Applying the theory of planned behavior to explore HAART adherence among HIV-positive immigrant Latinos: Elicitation interview results
Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Patient Education and Counseling
(Impact Factor: 2.2).
12/2011; 85(3):454-60. DOI: 10.1016/j.pec.2010.12.004
This study explored influences on intention to adhere to highly active antiretroviral therapy (HAART) among immigrant Latinos living with HIV/AIDS in the southeastern USA.
Our community-based participatory research (CBPR) partnership completed individual in-depth interviews with 25 immigrant Latinos, based on the theory of planned behavior (TPB), to explore beliefs toward HAART adherence and HIV testing.
Participants identified (a) seven outcomes of treatment adherence (e.g., "feeling good" and "controlling the virus"), (b) six groups of persons influencing adherence (e.g., family, partner/spouse), and (c) nine impediments to adherence (e.g., appointment scheduling, side effects of treatment). Fear of deportation, perceived costs of services, and barriers to communication emerged as impediments to both HAART adherence and HIV testing.
The findings suggest the utility of TPB in identifying factors to enhance HAART adherence among immigrant Latinos. Future research should explore the extent to which these identified TPB components quantitatively influence adherence intention and immunological and virological outcomes.
Culturally congruent interventions for immigrant Latinos may need to focus on facilitators of adherence, influential referent groups, and destigmatizing HIV/AIDS.
Available from: Amir Pakpour
- "Patient-related factors are considered as the main reasons for nonadherence . Next to socio-demographic  and clinical factors , empirical evidence suggests that patients' intention towards adherence is associated with medical adherence behavior in various patient populations   . Social cognitive theories have proposed intentions towards medication adherence being the most influential direct predictor of adherence behavior alongside an individual's control beliefs . "
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Medication adherence rates after coronary artery bypass graft (CABG) surgery are low due to intentional (e.g., deliberately choosing not to take medication) and unintentional (e.g., forgetting to take the medication) person-related factors. There is a lack of studies examining the psychological factors related to non-adherence in CABG patients. Intentions to take medication and planning when, where, and how to take medication and to overcome unintentional forgetting to take medication were hypothesized to be independently related to medication adherence. Furthermore, planning to overcome forgetting was hypothesized to be more strongly associated with medication adherence in patients who have stronger intentions to take medication, reflecting the idea that planning is a factor that specifically helps in patients who are willing to take medication, but fail to do so.
Measures of medication adherence, intention and planning were collected in a sample of (N=197) post-CABG surgery patients followed from discharge (baseline; Time 1) over a 12-month period (Time 2) in Boo-Ali Hospital in Qazvin, Iran. A series of hierarchical multiple regression analyses were performed in which medication adherence at Time 2 was regressed onto socio-demographic and clinical factors, the hypothesized psychological variables (adherence-related intention and planning), and interaction terms.
Intentions to take medication (B=.30, P<.01), action planning when, where, and how to take the medication (B=.19, P<.01), and coping planning how to avoid forgetting to take the medication (B=.16, P<.01) were independently related to medication adherence. Beyond that, action planning × intention to take medication (B=.06, P<.05) and coping planning × intention (B=.07, P<.01) interaction also significantly predicted adherence.
Intention to take medication was associated with better medication adherence and action and coping planning strategies to avoid forgetting to take the medication added significantly to the prediction of adherence in the year following CABG discharge. This is in line with theory and evidence about the independent roles of intentional and unintentional predictors of non-adherence. As hypothesized, planning to overcome unintentional forgetting to take the medication was more predictive of medication adherence in those patients who reported higher intentions to take medication, reflecting the idea that planning helps patients overcome unintentional reasons of being non-adherent.
Available from: Susana Sofia Monteiro Mourão
- "In fact, language difficulties have been identified as the main communication problem related to immigrants' non-adherence (e.g., Griva et al., 2013; Hakonsen & Toverud, 2011; Vissman et al., 2011). Besides this, some authors (e.g., Traylor, Schmittdiel, Uratsu, Mangione, & Subramanina, 2010) agree that language concordance between patients and health-care providers can be related with better TA, namely in Hispanic-Americans with diabetes. "
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ABSTRACT: Immigrants and ethnic minorities have been identified as vulnerable groups in health, in general, and
in what concerns therapeutic non-adherence (TA) in particular; i.e., (not)following health-care
providers’ therapeutic recommendations. The general aim of this paper is presenting a literature review
of immigrants’/ethnic minorities’ TA determinants.
We will start by highlighting the reasons as to why immigrants’/ethnic minorities’ therapeutic
(non)adherence should be a topic of concern. Then, we will present a review of the main determinants
of immigrants’/ethnic minorities’ TA, at different levels of analysis (e.g., broad structural level, social
and community networks; material and social conditions) and emphasize that non-adherence among
immigrants/ethnic minorities is mostly non-intentional, seeing as how it is associated with issues such
as: low socio-economic conditions, language barriers and cultural mismatches.
Finally, we will highlight the role of health-care providers in tackling this health-related problem and
reflect about the importance of promoting development and training of health-care providers’
Available from: Paschal Sheeran
- "In relation to adherence to treatment regimes among HIV patients, Munro et al  reviewed 6 behavioural models applied to promoting adherence in a limited number of studies but found little evidence for effectiveness. Studies in the last 5 years appear to be reiterating the same conclusion with some finding the Theory of Planned Behaviour (TPB)  instrumental to enhance adherence  whereas others found that only a small fraction of the variance in intention to adhere to antiretroviral therapy was explained by the classic TPB predictor set of attitude, norms and perceived control . Self-regulatory processes were found to mediate between intention and adherence . "
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The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes.
HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis).
The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients' beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above the effects of the behaviour-specific thinking and ii) the relationship between adherence to exercise and to medical treatment is stronger among those with more favourable views about the goal. Results from this study should identify the key contributing factors to inform subsequent adherence research and afford a more streamlined assessment matrix. The project also aims to inform patient care practices. UK CLINICAL RESEARCH NETWORK REGISTRATION NUMBER: UKCRN 7842.
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