The Mediating Role of Self-Efficacy and Psychosocial Variables on HIV Treatment Adherence
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High levels of adherence to highly active antiretroviral therapy (HAART) are required to manage HIV as a chronic illness, but many people with HIV do not achieve these optimum levels. To improve adherence rates, intervention programs designed to address the barriers to maintaining adherence have emerged. One theory driving these kinds of adherence-promoting interventions is social cognitive theory (SCT). SCT holds that self-efficacy, or the beliefs one has about his or her ability to do what is needed to achieve goals, is the most important factor associated with adherence. Working with approximately 85 patients starting a HAART regimen as part of their medical treatment at a nationally-recognized, Baltimore-based HIV treatment program, this research will use much of what is already known about patients starting a HAART regimen to look at the relations between self-efficacy and several psychosocial variables that have been identified by SCT and the literature at large as important barriers to adherence. Research has found that self-efficacy has a significant impact on treatment adherence, particularly that low self-efficacy is associated with nonadherence (Ammassari et al., 2002; Catz et al., 2000; Cha et al., 2008; DiIorio et al., 2009; Smith et al., 2003; Watt et al., 2009). Many psychosocial variables, such as psychopathology, social support and presence of barriers and facilitators to treatment, have also been found to be highly correlated with adherence. For example, psychological distress, which includes symptoms of depression, anxiety and psychosis, has been found to be significantly related to a person’s adherence to HAART regimens (Adewuya et al., 2010; Applebaum et al., 2009; Catz et al., 2000; Chesney, 2003; Gordillo et al., 1999; Heckman et al., 2004; O’Cleirigh & Safren, 2008; Sternhell & Corr, 2002; Vyavaharkar et al., 2007). Additionally, psychosocial factors have been found to be related to self-efficacy; for example, social support has been found to increase self-efficacy, and also preserve self-efficacy in the face of barriers to treatment adherence (Chesney, 2003; DiMatteo, 2004; Simoni et al., 2002; Simoni et al., 2006).
While many studies look at the relationship between psychosocial variables and adherence, or self-efficacy and adherence, few have used self-efficacy as a mediator in the relationship between these various psychosocial variables and adherence to HIV medication. This study will also examine the correlations between adherence and Axis I and Axis II psychopathology, patient and physician perceptions of social support, and participation in adherence-promoting facilitative programs. The author proposes that participants with higher self-efficacy scores will be able to maintain adherence, despite the presence of psychosocial barriers such as psychopathology, a lack of social support and a lack of participation in adherence-promoting programs. In this sense, self-efficacy mediates the impact of these psychosocial variables on adherence. The project will help strengthen local HIV treatment programming by using SCT to inform practices, provide empirical evidence for the many anecdotal assumptions about the efficacy of the program, and add to the literature at large by exploring different facets of important variables (such as Axis II pathology, both the patient’s and provider’s perception of social support).