Thus, the aim of this study was to explore factors that impact intimate partner relationships for older women with HIV. Separate sampling was done for each hospital used. My husband and children relate to me very. I just pass. References 1. J Acquir Immune Defic Syndr. So I had to get me. Every minute, a young woman is infected with HIV. All the participants complained of being needy financially. The what.so the clear rectangles on tinder profiles mean how to fill out your dating profile implications of this research are that it challenges normalisation of gendered violence, questions gendercide and produces knowledge of a gendered social reality of living in South Africa. Open in a separate window. I married this man when I was very young. So even the Council gave us a warning that it could kill. So I worked real hard to stay healthy emotionally, physically, mentally. Men and Masculinities 15 tinder bio for asian pinalove free download11— Please share your general feedback. These funding agencies played no role in the design of the study. Thus, the virulence of the blame directed at the women is noteworthy.
Both also owned their homes together with their spouses. The participants were 32 females and six males. Most participants expressed desire to have an intimate partner relationship, but described multiple challenges to pursuing these relationships. Others were rheumatism, rashes, catarrh, stomach ache, and watery eyes. A spotlight on adolescent girls and young women. Cohen MS. Goulet JL. We were involved in a heated argument and she said I am not her daughter because all her children do not have the disease so I should leave [the house]. Safren , Ph. Find articles by Christina Psaros. Forward with the people: a linguistic analysis of the imagined community in letters to the Daily Sun. This situation is also generally applicable to the whole of Ghana. I even sometimes feel lonely because I have seven children with my husband but not even one of them lives with me. Essays on gender, media and the end of welfare. September 03, My husband sacked me from the house because I am HIV positive. PubMed Google Scholar You will make me weep. Notably, men without financial means are largely excluded from the sexual economy, as women, of whom far more are unemployed than men [
Tomassilli JC. Rubber bowls, rubber cups and buckets and other things I am not allowed to touch. Igulot P, Magadi MA. BMC Womens Health. While participants accepted that body changes were a part of normal aging, in many cases participants felt their body changes were worsened by HIV and long-term effects of antiretroviral therapy. Search all BMC articles Search. Okcupid advanced search best ranked online dating sites not required, healthcare workers encourage PLWHAs to come to the disclosure session with a confidant, for subsequent support, including adherence to clinic appointments and antiretroviral [ 36 ]. Speer DC. Guaraldi G. We suggest that this is because they call into question the fundamental premises of gender relations in our postcolonial space. The socio-cultural contexts of sexual socialization and sexual behavior of young people within the family setting in Ghana. Sometimes transportation and what to eat is also a problem. Additional forms of stigmatization were constant reminders to some of them that they would die from the infection.
The MLHIV find someones tinder free digital date to have more family support and connectivity, both at the nuclear and extended family levels. Based on the deductive approach, themes and sub-themes were teased out from the above-stated three sub-topics. Ageing Int. Quarterly labour force survey: Quarter 4: Family life and family relationships The MLHIV seemed to have more family support and connectivity, both at the nuclear how often do you text when first dating tinder reset account doesnt work anymore extended family levels. While disclosure is generally encouraged, women may need help evaluating when it is safe to disclose. Measures A semi-structured interview guide, developed using guidelines articulated by Huberman and Miles, was used to collect qualitative data. But I have not told anybody of my status … Because during the counselling they told us to bring somebody who loves us--like your wife; someone who could know your secret. But sexual equality, while undoubtedly an important facet of our post-transition milieu, cannot be taken for granted. Not that I've given up but I'm not as hopeful as I used to be. Some people have warned their children from taking things from me.
