Self-efficacy as a crucial psychological predictor of treatment adherence among elderly people living with HIV: analyses based on the health belief model

ABSTRACT

Medication adherence to antiretroviral therapy (ART) among elderly people living with HIV (PLWH) is of serious concern. Our study aimed to understand the medication adherence of elderly PLWH under ART based on the health belief model (HBM). A baseline survey with a total of 529 elderly PLWH was conducted in Sichuan. Logistic and linear regression analysis, mediation analysis, and path analysis based on prior evidence were used. Only self-efficacy showed direct associations with medication adherence in the last four days (ORm = 1.37, 95%CI: 1.11, 1.70) and the last month (ORm = 1.39, 95%CI: 1.18, 1.63) in the multivariate analysis. Self-efficacy mediated the relations between perceived benefits, perceived barriers, cues to action and medication adherence. Inner relations existed within the HBM. In addition to the direct effects, perceived benefits (β = 0.149, p = 0.031; β = 0.093, p = 0.005), perceived barriers (β = −0.070, p = 0.008; β = −0.062, p = 0.012), and cues to action (β = 0.184, p = 0.013; β = 0.135, p = 0.014) showed indirect effects on medication adherence in the last four days and the last month, respectively. HBM may be effective in predicting medication adherence of elderly PLWH, and self-efficacy may be a crucial predictor and mediator. Efforts should be focused on how to enhance elderly PLWH’s self-efficacy without neglect of other medication beliefs.

KEYWORDS:

• HIV
• elderly PLWH
• medication adherence
• self-efficacy
• health belief model

Acknowledgements

We thank the Center for AIDS/STD Control and Prevention in Sichuan Center for Disease Control and Prevention, Lu County Center for Disease Control and Prevention, and Pidu District Center for Disease Control and Prevention for supporting the investigation. We also thank the International Institute of Spatial Lifecourse Epidemiology (ISLE) for the research support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by Sichuan Applied Psychology Research Center under grant number CSXL-192A02, Sichuan Provincial foundation for AIDS prevention and control under grant number 2018-WJW-02, Sichuan Science and Technology Program under grant number 2019YJ0148, Sichuan Sexual Sociology and Sex Education Research Center under grant number SXJYC1806 and the International Institute of Spatial Lifecourse Epidemiology (ISLE).