Bader Armin, Kremer Heidemarie, Erlich-Trungenberger Iabella, Rojas Roberto, Lohmann Monika, Deobald Olivia, Lochmann Rainer, Altmeyer Peter, Brockmeyer Norbert
Department of Dermatology, University of Bochum, Bochum, Germany.
Med Sci Monit. 2006 Dec;12(12):CR493-500. Epub 2006 Nov 23.
Research has found that patient adherence to antiretroviral therapy is crucial to treatment success, but this research did not investigate the patient's viewpoint. This study examined relationships between types of adherence and coping, psychosocial factors, quality of life (QoL), and physical symptoms from the perspective of people living with HIV/AIDS.
MATERIAL/METHODS: The quantitative study involved 100 HIV-positive participants. Questionnaires comprised the Trier Scales on Coping with Physical Illness, Medical-Outcomes-Study HIV Health-Survey QoL, Social Factors of Antiretroviral Therapy, and the HIV/AIDS Physical Symptom-Checklist. A sub-sample of 41 participants underwent semi-standardized interviews eliciting the type of adherence. Grounded Theory was the method of qualitative analyses.
Maladaptive coping (rumination) related to poor mental health (p<0.001), concealing the HIV-infection (p<0.01), and being treatment-naive (p<0.01). Spiritual coping was more likely in women (p<0.001). Overall, QoL was worse in participants with more physical symptoms (p<0.001) and in those seeking mental health care (p<0.001). Working and maintaining a regular daily routine were associated with better adherence (p<0.05). Four adherence types were identified: 'Traditional Adherence' (with indifferent, faithful, and anxious subtypes), 'Traditional Non-Adherence', 'Critical Adherence', and 'Critical Non-Adherence'. The traditional types underscored a paternalistic medical model, while critical types emphasized 'autonomous patients'. Critical types were less frequent (39%), although superior to traditional types (p<0.001) in internal locus of control, optimal social support, and adaptive coping.
Critical adherence is superior to traditional adherence with respect to physical and psychosocial factors. Strategies to improve adherence should therefore target empowerment and autonomy rather than patient obedience.
研究发现患者对抗逆转录病毒疗法的依从性对治疗成功至关重要，但该研究未调查患者的观点。本研究从艾滋病毒/艾滋病患者的角度探讨了依从性类型与应对方式、心理社会因素、生活质量（QoL）和身体症状之间的关系。
材料/方法：这项定量研究涉及100名艾滋病毒呈阳性的参与者。问卷包括应对身体疾病的特里尔量表、医学结果研究艾滋病毒健康调查生活质量量表、抗逆转录病毒疗法的社会因素量表以及艾滋病毒/艾滋病身体症状检查表。41名参与者的子样本接受了半标准化访谈，以确定依从性类型。扎根理论是定性分析的方法。
适应不良的应对方式（沉思）与心理健康不佳（p<0.001）、隐瞒艾滋病毒感染（p<0.01）以及初次接受治疗（p<0.01）有关。女性更有可能采用精神应对方式（p<0.001）。总体而言，身体症状较多的参与者生活质量较差（p<0.001），寻求心理保健的参与者生活质量也较差（p<0.001）。工作和保持规律的日常生活与更好的依从性相关（p<0.05）。确定了四种依从性类型：“传统依从性”（包括冷漠、忠诚和焦虑亚型）、“传统不依从性”、“批判性依从性”和“批判性不依从性”。传统类型强调家长式医疗模式，而批判性类型强调“自主患者”。批判性类型较少见（39%），尽管在内部控制点、最佳社会支持和适应性应对方面优于传统类型（p<0.001）。
在身体和心理社会因素方面，批判性依从性优于传统依从性。因此，提高依从性的策略应针对增强权能和自主性，而非患者的服从性。
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