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Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus

Authors Johnson MO, Sevelius JM, Dilworth SE, Saberi P, Neilands TB

Received 19 January 2012

Accepted for publication 10 February 2012

Published 11 May 2012 Volume 2012:6 Pages 395—404

DOI https://dx.doi.org/10.2147/PPA.S30040

Review by Single-blind

Peer reviewer comments 2

Mallory O Johnson, Jeanne M Sevelius, Samantha E Dilworth, Parya Saberi, Torsten B Neilands

Department of Medicine, University of California, San Francisco, CA, USA

Background: The Model of Health Care Empowerment (HCE) defines HCE as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. We examined the hypothesized antecedents and clinical outcomes of this model using data from ongoing human immunodeficiency virus (HIV)-related research. The purpose of this paper is to explore whether a new measure of HCE offers direction for understanding patient engagement in HIV medical care. Using data from two ongoing trials of social and behavioral aspects of HIV treatment, we examined preliminary support for hypothesized clinical outcomes and antecedents of HCE in the context of HIV treatment.
Methods: This was a cross-sectional analysis of 12-month data from study 1 (a longitudinal cohort study of male couples in which one or both partners are HIV-seropositive and taking HIV medications) and 6-month data from study 2, a randomized controlled trial of HIV-seropositive persons not on antiretroviral therapy at baseline despite meeting guidelines for treatment. From studies 1 and 2, 254 and 148 participants were included, respectively. Hypothesized antecedents included cultural/social/environmental factors (demographics, HIV-related stigma), personal resources (social problem-solving, treatment knowledge and beliefs, treatment decision-making, shared decision-making, decisional balance, assertive communication, trust in providers, personal knowledge by provider, social support), and intrapersonal factors (depressive symptoms, positive/negative affect, and perceived stress). Hypothesized clinical outcomes of HCE included primary care appointment attendance, antiretroviral therapy use, adherence self-efficacy, medication adherence, CD4+ cell count, and HIV viral load.
Results: Although there was no association observed between HCE and HIV viral load and CD4+ cell count, there were significant positive associations of HCE scores with likelihood of reporting a recent primary care visit, greater treatment adherence self-efficacy, and higher adherence to antiretroviral therapy. Hypothesized antecedents of HCE included higher beliefs in the necessity of treatment and positive provider relationships.

Keywords: human immunodeficiency virus, acquired immune deficiency syndrome, health care empowerment, adherence, compliance

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