Development of the conceptual 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：

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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 conceptual 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 depended 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

Citation： ZHANG Yue, XU Lei, YANG Zhongfang, CHEN Ben, ZHANG Lin, GONG Beibei, HU Yan. Development of the conceptual framework for psychological resilience interventions in people living with HIV/AIDS: a realist synthesis. Chinese Journal of Evidence-Based Medicine, 2026, 26(2): 172-177. doi: 10.7507/1672-2531.202509119 Copy

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, 李学靖, 张小艳, 等. 现实主义综述用于复杂护理干预评估的范围综述. 护理学杂志, 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 CA, Mooney KA. 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. Scientific World Journal, 2012, 2012: 390450.
10.	赵俊强. 现实主义综述: 现实主义哲学视角下理论驱动的复杂干预系统综述方法. 医学新知, 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. J Am Psychiat Nurses, 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.	郑雅群, 张丽琴, 祝亚清. PERMA模式下的心理学干预联合个案管理模式对HIV感染患者的影响. 齐鲁护理杂志, 2024, 30(9): 92-94.
24.	周璟, 肖丹, 李合林. 定点诊疗护理管理模式在艾滋病患者中的应用效果. 中西医结合护理(中英文), 2023, 9(4): 153-155.
25.	许静, 蔡小林. 多元化健康教育模式对艾滋病患者心理弹性、自我管理和生活质量的影响. 心理月刊, 2025, 20(7): 175-178.
26.	黄琴, 何丽芸, 张甜, 等. 个案管理模式对HIV/AIDS患者心理弹性及自我管理能力的影响. 护理学杂志, 2018, 33(5): 80-82, 88.
27.	王艺. 个案管理模式对HIV/AIDS患者心理弹性与自我管理能力的影响. 中西医结合护理(中英文), 2019, 5(4): 140-143.
28.	牛辉. 基于“功能性健康型态”的护理干预对艾滋病患者的心理弹性和睡眠质量的影响. 临床与病理杂志, 2021, 41(10): 2407-2413.
29.	吴冬燕. 基于慢性疾病轨迹模式的护理干预对艾滋病患者心理弹性自我管理和生活质量的影响. 基层医学论坛, 2024, 28(11): 126-129.
30.	区月炎. 基于慢性疾病轨迹模式的护理干预对艾滋病患者心理弹性自我管理和生活质量的影响分析. 中文科技期刊数据库(文摘版)医药卫生, 2024, (9): 184-187.
31.	刘桂芳. 接纳与承诺疗法对初诊艾滋病住院患者心理弹性的干预研究. 衡阳: 南华大学, 2021.
32.	张兵, 杨红丽, 栾玉泉, 等. 聚焦解决模式对HIV/AIDS患者焦虑抑郁和心理弹性的干预研究. 中国艾滋病性病, 2022, 28(9): 1050-1054.
33.	王芳, 覃晓婕, 黄爱丽, 等. 聚焦解决模式对首发艾滋病患者心理弹性的影响. 右江医学, 2024, 52(9): 821-828.
34.	陈伟梅, 李丽仙, 程林, 等. 聚焦解决模式在艾滋病患者心理干预中的应用效果评价. 实用预防医学, 2019, 26(9): 1091-1093.
35.	王丽, 张静静, 李爽, 等. 看图对话交互式健康教育模式在艾滋病患者抗病毒治疗中的应用. 齐鲁护理杂志, 2021, 27(9): 132-134.
36.	邵英, 王晶, 王亚丽, 等. 门诊优化护理管理模式对艾滋病患者心理弹性自我管理和生活质量的影响. 中国艾滋病性病, 2021, 27(6): 594-597.
37.	韦湘霞. 门诊优化护理管理模式改善艾滋病患者心理弹性自我管理水平的分析. 中文科技期刊数据库(引文版)医药卫生, 2023, (7): 99-102.
38.	韩秀花. 全程关爱模式护理对HIV感染者/AIDS患者心理弹性及应对方式的影响. 中国科技期刊数据库医药, 2022, (5): 92-94.
39.	苗小丽, 沈倩, 林爱玉. 全程关爱模式护理对HIV感染者/AIDS患者心理弹性及应对方式的影响. 中国民康医学, 2021, 33(2): 176-178.
40.	李瑶瑶. 全程关爱模式护理对HIV感染者AIDS患者心理弹性及应对方式的影响. 中国科技期刊数据库医药, 2024, (11): 215-218.
41.	黄巧莉, 陈春辉, 冯孝清, 等. 乡村振兴背景下个案管理模式在重庆山区艾滋病患者健康管理中的初步探索. 现代医药卫生, 2022, 38(17): 2885-2889.
