Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV

The engagement of patients with their health care providers (HCP) improves patients’ quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client’s choices, and management of client concerns. This study compares country-level differences in patients’ engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR −7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = −5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = −3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.

[1]  J. Simoni,et al.  Antiretroviral Therapy (ART) Side Effect Impacted on Quality of Life, and Depressive Symptomatology: A Mixed-Method Study. , 2013, Journal of AIDS & clinical research.

[2]  M. Lo,et al.  Resisting the colonization of the lifeworld? Immigrant patients' experiences with co-ethnic healthcare workers. , 2013, Social science & medicine.

[3]  Honghong Wang,et al.  Self‐Efficacy, Medication Adherence, and Quality of Life Among People Living With HIV in Hunan Province of China: A Questionnaire Survey , 2013, The Journal of the Association of Nurses in AIDS Care : JANAC.

[4]  D. Wantland,et al.  Mediators of antiretroviral adherence: A multisite international study , 2013, AIDS care.

[5]  Rosa M. Gonzalez-Guarda,et al.  Predictors of Self‐Efficacy for HIV Prevention Among Hispanic Women in South Florida , 2013, The Journal of the Association of Nurses in AIDS Care : JANAC.

[6]  Ying Liu,et al.  Traditional Chinese Herbal Medicines for Treating HIV Infections and AIDS , 2012, Evidence-based complementary and alternative medicine : eCAM.

[7]  D. Wantland,et al.  Focus on increasing treatment self-efficacy to improve human immunodeficiency virus treatment adherence. , 2012, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[8]  S. Skevington,et al.  Is quality of life poorer for older adults with HIV/AIDS? International evidence using the WHOQOL-HIV , 2012, AIDS care.

[9]  R. Remien,et al.  Patterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America , 2012, AIDS.

[10]  D. Wantland,et al.  Exploring the contribution of general self-efficacy to the use of self-care symptom management strategies by people living with HIV infection. , 2012, AIDS patient care and STDs.

[11]  D. Hillman,et al.  Medication-related barriers to entering HIV care. , 2012, AIDS patient care and STDs.

[12]  D. Wantland,et al.  A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH) , 2012, BMC Public Health.

[13]  Joaquim Oliveira,et al.  Virologic suppression in treatment-experienced patients after virologic rebound or failure of therapy. , 2011, Current opinion in HIV and AIDS.

[14]  C. Pearson,et al.  "You must take the medications for you and for me": family caregivers promoting HIV medication adherence in China. , 2011, AIDS patient care and STDs.

[15]  K. Fennie,et al.  Stigma mediates the relationship between self-efficacy, medication adherence, and quality of life among people living with HIV/AIDS in China. , 2011, AIDS patient care and STDs.

[16]  Peter Gordon,et al.  HIV patients' willingness to share personal health information electronically. , 2011, Patient education and counseling.

[17]  Shuntai Zhou,et al.  Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study. , 2011, The Lancet. Infectious diseases.

[18]  R. Glazier,et al.  Provider training and experience for people living with HIV/AIDS , 2011, The Cochrane database of systematic reviews.

[19]  J. Simoni,et al.  In sickness and in health: a qualitative study of how Chinese women with HIV navigate stigma and negotiate disclosure within their marriages/partnerships , 2011, AIDS care.

[20]  A. Webel,et al.  Psychometric properties of a Symptom Management Self-Efficacy Scale for women living with HIV/AIDS. , 2011, Journal of pain and symptom management.

[21]  F. Bastos,et al.  Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil. , 2010, Patient education and counseling.

[22]  H. Klein,et al.  Self-Esteent and HIV Risk Practices Among Young Adult Ecstasy Users , 2010, Journal of psychoactive drugs.

[23]  J. Tobin,et al.  Self-efficacy and distress in women with AIDS: the SMART/EST women's project , 2010, AIDS care.

[24]  J. Simoni,et al.  Optimizing HIV care by expanding the nursing role: patient and provider perspectives. , 2010, Journal of advanced nursing.

[25]  A. Kurth,et al.  Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study , 2010, BMC public health.

[26]  William Jack,et al.  The HAART cell phone adherence trial (WelTel Kenya1): a randomized controlled trial protocol , 2009, Trials.

[27]  K. Fennie,et al.  Consistent ART adherence is associated with improved quality of Life, CD4 counts, and reduced hospital costs in central China. , 2009, AIDS research and human retroviruses.

[28]  M. Sandelowski,et al.  A systematic review comparing antiretroviral adherence descriptive and intervention studies conducted in the USA , 2009, AIDS care.

[29]  B. Stanton,et al.  Psychosocial consequences for children experiencing parental loss due to HIV/AIDS in central China , 2009, AIDS care.

[30]  D. Wantland,et al.  Exploring HIV Stigma and Quality of Life for Persons Living With HIV Infection , 2009, The Journal of the Association of Nurses in AIDS Care : JANAC.

[31]  R. DiClemente,et al.  Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents , 2009, Psychology, health & medicine.

[32]  Eric A. Fenkl.  HIV/AIDS: Global Frontiers in Prevention/Intervention , 2009 .

