Xianhong Li

Stigma Mediates the Relationship Between Self-Efficacy, Medication Adherence, and Quality of Life Among People Living with HIV/AIDS in China

Although the relationship between self-efficacy and health-related behaviors is well known, limited data are available describing the association between self-efficacy and HIV stigma. Specifically, it is not known if the relationship between self-efficacy and health outcomes is mediated by HIV stigma. This study aimed to test these relationships. Data were collected from 202 HIV/AIDS patients in China using questionnaires measuring self-efficacy for disease management, self-reported 7 day medication adherence, perceived HIV/AIDS stigma and quality of life. The total mean score for self-efficacy was 6.73 (range, 2.78-10.0), and the total mean score for HIV stigma was 102.24 (range, 57.0-148.0). Seventy-four percent (150/202) of subjects reported missing no medication doses during past 7 days, and 73% (148/202) subjects reported a quality of life score over 60. There was a moderate level of association between self-efficacy and HIV stigma (Pearson r=-0.43, p=0.000). High self-efficacy predicted better medication adherence (odds ratio [OR]=1.82, 95% confidence interval [CI]=1.40-2.36) and better quality of life (OR=1.28, 95% CI=1.03-1.60) after controlling for demographic and HIV related characteristics. HIV stigma partially mediated the relationship between self-efficacy and medication adherence (OR=1.64, 95% CI=1.26-2.15; Sobel test result Z=1.975, p=0.048). HIV stigma totally mediated the relationship between self-efficacy and quality of life (OR=1.15, 95% CI=0.91-1.46; Sobel test result Z=2.362, p=0.018). The results suggest that, although self-efficacy is an important predictor for medication adherence and quality of life, HIV stigma as a mediator should not be neglected. Health care providers should also evaluate HIV stigma conditions when seeking to improve self-efficacy through interventions.

Stigma reported by people living with HIV in south central China.

&NA; This cross‐sectional study described the level of stigma reported by people living with HIV (PLWH) in south central China and identified factors associated with the individuals’ perceptions of stigma. The authors carried out face‐to‐face interviews among 322 PLWH. Over half (51%) reported experiencing stigma, 78% reported feelings of negative self‐worth, 75% reported interpersonal insecurity, 84% experienced financial problems, and 58% worried about disclosure of their disease. High levels of self‐perceived stigma were associated with subjects who were injection drug users (p = .001), who were less satisfied with responses from family members (p = .001), who had disclosed their HIV status widely (p = .001), and who reported poorer health status (p = .001). Nurses working with PLWH should carry out psychological assessments and care without judgmental attitudes and help PLWH disclose their HIV status to family members, which could reduce HIV‐related stigma in the context of Chinese culture.

Consistent ART Adherence Is Associated with Improved Quality of Life, CD4 Counts, and Reduced Hospital Costs in Central China

This study aimed to assess levels of ART adherence and to examine the relationship between adherence and treatment outcomes. A longitudinal study in Hunan and Hubei provinces used the CPCRA Antiretroviral Medication Self-Report and a 7-day Visual Analogue Scale to assess levels of adherence, while quality of life was evaluated using SF-36. CD4 cell count and the number, duration, and cost of hospitalizations were collected from participant medical records. Measurements were obtained at baseline, month 3, and month 6. A total of 113 participants enrolled and 98 completed the study. The mean level of adherence was 91%, 89%, and 88% at baseline and at 3 and 6 months, respectively. Of participants, 54/98 (58%) reported taking all doses at all three interviews and were classified as consistent adherers (CA). CAs had better physical function (p = 0.001), general health (p = 0.009), vitality (p = 0.016), social functioning (p = 0.001), and mental health (p = 0.023), and presented a higher CD4 cell count (p = 0.028). CAs also had fewer hospital admissions and readmissions (p = 0.005), shorter hospital stays (p = 0.005), and lower hospital expenses (p = 0.006). Consistent adherence is associated with better outcomes including improved quality of life, higher CD4 counts, and lower health care costs.

