Psychological model of ART adherence behaviors in persons living with HIV/AIDS in Mexico: a structural equation analysis

Sagarduy, José Luis Ybarra; López, Julio Alfonso Piña; Ramírez, Mónica Teresa González; Dávila, Luis Enrique Fierros

doi:10.11606/S1518-8787.2017051006926

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Artigos Originais • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.11606/S1518-8787.2017051006926 copy

Psychological model of ART adherence behaviors in persons living with HIV/AIDS in Mexico: a structural equation analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

The objective of this study has been to test the ability of variables of a psychological model to predict antiretroviral therapy medication adherence behavior.

METHODS

We have conducted a cross-sectional study among 172 persons living with HIV/AIDS (PLWHA), who completed four self-administered assessments: 1) the Psychological Variables and Adherence Behaviors Questionnaire, 2) the Stress-Related Situation Scale to assess the variable of Personality, 3) The Zung Depression Scale, and 4) the Duke-UNC Functional Social Support Questionnaire. Structural equation modeling was used to construct a model to predict medication adherence behaviors.

RESULTS

Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x²/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance.

CONCLUSIONS

The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.

HIV Long-Term Survivors Acquired, psychology; Medication Adherence; Immunodeficiency Syndrome, drug therapy; Models, Psychological; Patient Medication Knowledge; Health Knowledge, Attitudes, Practice

Measure	Mean	SD	Range (Possible)	Range (Current)	Cronbach’s alpha (α)
Decision-making	13.0	10.2	3–30	3–30	0.83
Tolerance of ambiguity	16.9	9.9	3–30	3–30	0.80
Tolerance of frustration	23.9	15.3	6–60	6–60	0.82
Motives to behave	11.4	5.7	4–16	4–16	0.92
Past competencies	16.2	7.2	5–25	5–25	0.88
Current competencies	17.0	3.7	4–20	4–20	0.75
Depression	40.0	8.8	20–80	20–69	0.76
Social support	47.9	9.5	11–55	11–55	0.87

Variable	n*	%*
Age (years)*	37.9 (20–72)	36.4–39.5
Gender
Male	106	61.6
Female	66	38.4
Marital status
Single	96	55.8
Married or cohabitating	71	41.3
Missing data	5	2.9
Education status (years)
Illiterate	3	1.7
Less than 9 years	126	73.2
More than 9 years	42	24.4
Missing data	1	0.5
Occupation
Employed	59	34.3
Unemployed	113	65.7
Time since infection (months)*	51.5 (6–40)	44.9–58.4
Viral load (copies/ml)
Undetectable	145	84.8
Between 401–30,000	5	2.9
More than 30,000	20	11.7
Missing data	1	0.6
CD4 cell count (cell/mm³)
Less than 200	20	11.7
Between 201–400	73	42.7
More than 400	78	45.6
Medication adherence behaviors
100% adherents	141	82.0
Non-adherents	31	18.0

Variable	2	3	4	5	6	7	8	9
1. Adherence behaviors	0.170	-0.042	-0.113	0.751^b	0.045	0.135	0.019	0.023
2. Decision-making		0.599^b	0.635^b	0.008	-0.002	-0.099	0.138	0.184^a
3. Tolerance of ambiguity			0.710^b	-0.146	0.061	-0.097	0.162^a	0.128
4. Tolerance of frustration				-0.204^b	-0.014	-0.109	0.133	0.078
5. Motives					-0.096	0.009	-0.051	0.011
6. Past competencies						-0.017	0.058	-0.007
7. Current competencies							-0.640^b	0.462^b
8. Depression								-0.396^b
9. Social support

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[1] Correspondence: José Luis Ybarra Sagarduy. Unidad de Trabajo Social y Ciencias para el Desarrollo Humano. Universidad Autónoma de Tamaulipas. Centro Universitario Adolfo López Mateos s/n Ciudad Victoria. Tamaulipas, México, C.P. 87149. E-mail: jsagarduy@uat.edu.mx