A structural equation model of patient-healthcare provider relationships and HIV-infected patient outcomes in Chinese populations

ABSTRACT

Obtaining maximum antiretroviral therapy (ART) adherence is critical for maintaining a high CD4 count and strong immune function in PLWHA. Key factors for achieving optimum adherence include good medication self-efficacy, decreased medication-taking difficulties, and positive patient-healthcare provider (HCP) relationships. Limited studies have analyzed the correlation of these factors and ART adherence in Chinese population. In this paper, structural equation modeling was performed to assess the proposed model of relations between patient-HCP relationships and adherence. Audio Computer-Assisted Self-Interview (ACASI) software was used to collect data on ART adherence and patient variables among 227 PLWHA in Shanghai and Taipei. Participants completed a one-time 60-minute ACASI survey that consisted of standardized measures to assess demographics, recent CD4 counts, self-efficacy, patient-HCP relationship, adherence, and medication-taking difficulties. The data shown the relationship between patient-HCP relationships and adherence was significantly consistent with mediation by medication self-efficacy. However, patient-HCP interaction did not directly influence medication-taking difficulties, and medication-taking difficulties did not significantly affect CD4 counts. Furthermore, patient-HCP interactions did not directly impact CD4 counts; rather, the relation was consistent with mediation (by either better medication self-efficacy or better adherence) or by improved adherence alone. Future interventions should be designed to enhance self-management and provide better patient-HCP communication. This improved communication will enhance medication self-efficacy and decrease medication-taking difficulties. This in turn will improve medication adherence and immune function among PLWHA.

KEYWORDS:

• Adherence
• self-efficacy
• medication-taking difficulties
• patient-healthercare provider relationships
• Chinese culture

Acknowledgements

We gratefully acknowledge all the study participants, without them, it is not possible to complete these projects. The contents of this article are solely the views of the authors and do not represent the official views of the National Institutes of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This publication resulted (in part) from research supported by National Institute of Nursing Research under Award Numbers [K23NR14107; PI: Chen, Wei-Ti]. In addition, this research reported in this publication was supported by the University of Washington Center for AIDS Research (CFAR), an NIH funded program [30 AI027757; PI: Holmes, King], which is supported by the following National Institutes of Health Institutes and Centers (National Institute of Allergy and Infectious Diseases) through an international pilot grant awarded to Dr. Wei-Ti Chen and by the University of Washington School of Nursing Research & Intramural Funding Program (RIFP). In addition, the research project was supported by DOH101-DC-1004 from the Taiwan Centers for Disease Prevention and Control (PI: Chuang, Peing).