Communication strategies to improve HIV treatment adherence

Although antiretroviral therapy has increased the survival of HIV-positive patients, traditional approaches to improving medication adherence have failed consistently. Acknowledging the role of communication in health behavior, we conducted a qualitative study to learn about patients' HIV treatment adherence experiences and to identify which communication strategies might influence adherence. Findings indicate that five constructs--cultural beliefs/language, stigma, cues to action, self-efficacy, and mood state--are potentially modifiable by improved communication. Results will be used to create a direct marketing campaign targeted to HIV-infected patients.     

Pilot study of the inpatient rehabilitation – scales of therapeutic occupation

The IR – SOTO is a self-help instrument that assists the occupational therapist in evaluating the adherence of an inpatient rehabilitation facility to an occupational approach to therapy. The IR – SOTO focuses on individualization of therapy, holism, naturalistic occupations, documentation of occupation and communication of occupational therapy principles. A series of practitioner panels provided feedback on the content validity of early versions of the instrument. Pilot testing of the revised instrument (a 62-item survey using seven-point Likert scales) was carried out using a mailed survey (n = 138) to nine inpatient rehabilitation facilities in different areas of the United States. The pilot version of the IR–SOTO was internally consistent, with alpha = 0.91. The overall mean score across items and across subjects of 5.48 on a seven-point scale (sd = 0.52) indicates some adherence to an occupational approach to therapy. The scores of one facility were significantly lower than five of the other facilities. Continued revision of the instrument to enhance reliability and validity is recommended, with testing of test–retest reliability as a priority. The IR–SOTO holds promise for measuring a facility's approach to the use of occupation as therapy in inpatient rehabilitation. Copyright © 1998 Whurr Publishers Ltd.     

Doctors,patients and the racial mortality gap

Research in the health sciences reports persistent racial differences in health care access, utilization, and outcomes. This study investigates three potential sources of these disparities – differential quality of care, physician discrimination, and patient response to therapy. It uses a unique panel dataset of physician–patient encounters, the resulting medication therapies and the patients’ adherence to those medical recommendations. Equalizing access to quality health care will not erase the racial differences in mortality among chronically ill patients. Targeted programs aimed at improving adherence with medication therapy among disadvantaged groups must be an integral part of any policy aimed at achieving equality in health outcomes.     

"Only two months destroys everything": a case study of communication about nonadherence to antiretroviral therapy in a South African HIV pharmacy context

Adherence to antiretroviral treatment (ART) is a complex phenomenon and patients do not always adhere for a variety of reasons. The quality of communication and the therapeutic relationship between health professionals and patients have an important influence on adherence, as do contextual and environmental factors. Little qualitative research exists that examines health care interactions in the context of adherence counselling. This article presents a case study of a discussion about nonadherence between a pharmacy assistant and a patient in a South African HIV context. A hybrid analytical approach revealed various themes such as how the topic of nonadherence is addressed, participants' responses to the patient's nonadherence, and the process of negotiating a new commitment to adherence. The case provides insight into the impact of contextual factors on the interaction and challenges involved in discussing nonadherence-in particular, the patient's attempts to save face, the pharmacy assistant's irritation and anger, and the patient's expressed regrets. This case raises questions around issues of patient agency. Health professionals are encouraged to consider the influence of context, lifeworld, and culture on patients' ability to adhere to treatment regimens. By working to improve communication processes and strengthen the therapeutic relationship, patients may be empowered to achieve better adherence levels.     

加强医患沟通是构建和谐医患关系的保障

医患关系是指医生与患者之间的关系,是医患之间构筑的一座双向交流的桥梁。和谐的医患关系能够有效减轻患者的痛苦,提高患者的依从性和配合度,从而提高医疗服务质量,减少由于沟通问题所引起的不必要的纠纷,促进社会和谐。有鉴于此,本文从我国医患关系现状、加强医患沟通的必要性与培养医患沟通技巧等方面进行分析,为加快构建和谐医患关系,提供参考。     

“Only Two Months Destroys Everything”: A Case Study of Communication About Nonadherence to Antiretroviral Therapy in a South African HIV Pharmacy Context

Adherence to antiretroviral treatment (ART) is a complex phenomenon and patients do not always adhere for a variety of reasons. The quality of communication and the therapeutic relationship between health professionals and patients have an important influence on adherence, as do contextual and environmental factors. Little qualitative research exists that examines health care interactions in the context of adherence counselling. This article presents a case study of a discussion about nonadherence between a pharmacy assistant and a patient in a South African HIV context. A hybrid analytical approach revealed various themes such as how the topic of nonadherence is addressed, participants' responses to the patient's nonadherence, and the process of negotiating a new commitment to adherence. The case provides insight into the impact of contextual factors on the interaction and challenges involved in discussing nonadherence—in particular, the patient's attempts to save face, the pharmacy assistant's irritation and anger, and the patient's expressed regrets. This case raises questions around issues of patient agency. Health professionals are encouraged to consider the influence of context, lifeworld, and culture on patients' ability to adhere to treatment regimens. By working to improve communication processes and strengthen the therapeutic relationship, patients may be empowered to achieve better adherence levels.     

