Title:
The mediating role of self-efficacy and psychosocial variables in HIV treatment adherence
Author:
Arianna E. Apelgren Perra
Thesis Advisor:
Matthew Kirkhart
Committee Member:
Beth A. Kotchick
Committee Member:
Jeffrey Lating
Committee Member:
James Miracky
Committee Member:
Heather Lyons
Degree Granting Institution:
Loyola University Maryland--College of Arts and Sciences
Place:
Baltimore (Md.)
Publisher:
Loyola University Maryland
Date Created:
2014
Type of Resource:
text
Genre:
thesis
Language:
eng
Format:
application/pdf
Physical Form:
electronic
Digital Source:
born digital
Abstract:
The treatment of HIV/AIDs remains an important public health issue for patients and providers. The nature of the disease makes optimal adherence to highly active antiretroviral therapy (HAART) an important personal and public health issue. However, as with other chronic illnesses, adherence to HAART medication remains a significant problem for many patients living with HIV. Using Bandura's Social Cognitive Theory (SCT) as a framework, this study centered on three central determinants of adherence behavior: (a) self-efficacy, (b) outcome expectancies, and (c) the presence or absence of facilitators and barriers to behavior change, such as the psychological disorder and social support. The Medication Support Team, an HIV treatment program based in a person-centered community health organization in Baltimore, MD, attempts to improve medication adherence and reduce public health risk by accounting for factors consistent with SCT constructs in treatment recommendations for patients. Using variables identified by literature and SCT, this study further elucidated the relation between psychosocial variables (including psychiatric disorder, social support, and use of adherence-promoting facilitators), self-efficacy, as measured by the HIV Medication Taking Self-Efficacy Scale, and adherence. Of the 96 patients who began the MST program during the data collection period, 43 ?ǣgraduated?ǥ from the MST program, indicating that they were identified by clinicians as being able to independently maintain regular undetectable viral loads. In partial support of hypotheses, results indicated higher scores on the Outcome Expectancy Subscale of the HIV MT SES were associated with adherence, as measured by an undetectable viral load at a patient's first follow-up appointment with a primary care provider. Additionally, presence of patient-identified social support was positively associated with graduation from the MST program. Furthermore, this study demonstrated that the clinicians in this program were able to identify those most likely to be adherent to HAART medications with 89.3% specificity, suggesting that the criteria used in this setting, along with SCT-identified variables of import, can be used to help other HIV treatment programs in similar settings identify which patients are at increased risk for nonadherence, as well as what supports may be helpful to promote adherence.
Degree:
Doctor of Clinical Psychology
Level:
Doctoral
Discipline:
Psychology
Restrictions on Access:
Author has given permission to make this work available online to the Loyola Notre Dame Library basic constituency.
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Identifier:
PerraAEA-14