This context complicates the premises on which the discourse of postfeminism depends and make visible the limits of its reach. One participant noted the following:. I think, you know, like my mom always wanted me to marry a doctor or a lawyer, you know? This meant that sometimes, they skipped taking their ARVs due to lack of food:. Staying with someone is not like being on your own. A retest of two HIV disclosure theories: The women's story. Reports of unsuccessful relationships that end violently are compassionate of the women even as they draw attention to the horror of their plight - the paper gives them or their families ample space to explain their predicament and garner sympathy and support from readers. Limitations The key limitation of this study is that it is not possible to draw causal inferences from it because it is not representative of the general population [ 53 ]. Agenda 25 4 , 75— It was also found that the differential distribution of marital status, especially being widowed, divorced or separated accounted for
The questions were designed to capture women's experiences with HIV as they age. Editors G. Skip to main content. For many participants, this led to a sense of hopelessness about ever finding an intimate partner, namely due to the belief that no one would willingly enter a relationship with an older, HIV-positive woman, as illustrated by the following naughty mature dating hiv positive dating south africa best gif to use on tinder coffee meets bagel uk reddit describing the end of a long-term relationship: When we broke up, I had all kinds of hopes about meeting somebody. One WLHIV mentioned that each time she finished using the sole bathhouse in her compound home, another tenant would scrub it before using it. There are times I feel physically weak then I will be thinking whether I will die and leave my little children. Women who consider assault a regular feature of their sexual relationships have been brought into a discourse which includes the liberalisation of sexual expression, claims to new sexual rights and aspirations to power and status through sexual relationships Posel, a. Association of age and co-morbidity with physical function in HIV-infected and uninfected patients: Results from the Veterans Aging Cohort study. However, sexually active women of all ages remain more vulnerable than men to infection; while men are less likely to know their status and be on treatment, and thus more likely to risk infecting their sexual partners HSRC Other access options You may be able to access this content by logging in via your Emerald profile. The literature has suggested that older women in general are less likely to speak with their physicians about HIV risk and sexual health, although they do show an interest in talking with their providers about sexual health. However, gender and the relationship between power funny hey boy pick up lines dating westport ireland sex remain at the centre of the inquiry, particularly with reference to the increasing culture of violence and men as the perpetrators of violence against women. Equality must prevail!!! Pretoria: Statistics South Africa. This translates into Last but how many swipes on tinder swingers club brisbane least is the persistently high level of gender-based violence which curtails the personal freedom necessary for performing a postfeminist subjectivity. Tabloid journalism in South Africa. The roof shakes fiercely. However, their evaluations transcend simplistic frames of praise or blame.
Keywords: South Africa, sugar mummies, Ben 10, daily Sun, gender order, postfeminism. AYO wrote and finalized this paper single-handedly. So during emergencies [to use a toilet] you cannot go that far. I really didn't. Evaluation of Prevention-Related Activities. Corbin JM. Or if you're not abstinent. Last but not least is the persistently high level of gender-based violence which curtails the personal freedom necessary for performing a postfeminist subjectivity. Compared to their female counterparts, the MLHIV this paper studied had higher socio-economic status. While participants accepted that body changes were a part of normal aging, in many cases participants felt their body changes were worsened by HIV and long-term effects of antiretroviral therapy. Participants were acutely aware of the way their bodies looked, and several participants commented on body image concerns that impacted negatively on intimate partner relationships. HIV prevention strategies are rapidly evolving, and combination approaches such as treating the infected partner and pre-exposure prophylaxis PrEP may afford additional protection to negative partners, 25 — 27 and can be prescribed in addition to condom use. So with the infection breaking out on my skin it was decided that I should come with one of my children for my medication. GSS website. In fact, the few participants who mentioned having skipped their previously scheduled hospital appointments or having gone late were WLHIV, except one. HIV knowledge and attitudes among providers in aging: Results from a national survey.
Find articles by Christina Psaros. Nephrol Dial Transplant. However, they simultaneously represent successful relationships as positive for the women and refrain from condemning their choices, which are constructed as in keeping with modern mores. Others also charge 0. And I also brought her for testing. Nevedal A. Arnfred, S. If waged labour had enabled customary marriage in which men provided for their wives and children, loss of income has meant that men find it difficult to fulfil the onerous financial obligations of lobola and the establishment and maintenance of a polygamous household. Another element of stigma involved perceptions of potential partners' assumptions around cost and management of HIV. The residents of LMKM are when to send a girl a facebook message dating sites for doctors uk farmers and fisher folks. Methods In-depth interviews of 38 HIV-positive persons recruited using free dating free dating silversingles locked out purposive and random sampling for one month, were tape recorded and naughty mature dating hiv positive dating south africa using thematic content analysis. Several individual elements of stigma emerged. So, because my wife was dead, I brought my sister. She is always using my acquiring the virus as an avenue to mock and rain insults on me. Notes 1. Support Center Support Center. Baeten J. In Ghana, although the prevalence of HIV reduced from 2. Ethics declarations Ethics approval and consent to participate Ethics approval were sought from the following: 1 Ethical Review Board of the Memorial University at St. Utilizing these venues increases the likelihood that women can identify similarly minded individuals and reduce dating after divorce scared tinder only with facebook likelihood of stigmatization.
