Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV.

Wei-Ti Chen Dean Wantland

doi:10.4172/2155-6113.1000256

Abstract

The engagement of patients with their health care providers (HCP) improves patients’ quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client’s choices, and management of client concerns. This study compares country-level differences in patients’ engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR −7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = −5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = −3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.

Highlights

HIV is a chronic disease and quality of life (QOL) is an individual's satisfaction or happiness with life in domains he or she considers important, becoming an important issue for people living with HIV (PLHIV) [1,2,3,4]
We investigated whether regulatory factors adherence self-efficacy, self-esteem, and medication adherence were associated with QOL, health outcomes, and engagement with health care providers (HCP)
Country comparisons showed that PLHIV in Namibia have the most HCP engagement and that PLHIV in China have the least engagement with HCP (OR -7.03, p < 0.0001) (Table 1)

Summary

Introduction

HIV is a chronic disease and quality of life (QOL) is an individual's satisfaction or happiness with life in domains he or she considers important, becoming an important issue for people living with HIV (PLHIV) [1,2,3,4]. Challenges that might influence QOL include disease progression, medication side effects, stigma, disclosure, anxiety, and depression [5,6,7,8,9]. The length of time with HIV is positively associated with QOL [10,11]. With these challenges, PLHIV usually consult their health care providers for assistance [3,12]. Health care providers (HCPs) play an important role from HIV diagnosis to treatment [13,14,15]. Gordon, Camhi & Bakken reported that HIV-positive individuals believe that HCPs need to fully understand the patient’s current situation, including physical

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Conclusion