新兴人类免疫缺陷病毒感染者的坚持自我管理和情境因素的影响。
Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus.
机构信息
Ann-Margaret Dunn Navarra, CPNP-PC, PhD, is Assistant Professor, New York University Rory Meyers College of Nursing, New York. Robin Whittemore, APRN, PhD, FAAN, is Professor, Yale School of Nursing, West Haven, Connecticut. Suzanne Bakken, RN, PhD, FAAN, FACMI, FIAHSI, is Alumni Professor of Nursing and Professor of Biomedical Informatics, Department of Biomedical Informatics, Columbia University School of Nursing, New York, New York. Michael J. Rosenberg, MD, PhD, is Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, New York, New York. Maurade Gormley, CPNP, MSN, is PhD Candidate, New York University Rory Meyers College of Nursing, New York. John Bethea, AS, is Undergraduate Student, New York University College of Arts and Sciences, New York. Marya Gwadz, PhD, is Professor and Associate Dean for Research, New York University Silver School of Social Work, New York. Charles Cleland, PhD, is Member of the Faculty, Department of Population Health, New York University School of Medicine, New York. Eva Liang, MA, is Research Assistant, New York University Rory Meyers College of Nursing, New York. Gail D'Eramo Melkus, ANP, EdD, FAAN, is Professor and Vice Dean for Research, New York University Rory Meyers College of Nursing, New York.
出版信息
Nurs Res. 2020 May/Jun;69(3):197-209. doi: 10.1097/NNR.0000000000000422.
BACKGROUND
Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort.
OBJECTIVES
As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior.
METHODS
The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources.
RESULTS
Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control.
DISCUSSION
Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.
背景
维持抗逆转录病毒疗法（ART）的依从性对感染人类免疫缺陷病毒（HIV）的少数族裔青少年和年轻成年人（青年）来说是一个重大挑战。鉴于 ART 依从性不佳的后果，迫切需要扩大对这一人群依从性行为的理解。
目的
作为探索性顺序、混合方法研究的一部分，我们使用定性探究来探索感染 HIV 的少数族裔青年的依从信息、动机和行为技能。我们的次要目的是了解围绕依从行为的背景因素。
方法
信息-动机-行为技能模型（IMB 模型）被应用于确定我们目标人群中依从行为的概念决定因素，同时注意到出现的主题。对接受 ART 治疗且病毒载量检测结果呈阳性（即 HIV 病毒载量可检测到）的 HIV 感染的少数族裔青年（16-29 岁）进行了方便样本的深入、个体、半结构化访谈，包括带有探针的开放式问题。新参与者的访谈会一直进行，直到达到信息冗余为止。定性访谈进行了数字录音、逐字转录，并使用 Atlas.ti（v8）进行分析。采用定向内容分析法生成类别和广泛主题。编码最初是概念驱动的（IMB 模型），然后转向数据驱动的方法，从而发现影响该人群依从行为的关键背景因素。通过成员检查、审计线索、详细的描述性数据和数据源的三角验证，确保了方法的严谨性。
结果
20 名少数族裔参与者（平均年龄=24.3 岁，55.0%为男性）完成了访谈。我们发现，依从信息是与 HIV 生物标志物相关理解的；依从动机和行为技能受到耻辱感和社会背景的影响。我们确定了五个关于 ART 自我管理的主要主题：（a）成年早期与慢性疾病共存，（b）耻辱感和披露问题，（c）支持系统和支持不足，（d）心理健康和行为健康风险和挑战，以及（e）HIV 传播模式和对权力和控制的看法。
讨论
IMB 模型的关键构建适用于参与的 HIV 感染青年，但并未完全解释依从行为的本质。因此，我们建议扩展当前的依从模型和框架，以纳入与 HIV 感染的少数族裔青年的 ART 自我管理相关的已知背景因素。
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