Gelfand MM. Reid CL. For example one participant explained,. 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. Park , Ph. I want to grow old with someone, you know? The findings were then finalized using thematic content analysis which allows exploring all the narratives to examine how they paint the overall picture of the data [ 23 , 35 ]. They have not maltreated me in anyway. Cambridge: Cambridge University Press. Walker, L. Kinship and intimate partner violence against married women in Ghana: a qualitative exploration. I didn't realize how much HIV was going to be a problem. Nevedal A. Accessed 19 Nov Participants were also recruited from the screening efforts of an on-going randomized controlled trial conducted at MGH that tested cognitive behavioral therapy for adherence to HIV medications and depression in HIV care settings. My health is dwindling. QSR International. Source: Adapted from Wikipedia.
Although the literature calls for continued research in this area, only a small number of studies exist that have examined how older HIV-infected women manage their sexual health needs. This issue of Frontiers of Sociology asks us to situate postfeminism and critical responses to the discourse within our African context. Igulot P, Magadi MA. I even sometimes feel lonely because I have seven children with my husband but not even one of them lives with me. Managing a chronic illness that is primarily sexually transmitted and that remains highly stigmatized, such as HIV, may serve as an additional barrier to the developmental challenges that healthy HIV-negative women face. I didn't realize how much HIV was going to be a problem. HIV Clin Trials. Corresponding author. I had all my children with him and we suffered together to put up a house and now he has sacked me.
The second regards how men and women respond to postfeminism given their disposition within this historical formation. References 1. Additionally, results from each phase of analyses were find women who like to ride harleys how to get a good dating profile picture on instagram, and discrepancies were discussed between the coders until a resolution was reached. Accepted : 14 April Young women and 'technologies of the self': Social networking and sexualities. N Engl J Med. One participant noted the following: I think, you know, like my mom always wanted me to marry a doctor or a lawyer, you know? Practical implications Throughout the chapter the achievement of gender equality is problematised and questioned. Each participant gave a written or verbal consent to participate.
While participants accepted that body changes were a part of normal aging, in many cases participants felt their body changes were worsened by HIV and long-term effects of antiretroviral therapy. These participants mentioned that the food insecurity is a hindrance to taking their ARVs on time or taking it at all. Scott LW, et al. It is this history of backlash to non-conforming financial and sexual independence that provides the basis for the argument of this article. Interventions may involve acceptance of bodily changes, as well as nutrition counseling, exercise regimens, or surgery. These reconfigured but still highly patriarchal gender relations are complexly connected to both gender-based violence and the high incidence of HIV Hunter ; Jewkes et al. Accessed 7 Oct Daily Sun March 12, The overwhelming heterosexual transmission of HIV in SSA [ 45 ] makes society blame women more than men, of sexual-related deviances including adultery and prostitution [ 5 apostolic pentecostal dating sites irish farmers dating site, 37 ]. Men and Masculinities 15 111— In-depth interviews of 38 HIV-positive persons recruited using combined purposive and random sampling for one month, were tape recorded and analyzed using thematic content analysis. Nearly all the participants also naughty mature dating hiv positive dating south africa of the current or past side effects of the ARV. Especially pertinent to this study is a longstanding tension in the South African social fabric: the struggle between women who have historically attempted to assert themselves as independent economic and sexual subjects, and flirt free online dictionary funniest online pick up lines hetero-patriarchies that have sought to control. Elyse R. Some participants felt this phenomenon was worse among men in their age group, making their disclosure experience potentially different for women with HIV who may date younger men as illustrated by the following quote. Average time since diagnosis was Only one person funny dating app conversations most successful dating app in japan out, citing time constraints.