Self-efficacy, medication adherence, and quality of life among people living with HIV in Hunan Province of China: a questionnaire survey.

&NA; Self‐efficacy is associated with health behavior and medication adherence in persons living with HIV infection (PLWH). This paper describes self‐efficacy, medication adherence, and quality of life (QOL), and it examines the relationships among these variables in PLWH in China. A cross‐sectional survey of 199 patients was completed using the HIV Self‐Efficacy Questionnaire and the QOL for Chinese HIV‐Infected Questionnaire. Medication adherence was measured through direct questioning of pill‐taking behavior. Results showed that self‐efficacy for disease management was moderate, with a mean score of 6.61. Of the 199 patients, 157 (78.9%) reported that medication adherence was higher than 90%. The scores for dimensions of QOL ranged from 33.1 to 81.4, with six dimensions lower than 60. Stepwise regression analyses showed that self‐efficacy, medication adherence, and drug use were significant predictors of QOL. These results suggest a need for intervention programs to improve self‐efficacy and quality of life in Chinese PLWH.

Shadow on My Heart: A Culturally Grounded Concept of HIV Stigma Among Chinese Injection Drug Users

&NA; Although stigma is a significant barrier to HIV prevention and treatment globally, the culture‐specific psychosocial processes through which HIV‐infected Chinese experience stigma have not been described. This study used grounded theory to explore the social and psychological processes of HIV‐related stigma experienced by Chinese injection drug users and proposed a culture‐specific concept of stigma. The focus group had six participants, and we conducted 16 individual interviews. The core category emerged as “Double struggle: Returning to normalcy.” Key concepts were dual stigma and family support, while keeping secrets and active drug use were factors influencing the struggle to return to normalcy. Family responsibility played an important role in bringing family members together to cope with HIV. Recommendations for Chinese health care providers include leveraging the traditional Chinese concept of family responsibility to establish a family alliance in response to the dual stigma and providing psychological counseling and education in treatment clinics.

Perceived stigma, medical social support and quality of life among people living with HIV/AIDS in Hunan, China

PURPOSE The present study aimed at examining the relationships among perceived stigma, social support, and quality of life (QOL) in people living with HIV (PLWH). METHODS We recruited 190 participants meeting the inclusion criteria from two HIV clinics in Hunan, China. HIV-related Stigma Scale, the Chinese Version of the Medical Outcomes Study - Social Support Survey (MOS-SSS-C), and the Medical Outcomes Study-HIV (MOS-HIV) were used to measure the perceived stigma, social support and QOL in PLWH. RESULTS The mean scores of the perceived stigma, social support, and QOL were 104.32, 53.63, and 61.97 respectively, which were in moderate range. Stepwise multivariate regression analysis showed (R(2)=.49, p<.01) a low score of internalized stigma and family stigma, a high score of tangible support for non-drug use and antiretroviral treatment, and high CD4 count predicted better QOL. CONCLUSION Perceived stigma and social support are correlated with the QOL in PLWH. Interventions designed to decrease perceived stigma and strengthen social support from family are necessary to improve the QOL in PLWH.

Efficacy of an Evidence-Based ARV Adherence Intervention in China

We designed a randomized controlled trial of a home based intervention to improve antiretroviral adherence and to assess the impact of depressive symptoms among people living with HIV in Hunan, China. At baseline, 110 subjects reported taking 90% or less of prescribed medication. At 6 months, when the intervention ended, 56% of subjects in the control and 87% of subjects in the experimental group were adherent. This difference was maintained at 12 months. In multivariate analyses, controlling for baseline visual analogue adherence scale, stigma, social support, and Center for Epidemiological Studies Depression scale, the experimental group had a significantly higher proportion of people who were adherent (p=0.009). The high prevalence of significant depressive symptoms (67%) at baseline is of concern. It is of particular importance that future studies look at the types of depression likely to be seen in these patients and differentiate early between those likely to benefit from HIV-related support and those who will require additional depression-targeted interventions.

