Prospective State and Trait Predictors of Daily Medication Adherence Behavior in HIV

Abstract

Background Many persons living with HIV (PLWH) are nonadherent to medication. Trait-level measures that ask about predictors of adherence in the abstract may not adequately capture state-level daily variability that more directly impacts adherence. Objectives This preliminary study was designed to test six predictors of electronically monitored adherence at both the state and trait levels, and to compare their relative effects. Methods Using a smartphone, 87 PLWH completed randomly cued daily surveys on thoughts, mood, stress, coping, social support, and treatment motivation. All participants also completed baseline surveys on each construct. These state and trait variables were tested as prospective predictors of next-day adherence in multilevel models, and their relative importance was quantified. The analysis sample consisted of 53 PLWH who stored their most frequent antiretroviral medication in a bottle that time-stamped openings to measure adherence. Results Higher state-level motivation, OR = 1.55, 95% CI [1.07, 2.24], and negative mood, OR = 1.33, 95% CI [1.07, 1.63], predicted greater adherence the following day. Importantly, these effects were only found at the state level. Trait-level control beliefs predicted greater adherence, OR = 1.65, 95% CI [1.17, 2.35], but contrary to prediction, validated trait-level measures of mood, stress, coping, social support, and motivation did not. Discussion Trait- and state-level measures predicted adherence, but there were differences between them. Motivation for treatment and negative mood predicted adherence when measured the preceding day, but not as aggregate measures. At the trait level, only control beliefs predicted adherence. Researchers should consider state-level variations in mood and motivation as possible explanations for nonadherence. Interventions could be developed to target state-level variables.

Bidirectional Relationships Between Fatigue and Everyday Experiences in Persons Living With HIV

“…This study was a secondary analysis of data from a research project designed to test seven different types of everyday experiences as predictors of medication adherence in HIV (Cook et al, n.d.). Based on the shape shifters framework, our goals in this study as depicted in Figure were to test the impact of baseline fatigue on PLWH's everyday experiences, and also to examine predictive relationships in the opposite direction, in which everyday experiences in turn might influence fatigue.…”

Applying two minds theory to self‐management of Type 1 diabetes

“…Intuitive‐level responses will be more predictive of actual behavior than narrative responses because narrative responses are only one consideration to future intuitive choices. When data are collected in the moment of a decision, the data likely reflect an Intuitive response (Cook, Schmiege, Starr, Carrington, & Bradley‐Springer, ). Examples of intuitive‐level responses include heart rate, breathing rate, galvanic skin response, or evaluation of state anxiety at that moment.…”

“…TMT has important implications for how behavioral scientists and nurses design behavioral interventions. Because TMT is a relatively new theoretical model, only a few applied studies have been conducted (Cook et al, ; Makic, Cook, Gilbert, Jankowski, & Al‐Salmi, ). Considering TMT's central premise that the intuitive system is the sole actuator of behavior, nurses should consider concentrating on interventions that influence the intuitive system and may produce the most direct effect on behaviors such as DSM.…”

“…Intuitive-level responses will be more predictive of actual behavior than narrative responses because narrative responses are only one consideration to future intuitive choices. When data are collected in the moment of a decision, the data likely reflect an Intuitive response (Cook, Schmiege, Starr, Carrington, & Bradley-Springer, 2017 (Reeder & David, 2016). Intuitive-level data may provide researchers a better understanding of the biopsychosocial variables occurring at the moment of decision and suggest novel intervention pathways.…”

Adherence to riluzole in patients with amyotrophic lateral sclerosis: An observational study

“…Adherence is defined as "the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen." 11 Adherence has been studied in many chronic illnesses, such as HIV infection, 12 hypertension, 13 diabetes, 14 epilepsy, 15 multiple sclerosis 16 and psychiatric disorders. 17 Overall, an average adherence of only 50% is indicated by the World Health Organization among patients with chronic diseases.…”