HMO's doctors teach each other to improve communication skills

Do you really communicate effectively with your patients--and if so, how does this communication influence outcomes and adherence to therapy? A California health plan has trained physicians to become communication consultants to each other as part of a larger program of service to patients. It is winning praise from members and doctors alike.     

The opinions of injecting drug user (IDUs) HIV patients and health professionals on access to antiretroviral treatment and health services in Valencia, Spain

The benefits of HIV treatment (Highly Active Antiretroviral Therapy [HAART]) have been less apparent in injecting drug users (IDUs), most probably as a result of poor adherence to treatment. We explored factors related to HIV treatment adherence as reported by 23 IDU-HIV patients and nine health professionals from healthcare services in Alicante and Valencia, Spain. We carried out a qualitative study based on personal interviews. Health professionals reported the lack of coordination among hospital services and difficulties in accessibility to nonspecialized services for IDU-HIV patients as relevant factors for treatment adherence. Their perception of a patient's likelihood of treatment adherence was also considered to influence the decision to prescribe HAART. A better treatment adherence was reported by those IDU-HIV patients with a good doctor-patient relationship and by women with family responsibilities. Patients considered the side effects of HIV treatment, the lack of social support, and the active use of recreational drugs as relevant factors to explain incompliance. Interventions and training of health providers should be aimed at the reduction of barriers in patient-provider communication and the overcoming of stereotypes, thus avoiding discriminatory attitudes in treatment in this vulnerable population.     

Inattention or reluctance? Parental responses to vaccination reminder letters

This paper studies non-adherence in the Danish Childhood Vaccination Program using a nationwide introduction of a vaccination reminder letter policy and administrative data from 2011–2017. First, I provide causal estimates of how the reminder letter policy affects vaccination adherence using a Regression Discontinuity Design (RDD). Second, I link parental responses to the reminder letter to parents’ causes for being non-adherent. I find that the reminder letter policy positively affects adherence. However, 72% of non-adherent parents are non-responsive to the reminder letter indicating that reluctance and not inattention is the leading cause for non-adherence. Thus, other policies beyond reminder letters – such as mandatory vaccination laws – are necessary to substantially increase vaccination coverage.     

ADHERENCE TO ANTIRETROVIRAL MEDICATIONS IN HIV/AIDS CARE: A NARRATIVE EXPLORATION OF ONE WOMAN’S FORAY INTO INTENTIONAL NONADHERENCE

Intentional nonadherence occurs when patients deliberately do not take their medications. This phenomenon has not been studied within HIV/AIDS care, a significant omission due to the difficulty of adherence to antiretroviral medications for HIV/AIDS patients and the severe risks associated with nonadherence. The purpose of this study was to explore, using HIV-positive women’s own recollections collected in diary format, how and why women living with HIV/AIDS intentionally fail to adhere to their antiretroviral medications. We examined the journal entries of 20 HIV-positive women written during a 1-month period. Although three participants wrote about their intentional nonadherence, the journal entries of only one woman are presented in detail. This woman’s story highlights the complex reasons for intentional nonadherence and the social/emotional ramifications of such nonadherence. Results suggest that intentional nonadherence is emotionally trying for patients and that patients’ adherence decisions are continually renegotiated, underscoring the need for routine provider–patient adherence communication.     

Adherence to antiretroviral therapy during HIV infection, a multidisciplinary approach

Since HIV infection has become a chronic disease, antiretroviral therapy is now used on a long-term basis. Response to treatment is conditioned by numerous inter-dependent factors, including non-compliance, which can result in failure of the therapeutic regimen. Although compliance is crucial for long-term efficacy of the treatment, it is a dynamic factor, and therefore difficult to evaluate. This literature review proposes a multidisciplinary approach to treatment adherence during HIV infection, and deals with the following questions: how should adherence and non-adherence be defined? How are they correlated to the treatment response? How is adherence measured in trials and cohorts, as well as in clinical practice? By what factors is it influenced? What tools can be implemented to improve adherence? The interaction between adherence and response to antiretroviral therapy requires communication between clinicians, healthcare providers, patients, virologists, pharmacologists, and the companies responsible for developing drugs. The pharmaceutical industry must sustain its efforts to ensure a balance between demands for efficacy and adherence when developing new drugs. And the methods implemented by numerous healthcare teams plead in favour of a dynamic approach to adherence, with the active participation of all.     

