Horne Robert, Cooper Vanessa, Gellaitry Grace, Date Heather Leake, Fisher Martin
Centre for Behavioural Medicine, Department of Policy and Practice, The School of Pharmacy, University of London, and Brighton University Hospital, National Health Service Trust, The Lawson Unit, United Kingdom.
J Acquir Immune Defic Syndr. 2007 Jul 1;45(3):334-41. doi: 10.1097/QAI.0b013e31806910e3.
To test the utility of the necessity-concerns framework in predicting highly active antiretroviral therapy (HAART) uptake and adherence.
This was a prospective follow-up study. Consecutive patients who were not currently receiving HAART were referred by their HIV physician. Immediately after a recommendation of HAART, patients completed the Beliefs about Medicines Questionnaire assessing their perceptions of personal necessity for HAART and concerns about potential adverse effects. The influence of these beliefs on the decision to accept or decline HAART and adherence 12 months later were assessed.
One hundred fifty-three participants were given a recommendation of HAART, and 136 (88.9%) returned completed questionnaires. Thirty-eight participants (28%) initially rejected the treatment offer. Uptake of HAART was associated with perceptions of personal necessity for treatment (odds ratio [OR]=7.41, 95% confidence interval [CI]: 2.84 to 19.37) and concerns about potential adverse effects (OR=0.19, 95% CI: 0.07 to 0.48). There was a significant decline in adherence over time. Perceived necessity (OR=2.19, 95% CI: 1.02 to 4.71) and concerns about adverse effects (OR=0.45, 95% CI: 0.22 to 0.96), elicited before initiating HAART, predicted subsequent adherence. These associations were independent of clinical variables and depression.
The necessity-concerns framework is a useful theoretic model for understanding patient perspectives of HAART and predicting uptake and adherence, with implications for the design of evidence-based interventions.
检验必要性-关注框架在预测高效抗逆转录病毒疗法（HAART）的接受率和依从性方面的效用。
这是一项前瞻性随访研究。未接受HAART治疗的连续患者由其HIV医生转诊。在推荐HAART后，患者立即完成了关于药物信念问卷，评估他们对HAART个人必要性的认知以及对潜在不良反应的担忧。评估这些信念对接受或拒绝HAART决定以及12个月后依从性的影响。
153名参与者收到了HAART推荐，136名（88.9%）返回了完整问卷。38名参与者（28%）最初拒绝了治疗提议。HAART的接受与对治疗个人必要性的认知相关（优势比[OR]=7.41，95%置信区间[CI]：2.84至19.37）以及对潜在不良反应的担忧相关（OR=0.19，95%CI：0.07至0.48）。随着时间推移，依从性显著下降。开始HAART之前引发的感知必要性（OR=2.19，95%CI：1.02至4.71）和对不良反应的担忧（OR=0.45，95%CI：0.22至0.96）预测了随后的依从性。这些关联独立于临床变量和抑郁。
必要性-关注框架是一个有用的理论模型，用于理解患者对HAART的看法并预测接受率和依从性，对基于证据的干预措施设计具有启示意义。
