Hammami Naïma, Nöstlinger Christiana, Hoerée Tom, Lefèvre Pierre, Jonckheer Tyl, Kolsteren Patrick
Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Pediatrics. 2004 Nov;114(5):e591-7. doi: 10.1542/peds.2004-0085.
To acquire a deeper understanding of factors that influence adherence to highly active antiretroviral therapy (HAART) in a pediatric population.
We performed a qualitative study of adherence in children who receive HAART in a Belgian pediatric acquired immune deficiency syndrome referral center. Eleven primary caregivers were interviewed to assess their child's adherence and influencing factors. The interview guidelines were developed on the basis of an extensive literature review. Adherence to treatment was assessed using caregivers' self-report and laboratory results. Content analysis for common items was performed, and statements of adherent and less-adherent patients were compared.
Three main factors influenced adherence. Adherent patients were found to internalize the medical information to a stronger extent than less-adherent patients. Adherent patients showed stronger motivation to stick to the medical regimen on the basis of personal cost-benefit analyses, ie, perceived benefits outweighed the costs or difficulties experienced. Adherent patients developed greater problem-solving capacities, ie, ways to deal with practical complications of medication intake. The interviews revealed a fourth, more dynamic component: knowledge, motivation, and capacities evolved in a progressive way, related to individual stages of coping with human immunodeficiency virus (HIV).
The data suggest that coping with HIV and the process of establishing good adherence may be interrelated. Caregivers who accept the disease may be more likely to internalize the received information and thus develop a stronger motivation to fight for the child's life. Problem-solving skills sustain this adherence, and medication becomes a priority in the adherent caregivers' daily lives. On the contrary, less-adherent caregivers may be situated at less advanced stages of the coping process. Thus, tailor-made approaches adapted to the individual HIV-related coping strategies need to be developed to improve adherence in children and caregivers.
更深入地了解影响儿科人群坚持高效抗逆转录病毒疗法（HAART）的因素。
我们对比利时一家儿科获得性免疫缺陷综合征转诊中心接受HAART治疗的儿童的依从性进行了定性研究。对11名主要照顾者进行了访谈，以评估其孩子的依从性及影响因素。访谈指南是在广泛文献综述的基础上制定的。使用照顾者的自我报告和实验室结果评估治疗依从性。对常见项目进行内容分析，并比较依从性好和依从性差的患者的陈述。
三个主要因素影响依从性。发现依从性好的患者比依从性差的患者更能将医疗信息内化为自身的观念。依从性好的患者基于个人成本效益分析，即认为益处大于所经历的成本或困难，表现出更强的坚持医疗方案的动机。依从性好的患者培养了更强的解决问题的能力，即处理药物摄入实际并发症的方法。访谈揭示了第四个更具动态性的因素：知识、动机和能力随着应对人类免疫缺陷病毒（HIV）的各个阶段逐步发展。
数据表明应对HIV与建立良好依从性的过程可能相互关联。接受疾病现实的照顾者可能更有可能将所接收的信息内化为自身观念，从而产生更强的为孩子的生命而抗争的动机。解决问题的技能维持了这种依从性，并且药物治疗在依从性好的照顾者的日常生活中成为优先事项。相反，依从性差的照顾者可能处于应对过程中较不先进的阶段。因此，需要制定适应个体HIV相关应对策略的量身定制的方法，以提高儿童及其照顾者的依从性。
