In many cases, HIV/AIDS can be controlled if patients comply with a prescribed medication regimen. Diiorio and coworkers tested a psychosocial model of medication adherence among people taking antiretroviral medications. The model was based primarily on social cognitive theory and included personal (self-efficacy, outcome expectancy, stigma, depression, and spirituality), social (social support, difficult life circumstances), and provider (patient satisfaction and decision-making) variables. Data for the analysis were obtained from a randomized controlled trial (Get Busy Living) designed to evaluate an intervention to foster medication adherence. Different analysis and modeling techniques were used to develop and test the model. Only baseline data were used in this cross sectional analysis. Participants were recruited from a HIV/AIDS clinic in Atlanta, GA. Prior to group assignment, participants were asked to complete a questionnaire that included assessment of the study variables. A total of 236 participants were included in the analysis. The mean age of the participants was 41 years; the majority of subjects were male, and most were African-American. In the final model, self-efficacy and depression demonstrated direct associations with adherence. Stigma, patient satisfaction, and social support were indirectly related to adherence through their association with either self-efficacy or depression.

VALUE OF STUDY TO READER: The findings reinforced the position that medication-taking behaviors are affected by a complex set of interactions among psychosocial variables and provide direction for adherence interventions. Self-efficacy with respect to their performance was a major variable in determining whether patients were adherent. This is why the assessment of self-efficacy, as found in the Diiorio et al study, is so important in self-management research.

C Diiorio et al. Adherence to Antiretroviral Medication Regimens: A Test of a Psychosocial Model. AIDS Behavior, November 3, 2007.