HIV/AIDS is a global contagious disease that has no cure. The disease can affect both adults and children and is associated with adverse physical health conditions. Previous studies show that the number of infected children in Indonesia is large. Therefore, they have psychological and physical stress due to bullying and the lack of acceptance of the disease. Besides, stress can also be a factor that weakens their immune system. Consequently, children with HIV/AIDS tend to experience social discrimination from their environment, including their families and friends. In this article, “Combination of Storytelling and Music Therapy to Reduce Stress in Children with HIV/AIDS and Discrimination in Surabaya,” Darmawan investigate whether storytelling and music therapies can reduce the severity of psychological distress in children living with HIV/AIDS.  While the study established that storytelling and music therapies are essential remedies of stress in HIV positive children, the outcomes were limited by a small sample and short study duration.
Darmawan obtained children who were infected with HIV and AIDS and performed a quasi-experiment study three times a week for three months. The study population was children aged from 6 to 10 years old suffering from HIV/AIDS in the Abdi Asih Non-Governmental Organization (NGO) area. The children participated in storytelling and music therapies that lasted for 60 minutes per session. The songs were obtained from youtube and were tailored to entertain the children to reduce stress. The results were compared between pre and post-intervention and analyzed using the Wilcoxon sign rank test. In fact, the stress level of the respondents decreased after music therapy and storytelling; the difference is even negative in 23 samples. In addition, children with HIV/ AIDS during the first two years had the most severe problem. The main problem was persistent stress to the point of depression. As HIV affects their daily social activities due to society’s stigma, the age of 6-12 years old is a sensitive phase for understanding their social environment. Thus, the combination of music and storytelling shows a higher success rate than music therapy or storytelling alone.
Despite the promising effects of storytelling and music therapies in reducing stress in HIV positive children, there were several limitations. First, the sample size was so small. Out of 60 children with HIV/ AIDS who participated in the storytelling and music therapies, only 23 children completed the Wilcoxon test. With such a small sample size, it was difficult to generalize these findings to all children with HIV/AIDS in Indonesia. Besides, the small sample lacked an equal gender distribution. For instance, 70% of the children who participated in this survey were boys, while only 30% were girls. Since psychological stress varies with gender, the small sample limited a thorough evaluation of the prevalence of stress. According to Hackshaw, a small sample is associated with misrepresenting all the variables from the larger population; thus, it limits the generalization of outcomes.  Therefore, the researchers could have recruited a large sample for substantive results. Secondly, the music and storytelling therapies were conducted for only three months. The short study duration was prone to outcomes that have not been thoroughly analyzed. Alvarez et al. in their article, “Sample size, study length, and inadequate controls were the most common self-acknowledged limitations in manual therapy trials: A methodological review,” suggest that the study duration should be long enough to promote a comprehensive assessment of all the study variables and a longer follow-up.  As such, the researchers could not estimate the long-term effects of music and storytelling In HIV/AIDS children. Of course, some scholars may have different perceptions of the sample size and study duration. For example, Biau et al. claim that a small sample is good when surveying young children since they require more attention than adults. Besides, young children demand close attention, hence the storytelling was more effective with the small sample. In addition, Polit et al. claim that a short study duration for simple medical assessments is ideal for quick outcomes.  Nonetheless, Stuckey and Nobel refute by arguing that all medical surveys must adhere to good research elements, such as adequate sample size and relatively long study duration. 
In conclusion, the researchers observed that storytelling and music therapies could help reduce stress in children with HIV/AIDS. Still, the findings were undermined by the small sample and short study duration. The music and storytelling sessions were conducted for only three months; thus, it was difficult to predict the long-term efficacy of such therapies in reducing stress in HIV positive children. Besides, the small sample and non-uniformity in gender representation limited the generalization of findings to the entire population of HIV positive children. Since the prevalence of stress in HIV positive children is gradually increasing, further studies should be conducted to establish ways to reduce the stress. Besides, the campaign against discrimination and stigma should be conveyed to protect the children living with HIV/AIDS.
- Darmawan TC. Combination of Storytelling and Music Therapy to Reduce Stress in Children with HIV/AIDS and Discrimination in Surabaya. JHS [Internet]. 2021Feb.26 [cited 2021 Nov1].14(1):14-20. Available from: https://journal2.unusa.ac.id/index.php/JHS/article/view/1749
- Hackshaw A. Small studies: strengths and limitations. Eur Respir J. [Internet]. 2008; 32(5): 1141–3. [Cited 2021 Nov1]. Available from: https://scholar.google.com/scholar?output=instlink&q=info:2bpNXkHMGnwJ:scholar.google.com/&hl=en&as_sdt=0,5&scillfp=17575385740135558862&oi=lle
- Alvarez G, Núñez-Cortés R, Solà I, Sitjà-Rabert M, Fort-Vanmeerhaeghe A, Fernández C, Bonfill X, Urrútia G. Sample size, study length, and inadequate controls were the most common self-acknowledged limitations in manual therapy trials: a methodological review. Journal of Clinical Epidemiology. [Internet]. 2021 Feb 1. [Cited 2021 Nov1]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0895435620311574
- Biau DJ, Kernéis S, Porcher R. Statistics in brief: the importance of sample size in the planning and interpretation of medical research. Clinical orthopaedics and related research. [Internet]. 2008 Sep. [Cited 2021 Nov1]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc2493004/
- Polit, D.F and Beck, C.T. Nursing Research: Generating and Assessing Evidence for Nursing Practice, 9th Ed. Philadelphia: Walters Kluwer Health. Lippincott Williams & Wilkins. [Internet].2012. [Cited 2021 Nov1]. Available from: https://www.bretagne-economique.com/sites/default/files/webform/pdf-nursing-research-by-denise-polit-pdf-download-free-book-f89d8b3.pdf
- Stuckey HL, Nobel J. The connection between art, healing, and public health: a review of current literature. Am J Public Health. 2010 Feb;100(2):254-63. DOI: 10.2105/AJPH.2008.156497. Epub 2009 Dec 17. PMID: 20019311; PMCID: PMC2804629. Available from: https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2008.156497