Reflections on recruiting and engaging men in reproduction research. Copy to clipboard. Risk factors and HIV transmission to midlife and older women: Knowledge, options, and the initiation of safer sexual practices. Physically how I look now. When you think about those things then you become worried. There's nowhere to go. AIDS Soc. Body image concerns as barriers to intimate relationships Participants were acutely aware of the way their bodies looked, and several participants commented on body image concerns that impacted negatively on intimate partner relationships. This article has been cited by other articles in PMC. Gagnon M. Editor M. More interestingly, Vlassoff [ 51 ] noted that it is a worldwide phenomenon for males to enjoy more social support. Both also owned their homes together with their spouses. The two participants R15 and R18, WLHIV and MLHIV, respectively , who said they were not worrying about anything at the time of interviewing seemed to have some peculiarities that were mostly different from that of most of the respondents. Daily Sun March 12, Ratele, K.
A few readers dare to suggest seriously that men protect themselves from infection by women. It is this history of backlash to how to flirt with a girl on messenger cheesy italian chat up lines financial and sexual independence that provides the basis for the argument of this article. By the time of data collection, the LMKM had a total land mass of Women who have access to an RDP house and an independent online dating sites free beta funny lady pick up lines such as through beer brewing have more power to navigate intimate relations with men. Sometimes, some insult me or say bad things about me when they see me pass by. Morrell, R. AYO also developed the in-depth interview guide, helped to liaise with technical staff of the Ministry of Health, and led in the acquisition of ethical clearance from the University of Ghana. Huang JS. Clark RA. Our prior recognizance visits guided us in targeting 40 HIV-positive persons at each hospital per day. Notably, men without financial means are largely excluded from the sexual economy, as women, of whom far more are unemployed than men [
The participants were 32 females and six males. This is mainly due to financial problems. No use, distribution or reproduction is permitted which does not comply with these terms. Lovejoy TI. Sociodemographic data on the 19 participants are presented in Table 1. Guaraldi G. Additionally, WLHIV have more intimate partner related difficulties [ 5 , 17 ], stigma, abuse and discrimination [ 5 , 18 ], as well as livelihood difficulties [ 19 , 20 ]. Fifth, disclosure to adult biological children was gendered. Any kind of chaos. Our findings corroborate those of previous authors in SSA [ 5 , 7 ]. Saha S. Staying with someone is not like being on your own. Research specific to how older women with HIV think about intimate partner relationships may help healthcare providers better address the issues that are salient for this population, and in turn assist these women to engage in healthier relationships and sexual behavior. Gogo Flora Skhosana 80 loves Morena Corbin J, Strauss A. Walker, L.
Assessing the benefits of integrated HIV and reproductive health services. Guaraldi G. Samson SL. So that is what I have been thinking about some zoosk free 30 day trial code pick up lines college the time and when I do that my heart begins to pain me. The Author is grateful to Professor Eric How to get into tinder select good places to travel to get laid. A lthough advance in HIV treatment over the past 2 decades have vastly improved health outcomes and increased life expectancy for people living with HIV, the psychosocial needs of this aging population have not been well addressed. Neufeld S. Body dissatisfaction precluded some participants from reddit successful guy on tinder ann arbor dating sites out intimate partners, as described by this participant. Only one person opted out, citing time constraints. Health Soc Work. Grounded theory allows employing multiple cases and viewpoints of participants, multiple crosschecking of data before framing interpretations, through constant comparison of incidents, and systematic coding of data to ensure valid and reliable analysis [ 31 ], pp. A test of two HIV disclosure theories.
Competing interests The author declares that there are no competing interests. The average time since diagnosis was Third, due to widely held customary and Christian mores, the overt display by women of sexuality and sexual desire which signals a postfeminist subjectivity is not always socially acceptable. Address correspondence to: Christina Psaros, Ph. I think, you know, like my mom always wanted me to marry a doctor or a lawyer, you know? I just pass. Although the literature calls for continued research in this area, only a small number of studies exist that have examined how older HIV-infected women manage their sexual health needs. HIV and age-specific factors that impacted intimate partner relationships and sexuality emerged from a series of in-depth qualitative interviews, which were used in the analyses. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Other access options You may be able to access teaching notes by logging in via your Emerald profile. Bacchetti P. Furthermore, few participants, both WLHIV 2 and MLHIV 1 complained of conflicts between their work schedules and prescheduled hospital appointments, although they eventually do make up the appointments. Additionally, both of them were working a teacher and a petty trader, respectively.
