AIDS and Behavior

, Volume 13, Issue 1, pp 66–75 | Cite as

The Information–Motivation–Behavioral Skills Model of ART Adherence in a Deep South HIV+ Clinic Sample

  • K. Rivet Amico
  • William Barta
  • Deborah J. Konkle-Parker
  • Jeffrey D. Fisher
  • Deborah H. Cornman
  • Paul A. Shuper
  • William A. Fisher
Original Paper

Abstract

High levels of adherence to antiretroviral therapy (ART) are critical to the management of HIV, yet many people living with HIV do not achieve these levels. There is a substantial body of literature regarding correlates of adherence to ART, and theory-based multivariate models of ART adherence are emerging. The current study assessed the determinants of adherence behavior postulated by the Information–Motivation–Behavioral Skills model of ART adherence in a sample of 149 HIV-positive patients in Mississippi. Structural equation modeling indicated that ART-related information correlated with personal and social motivation, and the two sub-areas of motivation were not intercorrelated. In this Deep South sample, being better informed, socially supported, and perceiving fewer negative consequences of adherence were independently related to stronger behavioral skills for taking medications, which in turn associated with self-reported adherence. The IMB model of ART adherence appeared to well characterize the complexities of adherence for this sample.

Keywords

Information Motivation Behavioral skills ART adherence Mississippi 

References

  1. Amico, K. R., Toro-Alfonso, J., & Fisher, J. D. (2005). An empirical test of the information, motivation, behavioral skills model of antiretroviral therapy adherence. AIDS Care, 17(6), 661–673.PubMedCrossRefGoogle Scholar
  2. Arnsten, J. H., Demas, P. A., Farzadegan, H., Grant, R. W., Gourevitch, M. N., Chang, C. J., et al. (2001). Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring. Clinical Infectious Diseases, 33, 1417–1423.PubMedCrossRefGoogle Scholar
  3. Bangsberg, D. R., Acosta, E. P., Gupta, R., Guzman, D., Riley, E. D., Harrogan, P. R., Parkin, N., & Deeks, S. G. (2006). Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS, 20(2), 223–231.PubMedCrossRefGoogle Scholar
  4. Bangsberg, D. R., & Deeks, S. G. (2002). Is average adherence to HIV antiretroviral therapy enough? Journal of General Internal Medicine, 17(10), 812–813.PubMedCrossRefGoogle Scholar
  5. Bartlett, J. A. (2002). Addressing the challenges of adherence. Journal of Acquired Immune Deficiency Syndromes, 29, s2–s10.PubMedGoogle Scholar
  6. Centers for Disease Control and Prevention. (2004). HIV/AIDS Surveillance Report, 2004, vol. 16. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved June 1, 2006, from http://www.cdc.gov/hiv/stats/hasrlink.htm
  7. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The ACTG Adherence Instruments. AIDS Care, 12, 255–266.PubMedCrossRefGoogle Scholar
  8. Copello, G. (2004). Congressional public policy forum: Fighting HIV/AIDS in the Southern United States. Retrieved November 7, 2006, from http://www.theaidsinstitute.org/downloads/fightaidsouth.doc
  9. De Bruin, M., Hospers, H. J., Van Den Borne, H. W., Kok, G., & Prins, J. M. (2005). Theory- and evidence-based intervention to improve adherence to antiretroviral therapy among HIV-infected patients in the Netherlands: A pilot study. AIDS Patient Care and STDs, 19, 284–294.CrossRefGoogle Scholar
  10. Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS risk behavior. Psychological Bulletin, 111, 455–474.PubMedCrossRefGoogle Scholar
  11. Fisher, W. A., & Fisher, J. D. (1993). A general psychological model for changing AIDS risk behavior. In J. Pryor & G. Reeder (Eds.), The social psychology of HIV infection (pp. 127–153). Hillsdale, NJ: Erlbaum.Google Scholar
  12. Fisher, J. D., & Fisher, W. A. (2000). Theoretical approaches to individual-level change. In J. Peterson & R. DiClemente (Eds.), HIV prevention handbook (pp. 3–55). New York: Kluwer Academic/Plenum Press.Google Scholar
  13. Fisher, W. A., Fisher, J. D., & Harman, J. (2003). The Information–Motivation–Behavioral skills model as a general model of health behavior change: Theoretical approaches to individual-level change. In J. Suls & K. Wallston (Eds.), Social psychological foundations of health (pp. 127–153). London: Blackwell Publishers.Google Scholar
  14. Fisher, J. D., Fisher, W. A., Amico, K. R., & Harman, J. J. (2006). An information–motivation–behavioral skills model of adherence to antiretroviral therapy. Health Psychology, 25, 462–473.PubMedCrossRefGoogle Scholar
  15. Haubrich, R. H., Little, S. J., Currier, J. S., Forthal, D. N., Kemper, C. A., Beall, G. N., et al. (1999). The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. AIDS, 13, 1099–1107.PubMedCrossRefGoogle Scholar
