with HIV using a strengths based therapeutic interview with image rescripting. 2019.
20.	Mirzapour P, Motlagh FZ, Alinaghi SAS, et al. Comparison of the effectiveness of positive thinking training and acceptance and commitment therapy on quality of life and resilience of people living with HIV. Hiv & Aids Review, 2022, 21(1): 50-57.
21.	De Santis JP, Florom-Smith A, Vermeesch A, et al. Motivation, management, and mastery: a theory of resilience in the context of HIV infection. Journal of the American Psychiatric Nurses Association, 2013, 19(1): 36-46.
22.	Aghaie N, SeyedAlinaghi S, Montazeri A, et al. Effectiveness of mindfulness-based stress reduction training on resilience in Iranian HIV-positive women: a clinical trial. Hiv & Aids Review, 2021, 20(3): 195-200.
23.	鄭雅群, 張麗琴, 祝亞清. PERMA模式下的心理學干預聯合個案管理模式對HIV感染患者的影響. 齊魯護理雜志, 2024, 30(9): 92-94.
24.	周璟, 肖丹, 李合林. 定點診療護理管理模式在艾滋病患者中的應用效果. 中西醫結合護理(中英文), 2023, 9(4): 153-155.
25.	許靜, 蔡小林. 多元化健康教育模式對艾滋病患者心理彈性、自我管理和生活質量的影響. 心理月刊, 2025, 20(7): 175-178.
26.	黃琴, 何麗蕓, 張甜, 等. 個案管理模式對HIV/AIDS患者心理彈性及自我管理能力的影響. 護理學雜志, 2018, 33(5): 80-82,8.
27.	王藝. 個案管理模式對HIV/AIDS患者心理彈性與自我管理能力的影響. 中西醫結合護理(中英文), 2019, 5(4): 140-143.
28.	牛輝. 基于“功能性健康型態”的護理干預對艾滋病患者的心理彈性和睡眠質量的影響. 臨床與病理雜志, 2021, 41(10): 2407-2413.
29.	吳冬燕. 基于慢性疾病軌跡模式的護理干預對艾滋病患者心理彈性自我管理和生活質量的影響. 基層醫學論壇, 2024, 28(11): 126-129.
30.	區月炎. 基于慢性疾病軌跡模式的護理干預對艾滋病患者心理彈性自我管理和生活質量的影響分析. 中文科技期刊數據庫(文摘版)醫藥衛生, 2024, (9): 184-187.
31.	劉桂芳. 接納與承諾療法對初診艾滋病住院患者心理彈性的干預研究. 衡陽: 南華大學, 2021.
32.	張兵, 楊紅麗, 欒玉泉, 等. 聚焦解決模式對HIV/AIDS患者焦慮抑郁和心理彈性的干預研究. 中國艾滋病性病, 2022, 28(9): 1050-1054.
33.	王芳, 覃曉婕, 黃愛麗, 等. 聚焦解決模式對首發艾滋病患者心理彈性的影響. 右江醫學, 2024, 52(9): 821-828.
34.	陳偉梅, 李麗仙, 程林, 等. 聚焦解決模式在艾滋病患者心理干預中的應用效果評價. 實用預防醫學, 2019, 26(9): 1091-1093.
35.	王麗, 張靜靜, 李爽, 等. 看圖對話交互式健康教育模式在艾滋病患者抗病毒治療中的應用. 齊魯護理雜志, 2021, 27(9): 132-134.
36.	邵英, 王晶, 王亞麗, 等. 門診優化護理管理模式對艾滋病患者心理彈性自我管理和生活質量的影響. 中國艾滋病性病, 2021, 27(6): 594-597.
37.	韋湘霞. 門診優化護理管理模式改善艾滋病患者心理彈性自我管理水平的分析. 中文科技期刊數據庫(引文版)醫藥衛生, 2023, (7): 99-102.
38.	韓秀花. 全程關愛模式護理對HIV感染者/AIDS患者心理彈性及應對方式的影響. 中國科技期刊數據庫醫藥, 2022, (5): 92-94.
39.	苗小麗, 沈倩, 林愛玉. 全程關愛模式護理對HIV感染者/AIDS患者心理彈性及應對方式的影響. 中國民康醫學, 2021, 33(2): 176-178.
40.	李瑤瑤. 全程關愛模式護理對HIV感染者AIDS患者心理彈性及應對方式的影響. 中國科技期刊數據庫醫藥, 2024, (11): 215-218.
41.	黃巧莉, 陳春輝, 馮孝清, 等. 鄉村振興背景下個案管理模式在重慶山區艾滋病患者健康管理中的初步探索. 現代醫藥衛生, 2022, 38(17): 2885-2889.
42.	付丹青. 需求層次理論的精細化護理干預對艾滋病患者心理韌性、自我護理效能的影響. 醫學信息, 2024, 37(z1): 40-42.
43.	吳紅, 賈靜月, 徐彩霞, 等. 需求層次理論的精細化護理干預對艾滋病患者心理韌性、自我護理效能的影響. 齊魯護理雜志, 2023, 29(11): 120-122.
