Reliability and Validity of the LifeWindows Information–Motivation–Behavioral Skills Antiretroviral Therapy Adherence Questionnaire Among HIV+ Patients in Shanghai

Figures & data

Table 1 Demographic Characteristics of the Participants (N=426) and Their Relationship with ART Adherence

	N (%)	n in High Adherence Group (n/N%)	p
Age
18–40	259(60.8%)	247(95.4%)	0.867
41–60	111(26.1%)	105(94.6%)
61–80	56(13.1%)	54(96.4%)
Sex
Male	402(94.4%)	383(95.3%)	1
Female	24(5.6%)	23(95.8%)
Education
Primary school or below	3(0.7%)	3(100%)	0.425
Junior high school	39(9.1%)	36(92.3%)
Senior high school	86(20.2%)	84(97.7%)
College degree or above	298(67.0%)	283(95.0%)
Marital Status
Single	279(65.5%)	268(96.1%)	0.457
Currently married	104(24.4%)	96(92.3%)
Divorced	38(8.9%)	37(97.4%)
Widowed	5(1.2%)	5(100%)
Income, Yuan (0.15$)/Month
≤3000	32(7.5%)	30(93.8%)	0.564
3000—6000	99(23.2%)	92(92.9%)
6001—12,000	163(38.3%)	157(96.3%)
≥12,000	132(31.0%)	127(96.3%)
Sexual Orientation
Heterosexual	109(25.6%)	107(98.2%)	0.123
Homosexual	220(51.6%)	210(95.5%)
Bisexual	52(12.2%)	49(94.2%)
Pansexual	3(0.7%)	3(100%)
Unsure	42(9.9%)	37(88.1%)
Transmission
Heterosexual	76(17.8%)	74(97.4%)	0.201
Homosexual	233(54.7%)	221(94.8%)
Blood-borne	7(1.6%)	7(100%)
Intravenous drug use	2(0.5%)	1(50%)
Unknown	108(25.4%)	103(95.4%)
Clinical Stage
HIV infection stage	322(75.6%)	307(95.3%)	1
AIDS stage	104(24.4%)	99(95.2%)
Adherence
High	406 (95.3%)
Low	20 (4.7%)
Total	426	406

Table 2 The Mean Scores of Three Sections in Two Groups (N=426)

	High Adherence (n=406) Mean/SD	Low Adherence (n=20) Mean/SD	p
Information	3.71±2.868	2.50±1.987	0.016*
Motivation	30.91±6.896	30.20±5.425	0.581
Behavioral skills	55.72±6.536	51.75±5.618	0.006**

Notes: *p<0.05, **p<0.01.

Table 3 Item Analysis for the LW-IMB-AAQ

Item	Mean±SD	CR	p	Item-Total Correlation	p
Information
1	0.43±0.495	8.804	<0.001	0.576	<0.001
2	0.38±0.485	14.775	<0.001	0.515	<0.001
3	0.38±0.486	4.196	0.001	0.424	<0.001
4	0.30±0.457	9.349	<0.001	0.413	<0.001
5	0.61±0.489	8.195	<0.001	0.494	<0.001
6	0.15±0.458	9.387	<0.001	0.382	<0.001
7	0.56±0.497	23.689	<0.001	0.575	<0.001
8	0.58±0.495	23.689	<0.001	0.613	<0.001
9	0.28±0.449	14.775	<0.001	0.478	<0.001
Motivation
1	1.78±0.749	0.325	0.749	0.114	0.021
2	2.88±1.182	8.179	<0.001	0.504	<0.001
3	3.15±1.276	38.004	<0.001	0.659	<0.001
4	3.90±0.793	5.371	<0.001	0.408	<0.001
5	4.44±1.249	5.57	<0.001	0.256	<0.001
6	3.32±1.230	15.317	<0.001	0.438	<0.001
7	3.15±1.213	22.59	<0.001	0.647	<0.001
8	2.52±1.067	14.236	<0.001	0.364	<0.001
9	3.06±1.123	24.171	<0.001	0.502	<0.001
10	2.78±1.119	14.146	<0.001	0.514	<0.001
Behavioral Skills
1	4.01±0.767	11.533	<0.001	0.524	<0.001
2	3.92±0.843	4.49	<0.001	0.403	<0.001
3	4.38±0.623	18.833	<0.001	0.599	<0.001
4	4.42±0.573	7.654	<0.001	0.649	<0.001
5	3.64±0.867	8.253	<0.001	0.456	<0.001
6	4.43±0.554	9.759	<0.001	0.654	<0.001
7	4.39±0.581	25.115	<0.001	0.683	<0.001
8	4.44±0.547	11.075	<0.001	0.72	<0.001
9	4.49±0.532	11.111	<0.001	0.724	<0.001
10	4.48±0.523	10.746	<0.001	0.718	<0.001
11	4.48±0.591	10.921	<0.001	0.705	<0.001
12	4.46±0.586	21.109	<0.001	0.734	<0.001
13	4.14±0.752	20.569	<0.001	0.539	<0.001

Abbreviation: CR, critical ratio.

