Influences on adherence in African American women with HIV
Looby, Sara E. Dolan. “Influences on adherence in African American women with HIV”. PhD, Boston College, 2008. http://hdl.handle.net/2345/39.
Little is known about adherence among African American women with HIV. This crossectional study investigated the direct and indirect effects of subjective wellbeing (SWB), physical activity, depression, and spiritual beliefs on adherence to antiretroviral therapy, condom use, and appointment keeping in 86 participants. These variables formed a theoretical model proposed in response to findings in the literature and clinical observations. Participants completed demographic and clinical questionnaires, the Center for Adherence Support Evaluation (CASE) Adherence Index (antiretroviral therapy adherence), Satisfaction with Life scale (SWB), Paffenbarger Physical Activity Questionnaire, CES-D (Depression), the Faith subscale of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (spiritual beliefs), and questions regarding condom use and appointment keeping. Descriptive statistics, ANOVA, t-tests, and Chi square analyses were used to analyze clinical and demographic variables, scale means, and effects on adherence variables. Linear and logistic regression analyses were used to test study hypotheses, and path analysis was used to confirm the relationships in the linear regression model. The final model for medication adherence explained 31% of the variance. SWB had a direct effect (β = .30, p < .01). Spiritual beliefs had direct (.21), and indirect effects (.07) through SWB. Having a history of hospitalization for mental illness had direct (-.25), and indirect effects (-.06) through SWB. Physical activity had only a direct effect (β = - .19, p = .05), and no effect on SWB (p = .26). Findings failed to support relationships hypothesized in the model for condom and appointment adherence, though age was shown to have a positive effect (B = 0.06, p < .05) on appointment adherence in the final model. Further research is needed to replicate these findings in a larger cohort of African American women with HIV, and to identify factors that impact condom use and appointment keeping. Study findings argue for the need to assess spiritual beliefs, connect individuals with programs designed to enhance spiritual beliefs, and other resources that may positively influence well-being and medication adherence in this population.