Ownby Raymond L, Waldrop-Valverde Drenna, Caballero Joshua, Jacobs Robin J
Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL.
Neurobehav HIV Med. 2012 Oct 18;4:113-121. doi: 10.2147/NBHIV.S36549.
Medication adherence in persons treated for human immunodeficiency virus (HIV) continues to be an important focus for intervention. While high levels of adherence are required for good clinical outcomes, research shows many patients do not achieve these levels. Despite multiple interventions to improve adherence, most require multiple sessions delivered by trained clinicians. Cost and lack of trained personnel limit the availability of these interventions. Alternatives to clinician-delivered interventions are interventions provided via electronic devices (eg, personal/tablet computers and smartphones). Modern technology allows devices to provide tailoring of content to patient characteristics and learning needs, and to be excellent platforms to deliver multimedia teaching content. The intervention reported drew on research on health literacy in persons with HIV and the relation of health literacy to medication adherence in persons treated for HIV to develop an electronically delivered application. Using the Information-Motivation-Behavioral Skills model as a conceptual framework for understanding patients' information needs, a computer-delivered intervention was developed, its usability and acceptability was assessed, and medication adherence in 118 patients for 1 month before and after they completed the intervention was evaluated. Changes in participant adherence were evaluated in sequential models with progressively lower levels of baseline medication adherence. Results show that although changes in adherence in the entire sample only approached statistical significance, individuals with adherence less than 95% showed significant increases in adherence over time. Participants' self-reported knowledge and behavioral skills increased over the course of the study. Their change in information predicted their post-intervention adherence, suggesting a link between the intervention's effects and outcomes. A computer-delivered intervention targeting HIV-related health literacy may thus be a useful strategy for improving patient adherence.
接受人类免疫缺陷病毒（HIV）治疗的患者的用药依从性仍然是干预的重要重点。虽然良好的临床结果需要高水平的依从性，但研究表明许多患者并未达到这些水平。尽管采取了多种干预措施来提高依从性，但大多数措施都需要经过培训的临床医生进行多次问诊。成本和缺乏训练有素的人员限制了这些干预措施的可用性。临床医生提供的干预措施的替代方案是通过电子设备（如个人/平板电脑和智能手机）提供的干预措施。现代技术使设备能够根据患者的特征和学习需求定制内容，并成为提供多媒体教学内容的优秀平台。报告的干预措施借鉴了对HIV感染者健康素养的研究以及健康素养与接受HIV治疗者用药依从性的关系，开发了一种电子交付的应用程序。以信息-动机-行为技能模型作为理解患者信息需求的概念框架，开发了一种计算机交付的干预措施，评估了其可用性和可接受性，并评估了118名患者在完成干预前后1个月的用药依从性。在基线用药依从性水平逐渐降低的连续模型中评估参与者依从性的变化。结果表明，虽然整个样本的依从性变化仅接近统计学显著性，但依从性低于95%的个体随着时间的推移依从性显著增加。在研究过程中，参与者自我报告的知识和行为技能有所提高。他们信息的变化预测了他们干预后的依从性，表明干预效果与结果之间存在联系。因此，针对HIV相关健康素养的计算机交付干预措施可能是提高患者依从性的有用策略。