How Medic–Patient Communication and Relationship Influence Chinese Patients’ Treatment Adherence

The deterioration of medic–patient relation in China raises the question about its impact on patients’ adherence to medical instructions. This study focuses on how the quantity and quality of medic–patient communication influences their relationship, and how the perceived relationship at individual level, institution level, and society level influences patients’ treatment adherence, through a survey conducted in a city of Southern China (N = 597, Response rate = 66%). The results of path analysis show that consulting time is positively associated with patients’ relationship with individual doctors and the whole medical system, as well as their satisfaction with hospital. Unpleasant experience of having disputes with medical workers is negatively associated with the medic–patient relationship at all of the three levels and causes conditional nonadherence. The more positive medic–patient relationship perceived by the patients, the more likely they will display unconditional adherence.     

Examining the Association Between Health Literacy and Medication Adherence Among Older Adults

Health literacy plays a vital role in patients’ understanding of their prescribed medication instructions. To inform strategies to assist providers in communicating in a manner that is easily understood by patients, it would be beneficial to determine the relationship between health literacy and the day-to-day aspects of medication adherence. This study identified: 1) differences of health literacy levels in medication adherence; 2) the association between health literacy and medication adherence; and 3) and factors associated with medication adherence score. A convenience sample of older predominantly African-American patients (N = 389), over the age of 60, completed a cross-sectional survey. Chi-square analysis assessed health literacy differences in five aspects of medication adherence. Ordinary linear regression analysis determined factors associated with medication adherence score. Patients with limited health literacy were more likely to forget to take their medications and more likely to take less medication than instructed than patients with adequate health literacy (χ²(5) = 15.91, p = .007, χ²(5) = 10.31, p = .036, respectively). REALM score was also significantly associated with medication adherence score (β= .016, p < .001, β = .009, p = .033), respectively). Findings suggest that providers seeking to improve medication adherence in older adults, particularly African-American patients, should focus communication on assessing health literacy levels prior to discussing medication instructions.     

Adherence to antiretroviral medications in HIV/AIDS care: a narrative exploration of one woman's foray into intentional nonadherence

Intentional nonadherence occurs when patients deliberately do not take their medications. This phenomenon has not been studied within HIV/AIDS care, a significant omission due to the difficulty of adherence to antiretroviral medications for HIV/AIDS patients and the severe risks associated with nonadherence. The purpose of this study was to explore, using HIV-positive women's own recollections collected in diary format, how and why women living with HIV/AIDS intentionally fail to adhere to their antiretroviral medications. We examined the journal entries of 20 HIV-positive women written during a 1-month period. Although three participants wrote about their intentional nonadherence, the journal entries of only one woman are presented in detail. This woman's story highlights the complex reasons for intentional nonadherence and the social/emotional ramifications of such nonadherence. Results suggest that intentional nonadherence is emotionally trying for patients and that patients' adherence decisions are continually renegotiated, underscoring the need for routine provider-patient adherence communication.     

Cultural Beliefs Underlying Medication Adherence in People of Chinese Descent in the United States

This article examines the meanings, practices, and cultural beliefs underlying medication adherence in people of Chinese descent living in the United States. The narratives were analyzed using interpretive phenomenology, resulting in the following themes that influenced the communication and behaviors around medication adherence of the participants: (a) cultural concepts of yin yang balance and “qi,” (b) understandings of Western and Chinese medicine’s efficacy profiles, (c) importance of family and social support, and (d) level of acculturation. This article discusses the influence of these themes on medication adherence and proposes that health communication campaigns, interventions, and doctor–patient communication about increasing medication adherence with people of Chinese descent should engage these understandings.     

The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes

The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.     

Evaluating the effectiveness of communication skills training: a review of research

This review considers the effectiveness of communication skills training programs within medical school settings. Several components of training are evaluated: microcounseling, standardized patients, role play, and videotape review. Overall, these interventions have been shown to be effective in improving targeted communication skills (ie, use of open-ended questions). However, outcome data that support the transfer of training to actual patient encounters and subsequent patient outcomes (ie, satisfaction, adherence) are lacking.     

Adherence to antiretroviral therapy: a qualitative study with physicians from Rio de Janeiro, Brazil

Brazil provides free antiretroviral (ARV) therapy to some 150,000 individuals living with HIV/ AIDS). ARV regimens require optimal adherence to achieve undetectable viral loads and to avoid viral resistance. Physicians play a key role to foster ARV adherence, but until now little is known about the communication between physicians/ people living with HIV/AIDS in this setting. In-depth interviews were conducted with 40 physicians treating people living with HIV/AIDS at six public reference centers in Rio de Janeiro, Brazil. Interview topics included: experiences in the treatment of people living with HIV/AIDS, relationship and dialogue with patients, barriers/facilitators to adherence, and effectiveness of available services. Barriers to ARV adherence were mainly related to the low quality of patient-provider relationship. Other barriers were related to "chaotic" patients' lifestyles, and inadequate knowledge and/or negative beliefs about HIV/AIDS and ARV effectiveness. It is necessary to improve networking between services, establish agile referral systems, and improve health professionals' integration. These structural changes could contribute to improved adherence, resulting in improved quality of life for people living with HIV/AIDS.