The mental adjustment to HIV scale: Measurement and dimensions of response to AIDS/HIV disease

Abstract

Attitudes of people with HIV disease towards HIV have seldom been measured. However, a well-established scale to measure attitudes toward cancer in those with the disease, the 38-item Mental Adjustment to Cancer (MAC) scale was modified to assess adjustment to HIV disease. We administered the scale to 107 Australian men with HIV infection, of whom 36 had an AIDS-defining condition, who were patients at an ambulatory care facility and in a research study. The data were factor analyzed using a method identical to that used in the development of the MAC scale to determine the latent dimensions of attitudes toward HIV/AIDS. The Mental Adjustment to HIV scale (MAH) factor analysis revealed five factors: Helplessness-Hopelessness, Fighting Spirit, and Denial-Avoidance as in the original MAC scale, plus a Fatalism subscale which also measured Preoccupation, and a new subscale, which measured Belief in Influencing the Course of the Disease. Together, these five factors accounted for half of the variance. These data suggest that while there are similarities between mental attitude to cancer and mental attitude to HIV in the latent dimensions of the questionnaire items, there are also some differences. Most significant is the belief in people with HIV disease in being able to personally influence the course of the illness, and the combination of Preoccupation with Fatalism. The five subscales of the MAH scale had Cronbach's alpha reliabilities between 0.80 and 0.55. The MAH appears to be a useful way to measure total attitudes and subscale scores of people with HIV infection, including AIDS, to their disease.

Adjustment as process and outcome: Measuring adjustment to HIV in Uganda

“…The four factor solution here contrasts markedly to the original five factor structure (Ross et al, 1994).…”

“…When first adapted from the MAC, the MAHIV contained 40 items, covering five factors of helplessnesshopelessness, fighting spirit, denial-avoidance, fatalism and beliefs in influencing the course of HIV (Ross et al, 1994). This differed from the MAC scale, with greater emphasis on personal influence of the course of illness seen in HIV.…”

“…The MAC and MAHIV were developed with little reference to theories of coping or adjustment, indeed, the MAHIV development paper contains no reference to theory, although it specifies its focus as mental attitudes and psychological responses (Ross et al, 1994). Watson et al (1988) did report theoretically supported associations between coping types and outcomes using the MAC, specifically that fatalism was linked to distress and fighting spirit was associated with better outcomes.…”

“…Some measures focus primarily on the outcome of adjustment such as the "Psychosocial Adjustment to Illness Scale" (Derogatis, 1986) and its self-report versions, which 4 covers vocational environment, sexual relationships, social environment, psychological distress, relationship with parent and family and health care orientation, asking about function, behaviour and affective outcome (Rodrigue et al, 2000). Other measures are more focussed on the process of adjustment, such as the "Mental Adjustment to Cancer" (MAC) scale (Watson et al, 1988) and the "Mental adjustment to HIV" (MAHIV) measure (Ross et al, 1994). The measures have been found to have variable structure and require relating back to theory.…”

“…Measures to investigate adjustment have not been developed for use in this setting. MAHIV factor analysis research has been limited to samples of asymptomatic homosexual men in American or Australia samples (Ross et al, 1994;Kelly et al, 2000). The MAHIV scale has been previously translated into Luganda and used in research (Kinyanda 6 et al, 2011), however factor analysis and psychometric properties were not fully reported.…”