Barriers and Health Beliefs Related to Weight Management Among Veterans With Human Immunodeficiency Virus

Abstract

The success of antiretroviral therapy has led to dramatic changes in causes of morbidity and mortality among U.S. Veterans with human immunodeficiency virus (HIV). Among the 25,000 Veterans treated for HIV, 70% are over age 50 and the rate of obesity has doubled in this population. Veterans with HIV have a 50% increased risk of myocardial infarction yet have limited presence in prevention-related programs designed to lower cardiovascular disease risk. This mixed methods study (focus groups, Schwarzer and Renner physical activity, and nutrition self-efficacy questionnaires) was used to explore factors related to health behavior and identify barriers that overweight Veterans with HIV face in enrolling in the MOVE weight management program. Institutional review board approval was granted before the start of the study. All participants were recruited from the Infectious Disease clinic if they met national inclusion criteria for the MOVE weight management program and had not previously participated in the program. Transcribed audio recordings were independently analyzed and coded by four of the researchers using an exploratory process to obtain consensus regarding themes. An interrater reliability analysis for the Kappa statistic was performed to determine consistency among raters. The relationship between physical activity self-efficacy scores and nutrition self-efficacy scores was tested using Spearman's correlation coefficient. The median age of the sample was 56 with high rates of diabetes (36%), hypertension (73%), hyperlipidemia (36%), and tobacco use history (82%). External barriers to participation were discussed in addition to 8 other themes, which influence treatment engagement for Veterans with obesity and HIV including adaptation, stigma, self-management, and support. Veterans held strong beliefs about responsibility and commitment to their health and wanted to assume an active and informed role in their health care. Veterans with high levels of perceived self-efficacy indicated intention to overcome barriers to improve their nutrition and increase their physical activity. Refer to the full manuscript online to see the results in tables. Despite the chronic life-threatening nature of their condition, Veterans with HIV display a remarkable ability to adapt and commit to their treatment regimen. However, the dual stigma of obesity and HIV was a significant barrier to participation in weight management. This group placed high value on exercise over eating healthier and the importance of social support particularly from their Veteran peers. Focus groups allowed for fluid interaction between group members and researchers, rich conversation, and allowed additional clarification and exploration of topics. One unanticipated effect of the focus groups was that participants may feel less isolated after being a part of the discussion and may develop supportive relationships with their peers. It is possible that participants demonstrated more positive behavioral adaptation or other possible sources of bias. The study findings provide insight into health beliefs and barriers to weight management for all populations struggling with chronic disease and stigma. Data collected will inform future recruitment and retention strategies to engage Veterans with HIV in prevention-related programs designed to enhance long-term health and wellness.