Development of Stage of Readiness and decisional balance instruments: tools to enhance clinical decision-making for adherence to antiretroviral therapy.

This study presents the development of Stage of Readiness (SOR) and decisional balance instruments based on the Transtheoretical Model of Behavior Change (TTM) to improve adherence to antiretroviral therapy (ART). These instruments were tested on HIV positive women who enrolled in an adherence support study at a women's HIV clinic at a mid-western medical school. The decisional balance instrument was analyzed and 8 of 11 items were retained. These items were validated by follow-up administration of the instrument. Baseline stage of change and decisional balance scores prospectively predicted 1-year viral load level, thus identifying participants in need of adherence support interventions. Use of these instruments can give a provider added objective data on which to base a decision to either prescribe ART immediately or to first implement an intervention tailored to enhance this patient's readiness to adhere.