[33]  Jui-Ying Feng,et al.  Stress, needs, and quality of life of family members caring for adults living with HIV/AIDS in Taiwan , 2009, AIDS care.

[34]  K Rivet Amico,et al.  Strategies for promoting adherence to antiretroviral therapy: A review of the literature , 2008, Current infectious disease reports.

[35]  R. Malow,et al.  HIV/AIDS: Global Frontiers in Prevention/Intervention , 2008 .

[36]  P. Stevens,et al.  Relationship of symptoms, perceived health, and stigma with quality of life among urban HIV-infected African American men. , 2008, Public health nursing.

[37]  C. Koopman,et al.  Behavioral mediation of the relationship between psychosocial factors and HIV disease progression. , 2008, Psychosomatic medicine.

[38]  C. Pearson,et al.  Chinese HIV‐Positive Patients and Their Healthcare Providers: Contrasting Confucian Versus Western Notions of Secrecy and Support , 2007, ANS. Advances in nursing science.

[39]  S. Bharat,et al.  Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective , 2007, SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance.

[40]  Webb Gc.  Chinese health care providers' attitudes about HIV: a review. , 2007 .

[41]  G. Webber.  Chinese health care providers’ attitudes about HIV: a review , 2007, AIDS care.

[42]  Jairo N. Fuertes,et al.  The physician-patient working alliance. , 2007, Patient education and counseling.

[43]  Zunyou Wu,et al.  Understanding HIV-related stigma and discrimination in a "blameless" population. , 2006, AIDS education and prevention : official publication of the International Society for AIDS Education.

[44]  D. Gullette,et al.  Sensation Seeking, Self‐Esteem, and Unprotected Sex in College Students , 2006, The Journal of the Association of Nurses in AIDS Care : JANAC.

[45]  Dean Wantland,et al.  Testing a Nurse-Tailored HIV Medication Adherence Intervention , 2006, Nursing research.

[46]  D. Wantland,et al.  Utility of a standardized nursing terminology to evaluate dosage and tailoring of an HIV/AIDS adherence intervention. , 2005, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[47]  F. Raffi,et al.  Health-related quality of life and patient–provider relationships in HIV-infected patients during the first three years after starting PI-containing antiretroviral treatment , 2004, AIDS care.

[48]  M. Ichikawa,et al.  Quality of life among people living with HIV/AIDS in northern Thailand: MOS-HIV Health Survey , 2004, Quality of Life Research.

[49]  M. Norton,et al.  Clinical assessment of symptom-focused health-related quality of life in HIV/AIDS. , 2004, The Journal of the Association of Nurses in AIDS Care : JANAC.

[50]  B. Turner,et al.  Antiretroviral adherence interventions: a review of current literature and ongoing studies. , 2003, Topics in HIV medicine : a publication of the International AIDS Society, USA.

[51]  Kwua-Yun Wang,et al.  Quality of life and related factors for people living with HIV/AIDS in Northern Taiwan. , 2003, The journal of nursing research : JNR.

[52]  C. McGibbon,et al.  A Behavioral-Medicine Program in HIV , 2003, Journal of holistic nursing : official journal of the American Holistic Nurses' Association.

[53]  A. Bandura,et al.  Negative self-efficacy and goal effects revisited. , 2003, The Journal of applied psychology.

[54]  B. Gazzard,et al.  Virologic Rebound on HAART in the Context of Low Treatment Adherence Is Associated With a Low Prevalence of Antiretroviral Drug Resistance , 2002, Journal of acquired immune deficiency syndromes.

[55]  J. Pesa,et al.  Assessing quality of life in women living with HIV infection , 2002, AIDS care.

[56]  L. Kazis,et al.  Health Status Assessments Using the Veterans SF‐12 and SF‐36: Methods for Evaluating Outcomes in the Veterans Health Administration , 2001, The Journal of ambulatory care management.

[57]  A. Wu,et al.  Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments , 2000, AIDS care.

[58]  W L Holzemer,et al.  Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. , 2000, AIDS patient care and STDs.

[59]  A Bandura,et al.  Self-efficacy pathways to childhood depression. , 1999, Journal of personality and social psychology.

[60]  Simoni Jm.  Keeping it up: maintaining adherence to antiviral therapies. , 1998 .

[61]  D. J. Lee.  Society and the Adolescent Self-Image , 1969 .

[62]  M. Rosenberg.  Society and the adolescent self-image , 1966 .

[63]  Stephen E. Johnson,et al.  The predictive validity of safety climate. , 2007, Journal of safety research.

[64]  C. Portillo,et al.  Self-care for fatigue in patients With HIV. , 2002, Oncology nursing forum.

[65]  C. Portillo,et al.  The Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention for enhancing adherence to HIV/AIDS medications: a pilot study. , 2000, The Journal of the Association of Nurses in AIDS Care : JANAC.

[66]  B. Flay,et al.  Phases of alcohol problem prevention research. , 1999, Alcoholism, clinical and experimental research.

[67]  J. Simoni.  Keeping it up: maintaining adherence to antiviral therapies. , 1998, The Body positive.