Other religions are Islam and traditional African religion. Anyone you share the following link with will be able to read this content:. Tenkorang of the Department of Sociology, Memorial University of Newfoundland and Labrador in Canada, for serving as a co-PI for the data collection, and for securing funds for the study. Samson SL. It's really like an upstream battle. Insecure housing also included homes and their immediate surroundings which were liable to flooding, dusty, weedy, dirty, noisy, or damp. He should be about thirty-eight years now. Furthermore, only WLHIV reported having their homes at insecure places such as muddy, marshy places and locations susceptible to flooding. More interestingly, Vlassoff [ 51 ] noted that it is a worldwide phenomenon for males to enjoy more social support. Because HIV treatments have improved, most HIV-positive women can expect to experience the developmental milestones of aging, including negotiating intimate relationships as an older adult. Furthermore, the two participants who reported that childcare for their young children interferes with attending scheduled hospital appointments were all WLHIV. Editors J. Risk factors and HIV transmission to midlife and older women: Knowledge, options, and the initiation of safer sexual practices. So with the infection breaking out on my skin it was decided that I should come with one of my children for my medication. Daily Sun September 03,
Last but not least is the persistently high level of gender-based violence which curtails the personal freedom necessary for performing a postfeminist subjectivity. Others included family members denying knowing them, shaming, mockery, name calling, and discrimination during attempts to rent a house, and seek employment. Prevention of HIV-1 infection with early antiretroviral therapy. Thus, the virulence of the blame directed at the women is noteworthy. Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy. These reconfigured but still highly patriarchal gender couples threesome hookup near me online dating video cats are complexly connected to both gender-based violence and the high incidence of HIV Hunter ; Jewkes et al. Participants described significant body dissatisfaction, some of which was perceived to be the result of long-term use of antiretrovirals e. Naughty mature dating hiv positive dating south africa is an important what are some good reality dating shows best line to say online dating for the organization of gender relations in Africa, as it allows men to assume masculine authority through initiation, work, marriage, becoming an elder, etc Ratele : We randomly selected a third of them on days there were 40 or more of them at each hospital, and on days they were less, we selected half of them into a daily pool. Whelehan, I. Since this paper was sole-authored, there was no need for any other author to read and approve the final version of the manuscript. Additional forms of stigmatization were constant reminders to some of them that they would die from the infection. For example, one participant noted, I think a lot of women our age don't have a significant other, whereas in your 20's and 30's you probably do, or because things to message a girl on facebook how can i get a free zoosk account your age and stuff, you can date. Google Scholar Ten Have TR. Prevalence and correlates of sexual behavior and risk management among HIV-positive adults free messaging sites for sex how to delete conversation on coffee meets bagel You will make me weep. Sexual risk behaviors in late middle age and older HIV seropositive adults. Silva ET.
It reveals the opprobrium attached to unmarried women who, living illegally in township spaces, won economic and social independence from customary patriarchal authority through beer brewing. Daily Sun Mizz B However, interviewing occurred until we reached thematic saturation. Gender and power. Health Soc Work. In fact, the few participants who mentioned having skipped their previously scheduled hospital appointments or having gone late were WLHIV, except one. I think a lot of women our age don't have a significant other, whereas in your 20's and 30's you probably do, or because of your age and stuff, you can date. Walker, C. Despite the limitations, this work adds to our understanding of the psychosocial challenges experienced by women with HIV as they transition into middle and older adulthood, and generates hypothesis for additional work. N Engl J Med.
Santos R. The building is also made with mud, and its state is … [Frightening? Gender differences in longevity in free-living older adults who eat-with-others: a prospective study in Taiwan. However, this positive reception is countered by a more pessimistic reading. I am afraid when I test the blood of my child in the lab, they might tell me she is also having the virus. Zablotsky D. She even supports me financially because she has a drinking spot which fetches her some income. Author highlighted the Lower Manya Krobo Municipality with an arrow, and also inserted the arrows showing directions north, south, east and west. Cambridge: Polity Press. Previous researchers [ 2728 ] noted that the Krobo patrilineal culture gives more social privileges to males compared to females. Tenkorang of the Department of Sociology, Memorial University of Newfoundland and Labrador in Canada, for serving as a co-PI pushy tinder guy online dating vermont the good people use tinder top 10 best dating site in the world collection, and for securing funds for the study. And whatever insult they feel like raining on me they. Only one person opted out, citing time constraints. Centers for Disease Control and Prevention. The WHO [ 10 ] noted that gender portends health inequities--doing so both singularly, and as a confounding variable to several social indicators such as age, sexual orientation, easter pick up lines free fuck hookup sites status, ethnicity, and disability.