  16. Kalichman, S. C., Rompa, D., DiFonzo, K., Simpson, D., Austin, J., Luke, W., Kyomugisha, F., & Buckles, J. (2001). HIV treatment adherence in women living with HIV/AIDS: Research based on the Information–Motivation–Behavioral Skills model of health behavior. Journal of the Association of Nurses in AIDS Care, 12(4), 58–67.PubMedCrossRefGoogle Scholar
  17. Kleeberger, C. A., Phair, J. P., Strathdee, S. A., Detels, R., Kingsley, L., & Jacobson, L. P. (2001). Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Miluticenter AIDS Cohort Study. Journal of Acquired Immune Deficiency Syndromes, 26(1), 82–92.PubMedGoogle Scholar
  18. Kline, R. B. (2005). Principles and practice of structural equation modeling, 2nd ed. NY: Guilford.Google Scholar
  19. Knobel, H., Guelar, A., Carmona, A., Espona, M., Gonzalez, A., Lopez-Colimes, J. L., et al. (2001). Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors. AIDS Patient Care and STDs, 15(4), 193–199.PubMedCrossRefGoogle Scholar
  20. Lichtenstein, B., Laska, M. K., & Clair, J. M. (2002). Chronic sorrow in the HIV-positive patient: Issues of race, gender, and social support. AIDS Patient Care and STDs, 16(1), 27–38.PubMedCrossRefGoogle Scholar
  21. LifeWindows Project Team (2006). The LifeWindows Information Motivation Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ). Retrieved December 20, 2006, from http://www.chip.uconn.edu/int/F_LWIMBARTQuestionnaire.pdf
  22. Lucas, G. M. (2005). Antiretroviral adherence, drug resistance, viral fitness, and HIV disease progression: A triangle web is woven. Journal of Antimicrobial Chemotherapy, 55, 413–416.PubMedCrossRefGoogle Scholar
  23. Moatti, J. P., & Spire, B. (2000). Living with HIV/AIDS and adherence to antiretroviral treatments. In J.-P. Moatti, Y. Souteyrand, A. Prieur, T. Sandfort, & P. Aggleton (Eds.), AIDS in Europe: New challenges for the social sciences (pp. 57–73). New York: Routledge.Google Scholar
  24. Murri, R., Ammassari, A., Gallicano, K., De Luca, A., Cingolani, A., Jacobson, D., et al. (2000). Patient-reported non-adherence to HAART is related to protease inhibitor levels. Journal of Acquired Immune Deficiency Syndrome, 24(2), 123–128.Google Scholar
  25. Nieuwkerk, P. T., & Oort, F. J. (2005). Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: A meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 38(4), 445–448.PubMedCrossRefGoogle Scholar
  26. Nieuwkerk, P. T., Sprangers, M. A., Burger, D. M., Hoetelmans, R. M., Hugan, P. W., Danner, S. A., et al. (2001). Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Archives of Internal Medicine, 161(16), 1962–1968.PubMedCrossRefGoogle Scholar
  27. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Aquier, C., Wagener, M. M., & Singh, N. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.PubMedGoogle Scholar
  28. Pearson, C. R., Simoni, J. M., Hoff, P., Kurth, A. E., & Martin, D. P. (2007). Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues. AIDS and Behavior, 11(2), 161–173.PubMedCrossRefGoogle Scholar
  29. Pfizer (2005). Global HIV/AIDS partnerships: Southern HIV/AIDS prevention initiative. Retrieved November 7, 2006, from http://www.pfizer.com/pfizer/subsites/philanthropy/caring/global.health.hiv.southern.jsp
  30. Simoni, J. M., Frick, P. A., & Huang, B. (2006a). A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychology, 25, 74–81.PubMedCrossRefGoogle Scholar
  31. Simoni, J. M., Kurth, A. E., Pearson, C. R., Pantaline, D. W., Merrill, J. O., & Frick, P. A. (2006b). Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS and Behavior, 10(3), 227–245.PubMedCrossRefGoogle Scholar
  32. Starace, F., Massa, A., Amico, R., & Fisher, J. D. (2006). Adherence to antiretroviral therapy: An empirical test of the information–motivation–behavioral skills model. Health Psychology, 25(2), 153–162.PubMedCrossRefGoogle Scholar
  33. Wagner, G., & Miller, L. G. (2004). Is the influence of social desirability on patients’ self-reported adherence overrated? Journal of Acquired Immune Deficiency Syndromes, 35(2), 203–204.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • K. Rivet Amico
    • 1
  • William Barta
    • 1
  • Deborah J. Konkle-Parker
    • 2
  • Jeffrey D. Fisher
    • 1
  • Deborah H. Cornman
    • 1
  • Paul A. Shuper
    • 1
  • William A. Fisher
    • 1
    • 3
    • 4
  1. 1.Center for Health, Intervention, and PreventionUniversity of ConnecticutStorrsUSA
  2. 2.University of Mississippi Medical CenterJacksonUSA
  3. 3.Department of PsychologyUniversity of Western OntarioLondonCanada
  4. 4.Department of Obstetrics and GynecologyUniversity of Western OntarioLondonCanada

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