44.	劉華, 石奧利, 李程娟, 等. 藝術表達療法對艾滋病首診患者心理彈性水平及應對方式的影響. 心理月刊, 2024, 19(23): 199-201.
45.	Abbas Q, Nisa M, Khan M U, et al. Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial. BMC Psychiatry, 2023, 23(1): 539.
46.	Brown MJ, Gao C, Kaur A, et al. Social support, internalized HIV stigma, resilience and depression among people living with HIV: a moderated mediation analysis. AIDS Behav, 2023, 27(4): 1106-1115.
47.	Koch A, Ritchwood TD, Bailey DE Jr, et al. Exploring resilience among black women living with HIV in the Southern United States: findings from a qualitative study. J Assoc Nurses AIDS Care, 2022, 33(2): 224-234.

1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet, 2013, 382(9903): 1525-1533.
2. Rueda S, Mitra S, Chen S, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open, 2016, 6(7): e011453.
3. 孟美琪, 李學靖, 張小艷, 等. 現實主義綜述用于復雜護理干預評估的范圍綜述. 護理學雜志, 2023, 38(16): 119-124.
4. Wong G, Greenhalgh T, Westhorp G, et al. RAMESES publication standards: realist syntheses. J Adv Nurs, 2013, 69(5): 1005-1022.
5. Pawson R, Greenhalgh T, Harvey G, et al. Realist review-a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy, 2005, 10(Suppl 1): 21-34.
6. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol, 2001, 56(3): 218-226.
7. Cohen S, Wills T A. Stress, social support, and the buffering hypothesis. Psychol Bull, 1985, 98(2): 310-357.
8. Padesky C A, Mooney K A. Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Clin Psychol Psychother, 2012, 19(4): 283-290.
9. Lee TY, Cheung CK, Kwong WM. Resilience as a positive youth development construct: a conceptual review. ScientificWorldJournal, 2012, 2012: 390450.
10. 趙俊強. 現實主義綜述: 現實主義哲學視角下理論驅動的復雜干預系統綜述方法. 醫學新知, 2020, 30(4): 291-301.
11. Wong G, Greenhalgh T, Westhorp G, et al. Health services and delivery research. Southampton (UK): NIHR Journals Library, 2014.
12. Greenhalgh T, Wong G, Westhorp G, et al. Protocol-realist and meta-narrative evidence synthesis: evolving standards (RAMESES). BMC Med Res Methodol, 2011, 11: 115.
13. Yu X, Lau JT, Mak WW, et al. A pilot theory-based intervention to improve resilience, psychosocial well-being, and quality of life among people living with HIV in rural China. J Sex Marital Ther, 2014, 40(1): 1-16.
14. Psaros C, Stanton A M, Goodman G R, et al. Adapting, testing, and refining a resilience intervention for older women with HIV: an open pilot study. J Women Aging, 2023, 35(4): 395-415.
15. Psaros C, Stanton AM, Goodman GR, et al. A resiliency intervention adapted for older women with HIV: results from a pilot randomized controlled trial in the northeastern US. J Health Psychol, 2025, 30(3): 434-450.
16. Fazeli PL, Hopkins CN, Wells A, et al. Examining the acceptability of a resilience building intervention among adults aging with HIV. J Assoc Nurses AIDS Care, 2022, 33(2): 155-167.
17. Hosaka KRJ, Mmbaga BT, Gallis JA, et al. Feasibility and acceptability of a peer youth led curriculum to improve HIV knowledge in Northern Tanzania: resilience and intervention experience from the perspective of peer leaders. BMC Public Health, 2021, 21(1): 1925.
18. Ronen K, Mugo C, Kaggiah A, et al. Facilitated WhatsApp support groups for youth living with HIV in Nairobi, Kenya: single-arm pilot intervention study. JMIR Form Res, 2023, 7: e49174.
19. Young A. Instrumental case study: the process of catalyzing resilience in an individual with HIV using a strengths based therapeutic interview with image rescripting. 2019.
20. Mirzapour P, Motlagh FZ, Alinaghi SAS, et al. Comparison of the effectiveness of positive thinking training and acceptance and commitment therapy on quality of life and resilience of people living with HIV. Hiv & Aids Review, 2022, 21(1): 50-57.
21. De Santis JP, Florom-Smith A, Vermeesch A, et al. Motivation, management, and mastery: a theory of resilience in the context of HIV infection. Journal of the American Psychiatric Nurses Association, 2013, 19(1): 36-46.
22. Aghaie N, SeyedAlinaghi S, Montazeri A, et al. Effectiveness of mindfulness-based stress reduction training on resilience in Iranian HIV-positive women: a clinical trial. Hiv & Aids Review, 2021, 20(3): 195-200.
23. 鄭雅群, 張麗琴, 祝亞清. PERMA模式下的心理學干預聯合個案管理模式對HIV感染患者的影響. 齊魯護理雜志, 2024, 30(9): 92-94.
