Papadopoulou, Andia; (2000) Adherence to combination therapies in people with HIV/AIDS. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Combination therapies have changed the lives of many individuals living with HIV and AIDS. High levels of adherence to the drugs are advocated for the therapies to be effective. At the same time non-adherence to the drugs has been linked to viral resistance and disease outcome. The practical and emotional demands of HIV treatment regimens are emerging as a major problem for adherence. Ethnic background has also been associated with low rates of adherence. In particular, it has been reported that black users of the drugs are more likely to be non-adherent. The Health Belief Model has been widely used in studies that have used theory driven methodologies to address adherence issues. According to this model adherence can be predicted from individuals' beliefs about the severity of HIV/AIDS, their susceptibility to it and the costs and benefits of taking the medication. However, fewer studies have used the revised Health Belief Model which includes two further concepts: Cues-to-action and self-efficacy. The present study aimed to use the revised Health Belief Model to identify contributing factors to non-adherence with combination drugs and to further explore the factors that could account for the low rates of adherence among different ethnic groups. This was a cross sectional study that utilised both quantitative and qualitative methods to address its research aims. The study was carried out at a north London district that serves a culturally diverse community. Fifty six participants were asked to complete a Health Belief Model questionnaire and an Adherence to Combination Drugs questionnaire. A focus group of seven black African participants was also conducted to explore in greater depth the difficulties of taking combination drugs in this population. Relationships between health beliefs and adherence to combination drugs were explored using regression analyses and correlation coefficients, while content analysis was carried out on data collected from the focus groups. The findings of the present study serve to support the relevance of the Health Belief Model in examining adherence difficulties. In particular, it was shown that beliefs about the difficulties and benefits of the drugs alongside the use of cues to remind individuals to take their drugs were strong predictors of adherence to combination therapies. Moreover, the findings from the focus group suggested that beliefs regarding HIV/AIDS and the drugs need to be considered within the wider socio-economic context of the individuals receiving these therapies. The findings were further discussed in relation to the areas that they identified as important in improving the likelihood that medication will be appropriately utilised by individuals in combination therapies.

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