Session number: 1089
Abstract title: Strategies, Skills, and Social Contexts that Enhance or Disrupt Adherence
Author(s):
MJ Mohler - Southern Arizona VA Health Care System, University of Arizona
K Kroesen - Southern Arizona VA Health Care System
CM Baldwin - University of Arizona
P Reid Duffy - University of Arizona
C Wendel - Southern Arizona VA Health Care System
J Bormann - VA San Diego Health Care System,University of California, San Diego
NM Ampel - Southern Arizona VA Health Care System,University of Arizona
AL Gifford - VA San Diego Health Care System,University of California, San Diego
Objectives: Objective: Although poor adherence is not the sole cause of HAART (highly active antiretroviral treatment) regimen treatment failure, it is often the only remediable factor, given an efficacious and appropriate therapeutic regimen. We sought to learn about effective adherence-support attitudes and skills, as well as barriers to adherence, in patients living with HIV who were on complex HIV antiretroviral regimens.
Methods: Design: We performed a qualitative inquiry, using a sub-sample of a previous descriptive study of antiretroviral adherence that employed Medication Event Monitoring System (MEMS) caps to ascertain percent adherence.
Methods: A high-adherer focus group was held using those patients found to be within the highest tertile of adherence. Content analysis was used to develop an inductive framework of “successful” adherence using focus group data. Individual interviews were used to explicate and deconstruct associations, perceived management strategies, and barriers to adherence in subjects within the lowest tertile of adherence. Content analysis explored the patterns, themes and barriers associated with poor adherence, and constant comparative analysis was used to compare and contrast the “successful adherence” framework with low adherer findings in order to validate the framework.
Results: Results: Content analysis indicated six adherence-enhancing factors: 1) adherence self-efficacy, 2) perceived treatment efficacy, 3) knowledge of regimen, 4) social support, 5) patient adherence skills, and 6) health care considerations, and a single adherence-disrupting category, 7) poorly structured daily life. Low adherer responses matched the inverse of five of the “successful adherence” categories. Two categories--“knowledge” and “health care considerations” – were found equivalent in both groups. No additional categories were identified by low adherers outside of those previously identified in high adherers.
Conclusions: Conclusions:Study findings both corroborate and augment previously reported adherence findings, and provide a framework to guide future chronic disease adherence research in areas of complex regimens, including HIV. Unique discoveries from this study include: 1) a working framework of successful adherence developed by adherence experts and validated by those with poor adherence behaviors; 2) the relationship of the belief in integrative (versus allopathic) medicine to poorer adherence; 3) the perception of maintenance of high adherence as being a source of stress in poor adherers, in contrast to being a stress-reducer in high adherers; and 4) the importance of general perceived self-efficacy and adherence specific self-efficacy on adherence behavior.
Impact statement: Impact:Application may result in improved detection of patients at highest risk of poor adherence, more effective targeted patient adherence support and skill building programs, and improved provider adherence management techniques.