Barcelona 2013
Barcelona 2013
Abstract book - Abstract - 171
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Conference Details
International Committee
Plenary Speakers
Presenting Speakers
Scientific Committee
Abstract #171  -  Adherence
  13.4: Adherence (Parallel) on Monday @ 14.30-16.00 in Teatre Chaired by Imma Serra,
Stuart Gibson

  Presenting Author:   Dr Elizabeth Lowenthal - University of Pennsylvania Perelman School of Medicine, United States
  Additional Authors:  Dr. Jorge Galindo-Sainz,  
We hypothesize that several psychosocial factors play large roles in adolescent adherence to antiretroviral treatments in high HIV prevalence, resource-limited settings. In particular, we are interested in the role of socio-emotional support, outcome expectancy, consideration of future consequences, perceived stigma, and psychological reactance. Because culturally-adapted and validated tools for measuring these factors in African adolescents are lacking, we aimed to elucidate culturally-specific factors of importance to establishing local construct validity.
Method / Issue:
Using in-depth interviews of 32 HIV+ adolescents in Botswana (Batswana), we explored how the psychosocial constructs are perceived in this cultural context. We also probed for additional factors that the adolescents consider important to their HIV medication adherence. Analyses were conducted with an analytic framework approach using NVivo9 software.
Results / Comments:
While the construct validity of some Western-derived assessment tools was confirmed, other tools were poorly representative of their constructs in this cultural context. Tools chosen to evaluate HIV-related outcome expectancy (Antiretroviral Medication Attitudes Scale) and perceived stigma (Stigma Scale Revised) were well-understood and relevant to the Batswana youth. Feedback from the adolescents suggested that tools to measure all other constructs need major modifications to obtain construct validity in Botswana. While peer support and acceptance are critical for Western adolescents, Batswana adolescents consistently reported that parental support and approval are more important than that of peers. Thus, measurement of socio-emotional support needs to focus on the adolescent-parent relationship in this cultural context. The Consideration of Future Consequences Scale was poorly understood and contained several items that lacked relevance for the Batswana adolescents. They also did not relate well to many components of the Hong Psychological Reactance Scale, although they thought psychological reactance played an important role in adherence. They suggested more culturally-appropriate and medication adherence-specific ways of assessing psychological reactance such as by asking adolescents to state the extent to which they agree with the statement: ?When someone tells me to take my pills, it makes me want to avoid them.? Denial of being HIV infected was an unexpected common theme. Ambivalence about taking medicines was also commonly expressed. One adolescent summarized this idea as follows: ?It?s like I have two ?hearts,? the other one tells me that ?you are healthy. Don?t drink the pills. You are healthy, no pains, nothing.? This I am saying from my past experience. The other one says ?you should drink (take) the pills because you are not healthy, mogare (virus) is awake in your body.? Then I will just leave the pills because I believed I was healthy.?
In-depth interviews of Batswana adolescents confirmed the construct validity of some Western-developed psychosocial assessment tools, but demonstrated limitations in others. Cultural-adaptation and validation studies should precede the use of psychosocial assessment tools to assess the needs of people living with HIV in settings outside of where they were initially developed. Previously underappreciated factors related to HIV medication adherence, such as denial and ambivalence, should be further explored.
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