24. 周璟, 肖丹, 李合林. 定點診療護理管理模式在艾滋病患者中的應用效果. 中西醫結合護理(中英文), 2023, 9(4): 153-155.
25. 許靜, 蔡小林. 多元化健康教育模式對艾滋病患者心理彈性、自我管理和生活質量的影響. 心理月刊, 2025, 20(7): 175-178.
26. 黃琴, 何麗蕓, 張甜, 等. 個案管理模式對HIV/AIDS患者心理彈性及自我管理能力的影響. 護理學雜志, 2018, 33(5): 80-82,8.
27. 王藝. 個案管理模式對HIV/AIDS患者心理彈性與自我管理能力的影響. 中西醫結合護理(中英文), 2019, 5(4): 140-143.
28. 牛輝. 基于“功能性健康型態”的護理干預對艾滋病患者的心理彈性和睡眠質量的影響. 臨床與病理雜志, 2021, 41(10): 2407-2413.
29. 吳冬燕. 基于慢性疾病軌跡模式的護理干預對艾滋病患者心理彈性自我管理和生活質量的影響. 基層醫學論壇, 2024, 28(11): 126-129.
30. 區月炎. 基于慢性疾病軌跡模式的護理干預對艾滋病患者心理彈性自我管理和生活質量的影響分析. 中文科技期刊數據庫(文摘版)醫藥衛生, 2024, (9): 184-187.
31. 劉桂芳. 接納與承諾療法對初診艾滋病住院患者心理彈性的干預研究. 衡陽: 南華大學, 2021.
32. 張兵, 楊紅麗, 欒玉泉, 等. 聚焦解決模式對HIV/AIDS患者焦慮抑郁和心理彈性的干預研究. 中國艾滋病性病, 2022, 28(9): 1050-1054.
33. 王芳, 覃曉婕, 黃愛麗, 等. 聚焦解決模式對首發艾滋病患者心理彈性的影響. 右江醫學, 2024, 52(9): 821-828.
34. 陳偉梅, 李麗仙, 程林, 等. 聚焦解決模式在艾滋病患者心理干預中的應用效果評價. 實用預防醫學, 2019, 26(9): 1091-1093.
35. 王麗, 張靜靜, 李爽, 等. 看圖對話交互式健康教育模式在艾滋病患者抗病毒治療中的應用. 齊魯護理雜志, 2021, 27(9): 132-134.
36. 邵英, 王晶, 王亞麗, 等. 門診優化護理管理模式對艾滋病患者心理彈性自我管理和生活質量的影響. 中國艾滋病性病, 2021, 27(6): 594-597.
37. 韋湘霞. 門診優化護理管理模式改善艾滋病患者心理彈性自我管理水平的分析. 中文科技期刊數據庫(引文版)醫藥衛生, 2023, (7): 99-102.
38. 韓秀花. 全程關愛模式護理對HIV感染者/AIDS患者心理彈性及應對方式的影響. 中國科技期刊數據庫醫藥, 2022, (5): 92-94.
39. 苗小麗, 沈倩, 林愛玉. 全程關愛模式護理對HIV感染者/AIDS患者心理彈性及應對方式的影響. 中國民康醫學, 2021, 33(2): 176-178.
40. 李瑤瑤. 全程關愛模式護理對HIV感染者AIDS患者心理彈性及應對方式的影響. 中國科技期刊數據庫醫藥, 2024, (11): 215-218.
41. 黃巧莉, 陳春輝, 馮孝清, 等. 鄉村振興背景下個案管理模式在重慶山區艾滋病患者健康管理中的初步探索. 現代醫藥衛生, 2022, 38(17): 2885-2889.
42. 付丹青. 需求層次理論的精細化護理干預對艾滋病患者心理韌性、自我護理效能的影響. 醫學信息, 2024, 37(z1): 40-42.
43. 吳紅, 賈靜月, 徐彩霞, 等. 需求層次理論的精細化護理干預對艾滋病患者心理韌性、自我護理效能的影響. 齊魯護理雜志, 2023, 29(11): 120-122.
44. 劉華, 石奧利, 李程娟, 等. 藝術表達療法對艾滋病首診患者心理彈性水平及應對方式的影響. 心理月刊, 2024, 19(23): 199-201.
45. Abbas Q, Nisa M, Khan M U, et al. Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial. BMC Psychiatry, 2023, 23(1): 539.
46. Brown MJ, Gao C, Kaur A, et al. Social support, internalized HIV stigma, resilience and depression among people living with HIV: a moderated mediation analysis. AIDS Behav, 2023, 27(4): 1106-1115.
47. Koch A, Ritchwood TD, Bailey DE Jr, et al. Exploring resilience among black women living with HIV in the Southern United States: findings from a qualitative study. J Assoc Nurses AIDS Care, 2022, 33(2): 224-234.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesDevelopment of the theoretical framework for psychological resilience interventions in people living with HIV/AIDS: a realist synthesis

Abstract Full text Figures/Tables Video References Cited by

Format

Content