Paul F Cook1, Sarah J Schmiege, Whitney Starr, Jane M Carrington, Lucy Bradley-Springer. 1. Paul F. Cook, PhD, is Associate Professor; and Sarah J. Schmiege, PhD, is Associate Professor, University of Colorado College of Nursing, Aurora. Whitney Starr, MSN, NP, is Instructor, University of Colorado School of Medicine, Aurora. Jane M. Carrington, PhD, RN, is Assistant Professor, University of Arizona College of Nursing, Tucson. Lucy Bradley-Springer, PhD, FAAN, ACRN, is Associate Professor Emeritus, University of Colorado School of Medicine, Aurora.
Abstract
BACKGROUND: Many persons living with HIV (PLWH) are nonadherent to medication. Trait level measures that ask about predictors of adherence in the abstract may not adequately capture state level daily variability that more directly impacts adherence. OBJECTIVES: This preliminary study was designed to test six predictors of electronically monitored adherence at both the state and trait levels and to compare their relative effects. METHODS: Using a smartphone, 87 PLWH completed randomly cued daily surveys on thoughts, mood, stress, coping, social support, and treatment motivation. All participants also completed baseline surveys on each construct. These state and trait variables were tested as prospective predictors of next-day adherence in multilevel models, and their relative importance was quantified. The analysis sample consisted of 53 PLWH who stored their most frequent antiretroviral medication in a bottle that time-stamped openings to measure adherence. RESULTS: Higher state level motivation, OR = 1.55, 95% CI [1.07, 2.24], and negative mood, OR = 1.33, 95% CI [1.07, 1.63], predicted greater adherence the following day. Importantly, these effects were only found at the state level. Trait level control beliefs predicted greater adherence, OR = 1.65, 95% CI [1.17, 2.35], but contrary to prediction, validated trait level measures of mood, stress, coping, social support, and motivation did not. DISCUSSION: Trait and state level measures predicted adherence, but there were differences between them. Motivation for treatment and negative mood predicted adherence when measured the preceding day, but not as aggregate measures. At the trait level, only control beliefs predicted adherence. Researchers should consider state level variations in mood and motivation as possible explanations for nonadherence. Interventions could be developed to target state level variables.
BACKGROUND: Many persons living with HIV (PLWH) are nonadherent to medication. Trait level measures that ask about predictors of adherence in the abstract may not adequately capture state level daily variability that more directly impacts adherence. OBJECTIVES: This preliminary study was designed to test six predictors of electronically monitored adherence at both the state and trait levels and to compare their relative effects. METHODS: Using a smartphone, 87 PLWH completed randomly cued daily surveys on thoughts, mood, stress, coping, social support, and treatment motivation. All participants also completed baseline surveys on each construct. These state and trait variables were tested as prospective predictors of next-day adherence in multilevel models, and their relative importance was quantified. The analysis sample consisted of 53 PLWH who stored their most frequent antiretroviral medication in a bottle that time-stamped openings to measure adherence. RESULTS: Higher state level motivation, OR = 1.55, 95% CI [1.07, 2.24], and negative mood, OR = 1.33, 95% CI [1.07, 1.63], predicted greater adherence the following day. Importantly, these effects were only found at the state level. Trait level control beliefs predicted greater adherence, OR = 1.65, 95% CI [1.17, 2.35], but contrary to prediction, validated trait level measures of mood, stress, coping, social support, and motivation did not. DISCUSSION: Trait and state level measures predicted adherence, but there were differences between them. Motivation for treatment and negative mood predicted adherence when measured the preceding day, but not as aggregate measures. At the trait level, only control beliefs predicted adherence. Researchers should consider state level variations in mood and motivation as possible explanations for nonadherence. Interventions could be developed to target state level variables.
Authors: William T Riley; Daniel E Rivera; Audie A Atienza; Wendy Nilsen; Susannah M Allison; Robin Mermelstein Journal: Transl Behav Med Date: 2011-03 Impact factor: 3.046
Authors: David R Bangsberg; Edward P Acosta; Reena Gupta; David Guzman; Elise D Riley; P Richard Harrigan; Neil Parkin; Steven G Deeks Journal: AIDS Date: 2006-01-09 Impact factor: 4.177
Authors: Tamsin K Phillips; Ira B Wilson; Kirsty Brittain; Allison Zerbe; Claude A Mellins; Robert H Remien; Catherine Orrell; Elaine J Abrams; Landon Myer Journal: J Acquir Immune Defic Syndr Date: 2019-03-01 Impact factor: 3.731
Authors: Akilah J Dulin; Sannisha K Dale; Valerie A Earnshaw; Joseph L Fava; Michael J Mugavero; Sonia Napravnik; Joseph W Hogan; Michael P Carey; Chanelle J Howe Journal: AIDS Care Date: 2019-01-11
Authors: Paul F Cook; Sarah J Schmiege; Lucy Bradley-Springer; Whitney Starr; Jane M Carrington Journal: J Assoc Nurses AIDS Care Date: 2017-09-09 Impact factor: 1.354
Authors: Alexandra M Psihogios; Mashfiqui Rabbi; Annisa Ahmed; Elise R McKelvey; Yimei Li; Jean-Philippe Laurenceau; Stephen P Hunger; Linda Fleisher; Ahna Lh Pai; Lisa A Schwartz; Susan A Murphy; Lamia P Barakat Journal: JMIR Res Protoc Date: 2021-10-22