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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Sharon B. Mannheimer, MD1, Nnaemeka E. Egwuatu, MBBS2, Paul W. Colson, PhD3, Sally Findley, PhD4, Nancy I. Holson, MPH2, Margaret E. Perkins, PhD2, Beverly Diamond, DSW5, Yael Hirsch-Moverman, MS3, Wafaa El Sadr, MD1, and Leah Farrell1. (1) Harlem Hospital Center, Columbia University College of Physicians and Surgeons, 506 Lenox Avenue rm 3101-A, New York, NY 10037, (212)939-2948, sbm20@columbia.edu, (2) Department of Infectious Diseases, Harlem Hospital, 506 Lenox Ave., New York, NY 10037, (3) Charles P. Felton Nat. TB Ctr., Harlem Hospital Center, 2238 Fifth Ave., New York, NY 10037, (4) Joseph L. Mailman School of Public Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032, (5) Irving Center for Clinical Research, Columbia University, 630 W 168th St, New York, NY 10032
Background. The Transtheoretical Model (TTM) describes behavior change as a progression through discrete stages: pre-contemplation (I), contemplation (II), preparation (III), action (IV) and maintenance (V). The decision to adopt new behavior involves evaluating the behavior's pros and cons (decisional balance), and assessing confidence in one's ability to accomplish health-related behaviors (self-efficacy). Our study evaluated the use of TTM for assessing adherence to antiretroviral therapy (ART). Methods. Self-efficacy, decisional balance and stage of change were assessed at baseline in an adherence support study. Adherence was measured by 3-day self-report. Decisional balance and self-efficacy were scored on a four-point scale. Clinical data was obtained from charts. Results. Assessment of 208 pts showed 2.4% TTM stage I, 2.9% stage II, 29.3% stage III, 52.4% stage IV and 47.8% stage V. By ANOVA, stage was associated with 3-day self-report (p=.001). Mean adherence increased from 32±.4% for stage III to 94±.1% for stage V. Self-efficacy score increased from 23.6±6.5 for stage I to 28.6±3.6 for stage V (p<.001). The score for decisional balance pros increased with stage, 33.6±7.9 to 41.8±6.1, (p=.023), while cons decreased with stage, 33.8±15.2 to 23.1±6.5 (p<.001). CD4 cell count increased with stage progression (p=.016). By multivariate analysis, higher stage was associated with increased self-efficacy (p=.041), fewer decisional balance cons (p=.008) and increased adherence levels (p<.001). Conclusion. Decisional balance and self-efficacy are associated with the stages of change in the TTM. The TTM is a useful model for assessing ART adherence behavior.
Learning Objectives:
Keywords: HIV/AIDS, Adherence
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.