Applying the Information-Motivation-Behavioral Skills Model in Medication Adherence Among Thai Youth Living with HIV: A Qualitative Study

Abstract

With disproportionately higher rates of HIV/AIDS among youth and increasing access to antiretroviral therapy (ART) in Thailand, there is a growing urgency in understanding the challenges to medication adherence confronting this population and in developing theory-based interventions to address these challenges. One potentially relevant model, the information-motivation-behavioral skills (IMB) model of adherence, was developed in Western settings characterized by a more individualistic culture in contrast to the more collectivistic culture of Thailand. We explored the application and adaptability of IMB on ART adherence among HIV-positive Thai youth through the analysis of qualitative data from a pilot motivational interviewing study. Twenty-two interview sessions from 10 HIV-positive Thai youth (17-24 years) were analyzed; 6 youth were on ART. Data support the utility of IMB as a potential framework for understanding ART adherence in this population. However, data indicate a consideration to expand the motivation construct of IMB to incorporate youths' perceived familial and social responsibilities and the need to adhere to medications for short-and long-term well-being of self, family, and society in a context of Buddhist values. These modifications to IMB could be relevant in other cultural settings with more collectivistic worldviews.

The Information-Motivation-Behavioral Skills Model of ART Adherence in Romanian Young Adults

“…For example, in a recent qualitative exploration of the IMB model among Thai youth, Rongkavilit et al (2010) reported social responsibilities as an important motivational factor specific to their population; they interpreted this finding in light of the prevalent Buddhist philosophy and collectivistic worldviews in Thai society. We could consider the altruistic motivation identified in our participants' discourse as similar to the motivational role of social responsibilities.…”

“…The model has received support from previous research with other populations on ART and has been the basis for a number of different adherence interventions (Amico et al, 2007;Amico et al, 2009;Amico, Toro-Alfonso, & Fisher, 2005;Fisher et al, 2008). It has been previously used in risk behaviour interventions in young people (Fisher et al 1996), in investigating challenges of ART adherence in HIV-positive youth (Rongkavilit et al, 2010), and ART-related views in youth at risk of HIV infection (Simon, Altice, Moll, Shange, & Friedland, 2010). In developing IMB model based interventions, the authors recommend a 3-step process: elicitation work with the target group, intervention development and implementation, and rigorous evaluation (Fisher et al, 2006).…”

Modeling a theory-based approach to examine the influence of neurocognitive impairment on HIV risk reduction behaviors among drug users in treatment

“…An application of health behavior change theory to HIV prevention among PWUDs can help researchers to identify the critical dynamics of this particular population HIV risk behaviors in need of targeted intervention efforts, and to empirically evaluate the ability of these theories to predict and promote prevention behavior. The theoretical approach used for this analysis is the Information-Motivation-Behavioral Skills model of health behavior change (IMB) (34,35) -a theoretical model, which has been successfully applied to the design and evaluation of a wide range of intervention approaches targeting various patient populations and diseases (14,(36)(37)(38)(39)(40)(41).…”

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

“…Starace et al, 2006;Kalichman et al, 2002), it is suggested that the components of the model are usually generalizable when applied to a well-defined population (Kalichman et al, 2005) and require more specific measurable variables (Amico et al, 2009). Other reviews have concluded that the IMB model has not consistently resulted in an accurate prediction of adherence, especially when it comes to defining and measuring the motivation portion of the model (Rongkavilit et al, 2010;Schneidermna, Antoni, & Ironson, 2014). The results of this study will add further clarification when the IMB model is associated to ART adherence, especially in an understudied population.…”