42.	付丹青. 需求层次理论的精细化护理干预对艾滋病患者心理韧性、自我护理效能的影响. 医学信息, 2024, 37(z1): 40-42.
43.	吴红, 贾静月, 徐彩霞, 等. 需求层次理论的精细化护理干预对艾滋病患者心理韧性、自我护理效能的影响. 齐鲁护理杂志, 2023, 29(11): 120-122.
44.	刘华, 石奥利, 李程娟, 等. 艺术表达疗法对艾滋病首诊患者心理弹性水平及应对方式的影响. 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, 李学靖, 张小艳, 等. 现实主义综述用于复杂护理干预评估的范围综述. 护理学杂志, 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 CA, Mooney KA. 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. Scientific World Journal, 2012, 2012: 390450.
10. 赵俊强. 现实主义综述: 现实主义哲学视角下理论驱动的复杂干预系统综述方法. 医学新知, 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. J Am Psychiat Nurses, 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. 郑雅群, 张丽琴, 祝亚清. PERMA模式下的心理学干预联合个案管理模式对HIV感染患者的影响. 齐鲁护理杂志, 2024, 30(9): 92-94.
24. 周璟, 肖丹, 李合林. 定点诊疗护理管理模式在艾滋病患者中的应用效果. 中西医结合护理(中英文), 2023, 9(4): 153-155.
25. 许静, 蔡小林. 多元化健康教育模式对艾滋病患者心理弹性、自我管理和生活质量的影响. 心理月刊, 2025, 20(7): 175-178.
26. 黄琴, 何丽芸, 张甜, 等. 个案管理模式对HIV/AIDS患者心理弹性及自我管理能力的影响. 护理学杂志, 2018, 33(5): 80-82, 88.
27. 王艺. 个案管理模式对HIV/AIDS患者心理弹性与自我管理能力的影响. 中西医结合护理(中英文), 2019, 5(4): 140-143.
28. 牛辉. 基于“功能性健康型态”的护理干预对艾滋病患者的心理弹性和睡眠质量的影响. 临床与病理杂志, 2021, 41(10): 2407-2413.
29. 吴冬燕. 基于慢性疾病轨迹模式的护理干预对艾滋病患者心理弹性自我管理和生活质量的影响. 基层医学论坛, 2024, 28(11): 126-129.
30. 区月炎. 基于慢性疾病轨迹模式的护理干预对艾滋病患者心理弹性自我管理和生活质量的影响分析. 中文科技期刊数据库(文摘版)医药卫生, 2024, (9): 184-187.
31. 刘桂芳. 接纳与承诺疗法对初诊艾滋病住院患者心理弹性的干预研究. 衡阳: 南华大学, 2021.
32. 张兵, 杨红丽, 栾玉泉, 等. 聚焦解决模式对HIV/AIDS患者焦虑抑郁和心理弹性的干预研究. 中国艾滋病性病, 2022, 28(9): 1050-1054.
33. 王芳, 覃晓婕, 黄爱丽, 等. 聚焦解决模式对首发艾滋病患者心理弹性的影响. 右江医学, 2024, 52(9): 821-828.
34. 陈伟梅, 李丽仙, 程林, 等. 聚焦解决模式在艾滋病患者心理干预中的应用效果评价. 实用预防医学, 2019, 26(9): 1091-1093.
35. 王丽, 张静静, 李爽, 等. 看图对话交互式健康教育模式在艾滋病患者抗病毒治疗中的应用. 齐鲁护理杂志, 2021, 27(9): 132-134.
36. 邵英, 王晶, 王亚丽, 等. 门诊优化护理管理模式对艾滋病患者心理弹性自我管理和生活质量的影响. 中国艾滋病性病, 2021, 27(6): 594-597.
37. 韦湘霞. 门诊优化护理管理模式改善艾滋病患者心理弹性自我管理水平的分析. 中文科技期刊数据库(引文版)医药卫生, 2023, (7): 99-102.
38. 韩秀花. 全程关爱模式护理对HIV感染者/AIDS患者心理弹性及应对方式的影响. 中国科技期刊数据库医药, 2022, (5): 92-94.
39. 苗小丽, 沈倩, 林爱玉. 全程关爱模式护理对HIV感染者/AIDS患者心理弹性及应对方式的影响. 中国民康医学, 2021, 33(2): 176-178.
40. 李瑶瑶. 全程关爱模式护理对HIV感染者AIDS患者心理弹性及应对方式的影响. 中国科技期刊数据库医药, 2024, (11): 215-218.
41. 黄巧莉, 陈春辉, 冯孝清, 等. 乡村振兴背景下个案管理模式在重庆山区艾滋病患者健康管理中的初步探索. 现代医药卫生, 2022, 38(17): 2885-2889.
42. 付丹青. 需求层次理论的精细化护理干预对艾滋病患者心理韧性、自我护理效能的影响. 医学信息, 2024, 37(z1): 40-42.
43. 吴红, 贾静月, 徐彩霞, 等. 需求层次理论的精细化护理干预对艾滋病患者心理韧性、自我护理效能的影响. 齐鲁护理杂志, 2023, 29(11): 120-122.
44. 刘华, 石奥利, 李程娟, 等. 艺术表达疗法对艾滋病首诊患者心理弹性水平及应对方式的影响. 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

Development of the conceptual framework for psychological resilience interventions in people living with HIV/AIDS: a realist synthesis

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