An adherence typology: Coping, quality of life, and physical symptoms of people living with HIV/AIDS and their adherence to antiretroviral treatment
Armin Bader, Heidemarie Kremer, Isabella Erlich-Trungenberger, Roberto Rojas, Monika Lohmann, Olivia Deobald, Rainer Lochmann, Peter Altmeyer, Norbert Brockmeyer
Med Sci Monit 2006; 12(12): CR493-500
Background: Research has found that patient adherence to antiretroviral therapy is crucial to treatment success, but this research did not investigate the patient’s viewpoint. This study examined relationships between types of adherence and coping, psychosocial factors, quality of life (QoL), and physical symptoms from the perspective of people living with HIV/AIDS.
Material/Methods: The quantitative study involved 100 HIV-positive participants. Questionnaires comprised the Trier Scales on Coping with Physical Illness, Medical-Outcomes-Study HIV Health-Survey QoL, Social
Factors of Antiretroviral Therapy, and the HIV/AIDS Physical Symptom-Checklist. A sub-sample of 41 participants underwent semi-standardized interviews eliciting the type of adherence. Grounded Theory was the method of qualitative analyses.
Results: Maladaptive coping (rumination) related to poor mental health (p<0.001), concealing the HIV-infection (p<0.01), and being treatment-naive (p<0.01). Spiritual coping was more likely in women (p<0.001). Overall, QoL was worse in participants with more physical symptoms (p<0.001) and in those seeking mental health care (p<0.001). Working and maintaining a regular daily routine were associated with better adherence (p<0.05). Four adherence types were identified: ‘Traditional Adherence’ (with indifferent, faithful, and anxious subtypes), ‘Traditional Non-Adherence’, ‘Critical Adherence’, and ‘Critical Non-Adherence’. The traditional types underscored a paternalistic medical model, while critical types emphasized ‘autonomous patients’. Critical types were less frequent (39%), although superior to traditional types (p<0.001) in internal locus of control, optimal social support, and adaptive coping.
Conclusions: Critical adherence is superior to traditional adherence with respect to physical and psychosocial factors. Strategies to improve adherence should therefore target empowerment and autonomy rather than patient obedience.
Keywords: Adult, Adaptation, Psychological, Acquired Immunodeficiency Syndrome - psychology, Antiretroviral Therapy, Highly Active - psychology, Female, Germany, HIV Infections - psychology, Humans, Male, Middle Aged, Patient Compliance, Quality of Life, Questionnaires, Social Support