Reconciling Incompatibilities: A Grounded Theory of HIV Medication Adherence and Symptom Management

Abstract

The purpose of this grounded theory study was to explain how ethnically diverse men and women living with HIV manage their interacting illness symptoms, medication side effects, and treatment adherence choices. The authors used the constant comparative method to analyze textual data from in-depth interviews with 66 HIV-infected people representing the changing HIV demographic profile in the San Francisco Bay area and generate a theory of Reconciling Incompatibilities. Adherence options of complying, not complying, or self-tailoring occurred in a context of attributional uncertainty as to whether distress was illness- or treatment-related, a sometimes silent virus, and perceived fickle medical markers. Conditions, including self-identity, illness ideology, concurrent treatment regimens, the meaning of time, medication burden and side effects, and lifestyle, coalesced to produce a state of mind that shaped adherence choices on a dose-by-dose basis. This theory offers a basis for interventions designed to promote optimal adherence choices concerning HIV therapies.

Medication Beliefs as Mediators of the Health Literacy–Antiretroviral Adherence Relationship in HIV-infected Individuals

“…Other potential, but untested mediators of this association include less detailed information provided to individuals with lower literacy by providers and therefore less knowledge of importance of adherence (Kalichman et al, 1999), lack of acceptance of information furnished by providers (Wilson, Hutchinson, & Holzemer, 2002), lack of basic organizational skills in individuals with low literacy, and more chaotic lifestyles due to daily stresses associated with insufficient literacy. Low literacy confers a number of individual characteristics which create obstacles to direct patientphysician communication and could in turn increase the likelihood of harboring mistaken beliefs (Bennett, Switzer, Aguirre, Evans, & Barg, 2006;Wolf et al, 2005).…”

Desafios da adesão ao tratamento de pessoas vivendo com HIV/Aids no Brasil

“…The understanding of treatment adherence as a dynamic phenomenon 17 and the introduction of ART as a crucial moment in the history of the patient were important factors among the interviewees, corroborating other studies. 13,19 The use of alcohol is considered a factor associated to the lack of adherence to the treatment of chronic diseases in general, 3,5 currently representing a challenge to people who live with HIV/AIDS. 15,17, *…”

Antiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort Study

“…A comprehensive intervention for enhancing and maintaining HIV patient adherence over time needs to incorporate multifactorial strategies (e.g., cognitive, behavioral and symptom-management strategies) [9][10][11][12]. A study published by Simoni et al [13] pointed out that various cART adherence intervention strategies are successful, but that more research is needed to identify the most efficacious intervention components and the best method for implementing them in real world settings.…”