It was also found that the differential distribution of marital status, especially being widowed, divorced or separated accounted for They mostly had low socio-economic status SESespecially the females. QSR International. Recently the Council [Municipal Office] came to warn us that if the building collapses resulting in death, they will not let us go scot-free … the family house is old and so it leaks when it rains. Arnfred Uppsala: Nordic Africa Institute. The boy is struggling. I feel disturbed and depressed because people say I will die. And whatever insult they feel like raining on me they. The second regards how men and women respond to postfeminism given their disposition within this historical formation. Others included family members denying knowing them, shaming, mockery, name calling, and discrimination during attempts to wallpaper pick up lines groupon online dating a house, and seek employment. I mean if you can get a guy to find you reasonably attractive…you tell him you got the virus and tinder shortcuts habesha speed dating in london might as well tell him you got leprosy. Geneva, Switzerland: WHO. Communicatio In print. This context complicates the premises on which the discourse of postfeminism depends and make visible the limits of its reach. They were further informed that participation was voluntary, and opting out prior to the commencement or in the course of the study would attract no penalty. Tenkorang of the Department of Sociology, Memorial University of Newfoundland and Labrador in Canada, for serving as a co-PI for the data collection, and for securing funds for the study. We were involved in a heated argument and she said I am not her daughter because all her children do not have the disease so I should leave [the house].
The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Accessed 16 Mar The practice of social research. Social implications The social implications of this research are that it challenges normalisation of gendered violence, questions gendercide and produces knowledge of a gendered social reality of living in South Africa. Mathews, S. So I worked real hard to stay healthy emotionally, physically, mentally. So yeah, there are lots of prohibitions. The majority of research examining relationships and sexual behavior among older adults has been conducted with HIV negative samples. Accessed 15 Dec Because people my age and age group, there's still that stigma. Igulot P, Magadi MA. AYO also developed the in-depth interview guide, helped to liaise with technical staff of the Ministry of Health, and led in the acquisition of ethical clearance from the University of Ghana. And it's work, believe me. When drugs are prescribed for me I get only those that are free or those that are covered by the health insurance. Version 9. Sex Transm Dis. September 03, Some readers do sympathise, linking the crime to the wider problem of gender-based violence. Results Characteristics of participants Summary characteristics The participants were 32 females and six males.
Life has not been easy for me at all especially because my husband is dead so I have to take care of all the children by myself. Reid, and L. They are typical of the reportage on this topic, and are purposely selected for the wide range of Facebook comments they provoke. Lindau ST. Both also owned their homes together with their spouses. And that was the reason why he left. This history includes an ongoing struggle to order patriarchal gender relations. Daily Sun Mizz B It examines both the similarities and differences in the experiences of PLWHAs in the study district. Contemp Clin Trials. Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Sorry, a shareable link is not currently available for this article. September 03, Eady A. Body image in middle-aged HIV-infected and uninfected women. However, this positive reception is countered by a more pessimistic reading.
This is mainly due to financial problems. Wasserman, H. I know that was the reason why my husband sacked me from the house. McRobbie, A. The number of comments on the three articles altogether is 3, J Women Aging. Nevedal A. I got me together, and it does have to do with HIV, not because I feel unattractive or anything; because I want me together, and it always plays best dating sites least like tinder booty call brooklyn drugs or. I had all my children with him and we suffered together to put up a house and now he has sacked me.
I begged for food. And you know, it's just not easy when you're living with the virus. PubMed Google Scholar Cambridge: Polity Press. I have been staying alone for about twelve years now. Iqani, M. People, I think, fear that being with a woman with HIV is going to have an expensive impact on them. Qualitative interviews were coded by two raters and content analyses were conducted using NVivo 9 software.