Cultural adaptation of an evidence-based nursing intervention to improve medication adherence among people living with HIV/AIDS (PLWHA) in China.

BACKGROUND Adapting nursing interventions to suit the needs and culture of a new population (cultural adaptation) is an important early step in the process of implementation and dissemination. While the need for cultural adaptation is widely accepted, research-based strategies for doing so are not well articulated. Non-adherence to medications for chronic disease is a global problem and cultural adaptation of existing evidence-based interventions could be useful. OBJECTIVES This paper aims to describe the cultural adaptation of an evidence-based nursing intervention to improve medication adherence among people living with HIV/AIDS and to offer recommendations for adaptation of interventions across cultures and borders. SITE: The intervention, which demonstrated efficacy in a randomized controlled trial in North America, was adapted for the cultural and social context of Hunan Province, in south central China. SOURCES OF DATA The adaptation process was undertaken by intervention stakeholders including the original intervention study team, the proposed adaptation team, and members of a Community Advisory Board, including people living with HIV/AIDS, family members, and health care workers at the target clinical sites. PROCEDURES The adaptation process was driven by quantitative and qualitative data describing the new population and context and was guided by principles for cultural adaptation drawn from prevention science research. RESULTS The primary adaptation to the intervention was the inclusion of family members in intervention activities, in response to the cultural and social importance of the family in rural China. In a pilot test of the adapted intervention, self-reported medication adherence improved significantly in the group receiving the intervention compared to the control group (p=0.01). Recommendations for cultural adaptation of nursing interventions include (1) involve stakeholders from the beginning; (2) assess the population, need, and context; (3) evaluate the intervention to be adapted with attention to details of the original studies that demonstrated efficacy; (4) compare important elements of the original intervention with those of the proposed new population and context to identify primary points for adaptation; (5) explicitly identify sources of tension between intervention fidelity and cultural adaptive needs; (6) document the process of adaptation, pilot the adapted intervention, and evaluate its effectiveness before moving to dissemination and implementation on a large scale.

Depressive symptoms and social support among people living with HIV in Hunan, China.

&NA; Depressive symptoms are common among people living with HIV (PLWH) and are associated with poor adherence to antiretroviral treatment and poor treatment outcomes. Our study investigated the prevalence of and factors associated with depressive symptoms in PLWH in one Chinese province. Data were collected from 496 PLWH between July 2009 and July 2010 at two HIV treatment sites in Hunan Province, China. Sixty‐two percent (n = 309) of participants scored 16 or more on the Center for Epidemiological Studies of Depression scale, indicating moderate to high levels of depressive symptoms. Independent predictors of depressive symptoms included active heroin use, lack of a stable job, female gender, and limited social support. These data suggest that interventions addressing depressive symptoms should be included in HIV care programs provided by the Chinese government, with a special focus on PLWH who are heroin users, female, unemployed, or socially isolated.

The Health Belief Model: A Qualitative Study to Understand High-risk Sexual Behavior in Chinese Men Who Have Sex With Men

&NA; The Health Belief Model (HBM) has been widely used to explain rationales for health risk‐taking behaviors. Our qualitative study explored the applicability of the HBM to understand high‐risk sexual behavior in Chinese men who have sex with men (MSM) and to elaborate each component of the model. HIV knowledge and perception of HIV prevalence contributed to perceived susceptibility. An attitude of treatment optimism versus hard life in reality affected perceived severity. Perceived barriers included discomfort using condoms and condom availability. Perceived benefits included prevention of HIV and other sexually transmitted illnesses. Sociocultural cues for Chinese MSM were elaborated according to each component. The results demonstrated that the HBM could be applied to Chinese MSM. When used with this group, it provided information to help develop a population‐ and disease‐specific HBM scale. Results of our study also suggested behavioral interventions that could be used with Chinese MSM to increase condom use.