Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV

Abstract

The engagement of patients with their health care providers (HCP) improves patients’ quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client’s choices, and management of client concerns. This study compares country-level differences in patients’ engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR −7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = −5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = −3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.

Resilience and HIV: a review of the definition and study of resilience

“…Another longitudinal study found that treatment self-efficacy also predicted medication adherence, visit adherence, CD4 cell count, and viral load (Turan et al, 2016). Three of the studies examined resilience resources that were associated with healthcare engagement and found that individual and interpersonal resources were critical to remaining engaged-in-care (Chen et al, 2013;Colasanti et al, 2017;Pecoraro et al, 2016).…”

“…Three articles examined resilience resources associated with healthcare engagement among PLWH. These studies suggested that PLWH who were engaged-incare had higher proactive coping (Pecoraro et al, 2016), greater HIV treatment adherence self-efficacy (Chen et al, 2013), social support (Colasanti, Stahl, Farber, del Rio, & Armstrong, 2017;Pecoraro et al, 2016), and more spirituality/religious beliefs (Pecoraro et al, 2016). However, Chen et al (2013) also found that PLWH with better healthcare provider engagement had lower self-esteem.…”

Social resources, health promotion behavior, and quality of life in adults living with HIV

“…Engagement with care is often defined in terms of numbers of appointments rather than the quality of the relationship between the patient and the rest of the health care team. However, when investigating the quality of the social relationships between patient and health care provider, improved quality of the relationships has been found to be highly predictive of HIV medication adherence (Bakken et al, 2000; Chen et al, 2013; Johnson et al, 2006). Additionally, a recent multi-site randomized clinical trial found that enhanced personal contact with a clinic staff member improved the number of primary care visits in HIV clinics (L.…”

Psychometric properties of the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in patients with stroke

“…Self-efficacy, the key construct of Social Cognitive Theory, refers to an individual’s judgment of his/her confidence to carry out a specific task in order to produce a desired outcome. 10 In patients with chronic diseases, positive self-efficacy consistently predicts the adoption of and adherence to a variety of health-related behaviors, including medication adherence, 11 self-care behavior, and quality of life. 12 , 13 …”