Table 4 The Reliability of the LW-IMB-AAQ

	α (n=426)	ICC (n=50)	Spearman–Brown Coefficient
Information	0.848	0.643***	0.825
Motivation	0.813	0.654***
Behavioral skills	0.915	0.626***
Total	0.889	0.799***

Notes: ***p<0.001, α, Cronbach’s α coefficients.

Abbreviation: ICC, interclass correlation coefficient

Table 5 Exploratory Factor Analysis of the Questionnaire

	Subscales
Information	Subscale 1	Subscale 2
1: I know how each of my current HIV medications is supposed to be taken (for example whether or not my current medications can be taken with food, herbal supplements, or other prescription medications).	0.609
2: I know what to do if I miss a dose of any of my HIV medications (for example, whether or not to take the pill (s) later).	0.600
3: Skipping a few of my HIV medications from time to time would not really hurt my health.		0.757
4: I know what the possible side effects of each of my HIV medications are.	0.725
5: As long as I am feeling healthy, missing my HIV medications from time to time is OK.		0.834
6: I understand how each of my HIV medications works in my body to fight HIV.	0.787
7: If I do not take my HIV medications as prescribed, these kinds of medications may not work for me in the future.		0.665
8: I believe that if I take my HIV medications as prescribed, I will live longer.		0.600
9: I know how my HIV medications interact with alcohol and street drugs.	0.745
Motivation	Subscale 1	Subscale 2	Subscale 3
2: I get frustrated taking my HIV medications because I have to plan my life around them.	0.771
3: I do not like taking my HIV medications because they remind me that I am HIV+.	0.783
4: I feel that my healthcare provider takes my needs into account when making recommendations about which HIV medications to take.			0.951
5: Most people who are important to me who know I am HIV positive support me in taking my HIV medications.		0.924
6: My healthcare provider does not give me enough support when it comes to taking my medications as prescribed.		0.509
7: It frustrates me to think that I will have to take these HIV medications every day for the rest of my life.	0.808
8: I am worried that the HIV medications I have been prescribed will hurt my health.	0.727
9: It upsets me that the HIV medications I have been prescribed can affect the way I look.	0.779
10: It upsets me that the HIV medications I have been prescribed can cause side effects.	0.829
Behavioral skills	Subscale 1	Subscale 2
1: How hard or easy is it for you to stay informed about HIV treatment?		0.780
2: How hard or easy is it for you to get the support you need from others for taking your HIV medications (for example, from friends, family, doctor, or pharmacist)?		0.673
3: How hard or easy is it for you to get your HIV medication refills on time?	0.697
4: How hard or easy is it for you to take your HIV medications when you are wrapped up in what you are doing?	0.751
5: How hard or easy is it for you to manage the side effects of your HIV medications?		0.747
6: How hard or easy is it for you to remember to take your HIV medications?	0.798
7: How hard or easy is it for you to take your HIV medications because the pills are hard to swallow, taste bad, or make you sick to your stomach?	0.852
8: How hard or easy is it for you to make your HIV medications part of your daily life?	0.890
9: How hard or easy is it for you to take your HIV medications when your usual routine changes (for example, when you travel or when you go out with your friends)?	0.903
10: How hard or easy is it for you to take your HIV medications when you do not feel good emotionally (for example, when you are depressed, sad, angry, or stressed out)?	0.926
11: How hard or easy is it for you to take your HIV medications when you feel good physically and do not have any symptoms of your HIV disease?	0.814
12: How hard or easy is it for you to take your HIV medications when you do NOT feel good physically?	0.879
13: How hard or easy is it for you to talk to your health care provider about your HIV medications?		0.633

Table 6 Fitness of the LW-IMB-AAQ

χ^2	df	P	χ^2/df	CFI	GFI	RMSEA
7.476	7	0.381	1.068	0.999	0.995	0.013

Note: χ², Minimum Fit Function.

Abbreviations: df, degree of freedom; CFI, Comparative Fit Index; GFI, Goodness of Fit Index; RMSEA, Root Mean Square Error of Approximation.

Table 7 Convergent Validity and Discriminant Validity of the Questionnaire

	AVE	Subscales
Information		Knowledge	Effect
Knowledge	0.518	0.72
Effect	0.486	0.620***	0.697
Motivation		Personal	Social
Personal	0.557	0.746
Social	0.904	0.148**	0.951
Behavioral skills		Self-efficacy	Objective abilities
Self-efficacy	0.505	0.711
Objective abilities	0.701	0.424***	0.837

Notes: **p<0.01, ***p<0.001.

Abbreviations: AVE, average variance extracted; Knowledge, knowledge about ART and how to take it; Effect, the effect of ART on health; Personal, personal motivation; Social, social motivation; Self-efficacy, self-efficacy about insisting on taking ART; Objective abilities, objective abilities of using skills to improve ART adherence.