The information-motivation-behavioral skills (IMB) model of antiretroviral therapy (ART) adherence among people living with HIV in Shanghai

ABSTRACT

The Information-Motivation-Behavioral skills (IMB) model of antiretroviral therapy (ART) adherence was applied in people living with HIV/AIDS in Shanghai, China to understand how adherence-related information, motivation and behavioral skills would affect ART adherence. The LifeWindows Information-Motivation-Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ) was translated into Chinese and used. The IMB model was then implemented by testing standardized path estimates with standard model fitness indices in the participants. 426 participants from 11 community centres in Putuo district of Shanghai were recruited, of which 95.3% reported a high level of adherence (>95% adherence). The fitness indices of the final adjusted model were χ2 = 6.110, df = 7, p = 0.527(>0.05), CFI = 1.000(>0.9) and RMSEA = 0.000 (<0.08). In the model, information, which was separated into two sections (the perceived effect of ART on health and knowledge about ART medication), had an indirect effect on the ART adherence through behavioral skills, while motivation did not have such an effect. Neither information nor motivation had a direct effect on ART adherence. In addition, motivation was related to the two sections of information. The feasibility of the IMB model of ART adherence is verified by its application to predictive of adherence-related behaviors among HIV+ patients in this study.

KEYWORDS:

• IMB model
• China
• HIV
• ART
• adherence

Acknowledgements

YC, HZ, ZP had the idea for and designed the study and had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. WW was in charge of contacting community doctors and supervising the distribution of this questionnaire. YC, ZP, HC, WW, YL, RW, XY, CX, RL contributed to writing of the manuscript. YC, ZP, HC contributed to critical revision of the report. KZ, YY, YH, ZS, YW, ZL, ZY were in charge of contacting participants, distributing questionnaires and helping participants fill in them. All authors reviewed and approved the final version.

Declarations

Ethics approval and consent to participate

Participants filled out questionnaires with their community doctors’ help when they came to doctor’s for annual check. Before filling out questionnaires, written informed consent was obtained from the participants. Community doctors were requested to sign a form pledging that they had made clear explanations to the participants and answered all questions before the participants signed the informed consent. A 50-yuan (about $8) compensation was given to each subject investigated to improve the compliance. We made the claim that in the whole process of dealing with our participants, we strictly complied with APA ethical standards. This study was approved by the Ethics Committee of the School of Public Health Shanghai Jiao Tong University.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

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

Additional information

Funding

This work was supported by the National Natural Science Funds of China under Grant 71603166 and 71673187 and by Shanghai Three-year Action Plan for Public Health under Grant GWV-10.1-XK15, GWV-10.1-XK18, GWV-10.2-XD13 and 72061137001 by the Natural Science Foundation of China International/Regional Research Collaboration Project, and HLPM201907020105 by the High-Level Project of Medicine in Longhua, Shenzhen. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.