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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus
Nursing research (New York), v 69(3), pp 197-209
01 May 2020
PMID: 31972851
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort.
Objectives
As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior.
Methods
The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources.
Results
Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control.
Discussion
Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.
Metrics
Details
- Title
- Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus
- Creators
- Ann-Margaret Dunn Navarra - New York UniversityRobin Whittemore - Yale Sch Nursing, West Haven, CT USASuzanne Bakken - Columbia UniversityMichael J. Rosenberg - Albert Einstein College of MedicineMaurade Gormley - NYU, Rory Meyers Coll Nursing, 433 First Ave,Room 410, New York, NY 10010 USAJohn Bethea - NYU, Coll Arts & Sci, New York, NY 10010 USAMarya Gwadz - Institute of Social WorkCharles Cleland - College Station Medical CenterEva Liang - NYU, Rory Meyers Coll Nursing, 433 First Ave,Room 410, New York, NY 10010 USAGail D'Eramo Melkus - Nursing
- Publication Details
- Nursing research (New York), v 69(3), pp 197-209
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 13
- Grant note
- K23NR015970 / National Institute of Nursing Research Career Development Award
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Biology; College of Arts and Sciences; Drexel University
- Web of Science ID
- WOS:000534337800007
- Scopus ID
- 2-s2.0-85089405055
- Other Identifier
- 991020099052804721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Nursing