Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus

Figures & data

Figure 1 Hypothesized mode1 of health care empowerment.

Table 1 Participant characteristics

	Study 1 (n = 254)	Study 2 (n = 148)	P
Age, mean (SD), years	45.4 ± 9.6	44.5 ± 8.1	0.51
Percent male	254 (100.0)	121 (81.8)	<0.0001
Race	–	–	<0.0001
Black/African American	45 (17.8)	73 (49.3)	–
White	135 (53.2)	48 (32.4)	–
Other	74 (29.1)	27 (18.2)	–
Hispanic ethnicity	46 (18.1)	16 (10.8)	0.05
Sexual orientation	–	–	<0.0001
Heterosexual	2 (0.8)	46 (31.1)	–
Homosexual	229 (90.2)	72 (48.7)	–
Bisexual/other	23 (9.1)	30 (20.3)	–
Education	–	–	<0.0001
<High school	12 (4.7)	32 (21.6)	–
High school	64 (25.2)	59 (39.9)	–
Some college	74 (29.1)	42 (28.4)	–
College graduate	104 (40.9)	15 (10.1)	–
Income <US$20,000	134 (52.8)	120 (88.5)	<0.0001
Ever homeless or lived in shelter	71 (28.0)	108 (74.0)	<0.0001
History of injection drug use	82 (32.3)	73 (49.3)	0.0007
CD4 count	–	–	<0.0001
<200	19 (7.5)	45 (30.4)	–
200–500	93 (36.6)	84 (56.8)	–
>500	142 (55.9)	19 (12.8)	–
Viral load undetectable (%)	134 (53.4)	20 (14.0)	<0.0001
Months since HIV+ mean (SD)	154.5 (94.4)	135.6 (89.6)	0.05
Health care empowerment, mean (SD)	113.7 (12.2)	103.3 (19.0)	<0.0001

Note: Comparisons were made using Pearson’s Chi-square test for binary, nominal, and ordinal variables and the Wilcoxon rank-sum test for continuous variables.

Abbreviations: SD, standard deviation; HIV, human immunodeficiency virus.

Table 2 Hypothesized clinical correlates of health care empowerment

Clinical correlate	Study 1		Study 2
	r (95% CI)	P	r (95% CI)	P
On ART	–	–	0.07 (−0.10, 0.23)	0.43
Primary care appointment last 3 months	0.29 (0.12, 0.46)	0.001	0.25 (0.08, 0.41)	0.003
Adherence self-efficacy: integration	0.39 (0.28, 0.49)	<0.001	0.26 (0.12, 0.41)	<0.001
Adherence self-efficacy: perseverance	0.33 (0.22, 0.43)	<0.001	0.08 (−0.10, 0.27)	0.38
Three-day 100% ART adherence	0.21 (0.07, 0.35)	0.004	0.14 (−0.07, 0.34)	0.19
Thirty-day ART adherence	0.23 (0.10, 0.37)	0.001	0.27 (0.10, 0.43)	0.002
CD4+ cell count	0.02 (−0.10, 0.14)	0.70	0.14 (−0.02, 0.30)	0.08
Detectable viral load	−0.08 (−0.21, 0.04)	0.19	0.03 (−0.16, 0.20)	0.79

Notes: n = 254 for study 1; n = 148 for study 2. All coefficients were estimated using full-information maximum likelihood in Mplus 6. All coefficients are standardized with binary correlates standardized on health care empowerment only and continuous correlates standardized on both health care empowerment and the correlates; coefficients may be interpreted as bivariate correlations. All inferences were generated using robust variance estimation (Mplus estimator MLR), with confidence intervals and test statistics additionally corrected for nesting of participants within couples in study 1.

Abbreviations: ART, antiretroviral therapy; CI, confidence interval; MLR, maximum likelihood with robust standard errors and test statistics.

Table 3 Hypothesized antecedents of health care empowerment (study 1, n = 254)

