AFISE Information-Motivation-Behavioural skills model

The Information-Motivation-Behavioural skills model of ART adherence in Romanian young adults Abstract We report the adaptation and validation of the Information-Motivation-Behavioral skills (IMB) model of ART adherence (Fisher, Fisher, Amico, & Harman, 2006) to a population of treatment-experienced Romanian young adults. Subscales Content examples Information (16 items) Background Aim Methods Results Due to nosocomial infection in the late 1980’s, many HIV-infected young adults in Constanta, Romania have been receiving antiretroviral treatment (ART) since childhood. The Baylor Black Sea Foundation offers psychosocial support services for this unique population. The transition to adulthood brings the specific chal- lenge of moving from caregiver-managed to self-managed adherence. Adherence support in this cohort is needed, but presently there is limited guidance for in- tervention targets or content. Motivation (13 items) We applied the IMB model to this population to identify core factors and specific adherence-related issues that require intervention, and to develop an assess- ment tool for use in research and clinical practice. • Sample: 162 participants aged 18-24, 85 females, mean treatment duration 9 years (range 1-22 years), 80 from urban areas, 147 unemployed (of which only 39 currently studying), 22 with children. • Scores on adherence-related information, motivation and behavioural skills were significantly correlated with adherence indicators (self-report, physician’s as- sessment and pill count) and viral load (Table 2). • Path analyses of the relationships stipulated by the IMB-model confirmed previous research (e.g. Amico et al, 2009): behavioural skills mediated the relation- ship between information and motivation (as predictors) and pill count and self-reported adherence (as outcomes in separate analyses; Figures 1 and 2; Table 4). • Nonparametric IRT analyses (Mokken; van der Ark, 2007) identified several distinct issues relevant to adherence (Table 3). Authors: Alexandra Dima 1 , Ana-Maria Schweitzer 2 , K. Rivet Amico 3 1 2 3 – Amsterdam School for Communication Research, University of Amsterdam, the Netherlands - Baylor Black Sea Foundation, Constanta, Romania - Center for Health, Intervention and Prevention, University of Connecticut, USA Contact: a.dima@uva.nl aschweitzer@baylor-romania.ro • The IMB model provided a useful theoretical framework for the identification of potential intervention targets, which may guide future adherence-support work with this group. • The adherence-related themes identified via Mokken analysis may provide an additional complementary approach for clinical intervention. • This study represents an important advancement towards assessing ART adherence determinants and developing tailored adherence interventions in this population. • Further validation research is recommended in this population and other Romanian populations. References: Amico, K. R., Barta, W., Konkle-Parker, D. J., Fisher, J. D., Cornman, D. H., Shuper, P., & Fisher, W. A. (2009). The information-motivation-behavioral Skills model of ART adherence in a Deep South HIV positive clinic sample. AIDS and Behavior, 13, 66–75. Arbuckle, J. L. (2010). Amos (Version 19.0) [Computer Program]. Chicago: IBM SPSS. van der Ark, L. A. (2007). Mokken scale analysis in R. Journal of Statistical Software, 20 (11), 1-19. Dima, A., Schweitzer, A.-M., Diaconita, R., Remor, E. & Wanless, R. (2012). Adherence to ARV medication in Romanian young adults: self-reported behaviour and psychological barriers. Psychology, Health & Medicine. doi:10.1080/13548506.2012.722648 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(4), 462–473. LifeWindows Project Team (2006). The LifeWindows Information Motivation Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ). Unpublished instrument. Retrieved September 14, 2008, from http://www.chip.uconn.edu/int/F_LWIMBARTQuestionnaire.pdf R Development Core Team (2009). R: A language and environment for statistical computing. [Computer software] Vienna, R Foundation for Statistical Computing. Retrieved from http://www.R-project.org. Remor, E. (2002). Manual del cuestionario para la evaluación de la adhesión al tratamiento antirretroviral : CEAT-VIH. [Manual of the questionnaire to assess adherence to antirretroviral treatment]. (PDF document). Madrid: Department of Psychobiology and Health, Faculty of Psychology, UAM. Outcome variable Self-reported adherence Pill count Degrees of freedom 2 2 P value .401 .239 χ2 1.828 2.863 Figure 1. Path analyses of the IMB model (pill count) information .14* e2 e1 .58 behavioral skills .51** motivation .26** .07 pill count Path analysis IMB model Standardized estimates χ 2 (2) = 2.863 p=.239 RMSEA = .05 (.00 -17) CFI = .996 .68** Table 2. Bivariate associations between IMB constructs and adherence and viral load measures External criterion Self-reported adherence Doctor- assessed adherence Pill count Viral load Measurement 4-item scale (total score range 4-16) 1= stop therapy 2= < 80% 3= 80-95% 4= > 95% 1= < 65% 2= 65-95% 3= 95-100% 0= >400 c/ml 1=