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Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus.
Nurs Res 2020NR

Abstract

BACKGROUND

Maintaining adherence to antiretroviral therapy is a significant challenge for HIV-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal antiretroviral therapy 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 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 receiving antiretroviral therapy 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 with directed content analysis to generate categories and broad themes. Coding was initially conceptually driven 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 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 antiretroviral therapy self-management: (1) emerging adulthood with a chronic illness; (2) stigma and disclosure concerns; (3) support systems and support deficits; (4) mental and behavioral health risks and challenges; and (5) mode of HIV transmission and perceptions of power and control.

DISCUSSION

Key constructs of the information-motivation- behavioral 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 antiretroviral therapy self-management among HIV-infected racial and ethnic minority youth.

Authors+Show Affiliations

New York University Rory Meyers College of Nursing, New York, NY Yale School of Nursing, West Haven, CT Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University School of Nursing, Department of Biomedical Informatics, New York, NY Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY New York University Rory Meyers College of Nursing, New York, NY New York University College of Arts and Sciences, New York, NY New York University Silver School of Social Work, New York, NY Department of Population Health, New York University School of Medicine, New York, NY New York University Rory Meyers College of Nursing, New York, NY New York University Rory Meyers College of Nursing, New York, NY.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31972851

Citation

Navarra, Ann-Margaret Dunn, et al. "Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus." Nursing Research, 2020.
Navarra AD, Whittemore R, Bakken S, et al. Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nurs Res. 2020.
Navarra, A. D., Whittemore, R., Bakken, S., Rosenberg, M. J., Gormley, M., Bethea, J., ... D'Eramo Melkus, G. (2020). Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nursing Research, doi:10.1097/NNR.0000000000000422.
Navarra AD, et al. Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nurs Res. 2020 Jan 15; PubMed PMID: 31972851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. AU - Navarra,Ann-Margaret Dunn, AU - Whittemore,Robin, AU - Bakken,Suzanne, AU - Rosenberg,Michael J, AU - Gormley,Maurade, AU - Bethea,John, AU - Gwadz,Marya, AU - Cleland,Charles, AU - Liang,Eva, AU - D'Eramo Melkus,Gail, Y1 - 2020/01/15/ PY - 2020/1/24/entrez PY - 2020/1/24/pubmed PY - 2020/1/24/medline JF - Nursing research JO - Nurs Res N2 - BACKGROUND: Maintaining adherence to antiretroviral therapy is a significant challenge for HIV-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal antiretroviral therapy 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 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 receiving antiretroviral therapy 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 with directed content analysis to generate categories and broad themes. Coding was initially conceptually driven 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 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 antiretroviral therapy self-management: (1) emerging adulthood with a chronic illness; (2) stigma and disclosure concerns; (3) support systems and support deficits; (4) mental and behavioral health risks and challenges; and (5) mode of HIV transmission and perceptions of power and control. DISCUSSION: Key constructs of the information-motivation- behavioral 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 antiretroviral therapy self-management among HIV-infected racial and ethnic minority youth. SN - 1538-9847 UR - https://www.unboundmedicine.com/medline/citation/31972851/Adherence_Self-Management_and_the_Influence_of_Contextual_Factors_Among_Emerging_Adults_With_Human_Immunodeficiency_Virus L2 - http://dx.doi.org/10.1097/NNR.0000000000000422 DB - PRIME DP - Unbound Medicine ER -