	Unadjusted		Adjusted
	r (95% CI)	P	β (95% CI)	P
Contextual/environmental factors
Race/ethnicity	χ^2(3) = 1.91a	0.59	–	–
White (non-hispanic, reference)	–	–	–	–
Black (non-hispanic)	0.04 (−0.07, 0.15)	0.47	–	–
Hispanic	−0.01 (−0.13, 0.11)	0.87	–	–
Other race	−0.11 (−0.27, 0.05)	0.19	–	–
Age	0.15 (0.04, 0.26)	0.01	–	–
Personal resource factors
Income <US$20,000	0.04 (−0.09, 0.16)	0.55	–	–
Relationship satisfaction (CSI)	0.05 (−0.09, 0.18)	0.52	–	–
Social problem solving (constructive)	0.39 (0.26, 0.52)	<0.001	0.17 (0.05, 0.29)	0.01
Social problem solving (dysfunctional)	−0.36 (−0.50, −0.21)	<0.001	−0.28 (−0.43, −0.12)	<0.001
Need for BMQ	0.21 (0.10, 0.33)	<0.001	0.14 (0.02, 0.25)	0.02
BMQ concerns	−0.05 (−0.18, 0.08)	0.49	–	–
Shared decision-making	0.26 (0.12, 0.40)	<0.001	0.19 (0.09, 0.30)	<0.001
Provider knows me as a person	0.32 (0.20, 0.43)	<0.001	0.27 (0.17, 0.37)	<0.001
Autonomy preference index	0.24 (0.09, 0.39)	0.001	0.22 (0.10, 0.34)	<0.001
Decision-making opportunity scale	0.39 (0.21, 0.56)	<0.001	–	–
Intrapersonal factors
Depression	−0.18 (−0.30, −0.06)	0.004	0.25 (0.10, 0.41)	0.001
DES positive emotion	0.34 (0.22, 0.47)	<0.001	0.28 (0.13, 0.44)	<0.001
DES negative emotion	−0.16 (−0.28, −0.04)	0.01	–	–

Notes: All coefficients were estimated using full-information maximum likelihood in Mplus 6. All coefficients are standardized with binary correlates standardized on health care empowerment only and continuous correlates standardized on both health care empowerment and the correlates. Unadjusted coefficients may be interpreted as bivariate correlations; adjusted coefficients may be interpreted as standardized regression coefficients. All inferences were generated using robust variance estimation (Mplus estimator MLR) with confidence intervals and test statistics corrected for nesting of participants within couples.

a Joint Wald significance test of race dummy variables.

Abbreviations: CSI, Couple Satisfaction Index; DES, Differential Emotions Scale; BMQ, Beliefs About Medications Questionnaire; MLR, maximum likelihood with robust standard errors and test statistics.

Table 4 Hypothesized antecedents of health care empowerment, study 2 (n = 148)

	Unadjusted		Adjusted
	r (95% CI)	P	β (95% CI)	P
Contextual/environmental factors
Race/ethnicity	χ^2(2) = 00.14a	0.93	–	–
White (non-hispanic, reference)	–	–	–	–
Black (non-hispanic)	−0.02 (−0.18, 0.14)	0.81	–	–
Hispanic and other races	−0.01 (−0.16, 0.14)	0.92	–	–
Age	−0.04 (−0.19, 0.12)	0.65	–	–
Female gender	−0.03 (−0.21, 0.16)	0.78	–	–
HIV stigma (distancing)	−0.03 (−0.21, 0.14)	0.73	–	–
Personal resource factors
Income <US$10,000	0.16 (0.02, 0.30)	0.03	–	–
Social support (social provisions scale)	0.40 (0.27, 0.53)	<0.001	–	–
Treatment knowledge	0.31 (0.14, 0.49)	<0.001	–	–
Trust in provider	0.33 (0.19, 0.47)	<0.001	–	–
Need for BMQ	0.30 (0.04, 0.55)	0.02	0.27 (0.07, 0.48)	0.01
BMQ concerns	−0.23 (−0.42, −0.03)	0.02	–	–
Shared decision-making	−0.08 (−0.23, 0.08)	0.35	–	–
Provider knows me as a person	0.22 (0.06, 0.38)	0.01	–	–
Patient reactions assessment	−0.48 (−0.62, −0.33)	<0.001	−0.31 (−0.49, −0.14)	<0.001
Positive provider interactions	0.43 (0.30, 0.56)	<0.001	0.25 (0.08, 0.42)	0.004
Intrapersonal factors
Depression	−0.20 (−0.36, −0.03)	0.02	–	–
Perceived stress	−0.09 (−0.25, 0.08)	0.30	–	–

Notes: All coefficients were estimated using full-information maximum likelihood in Mplus 6. All coefficients are standardized with binary correlates standardized on health care empowerment only and continuous correlates standardized on both health care empowerment and the correlates. Unadjusted coefficients may be interpreted as bivariate correlations; adjusted coefficients may be interpreted as standardized regression coefficients. All inferences were generated using robust variance estimation (Mplus estimator MLR).

a Joint Wald significance test of race dummy variables.

Abbreviations: CI, confidence interval; BMQ, Beliefs About Medications Questionnaire; HIV, human immunodeficiency virus; MLR, maximum likelihood with robust standard errors and test statistics.