Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus.
Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus.
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DOI：
10.2147/ppa.s30040
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发表时间：
2012
影响因子：
2.2
通讯作者：
Neilands TB
中科院分区：
文献类型：
--
作者：
Johnson MO;Sevelius JM;Dilworth SE;Saberi P;Neilands TB
卫生保健授权模式（HCE）将卫生保健授权定义为参与、知情、协作、承诺和容忍卫生保健不确定性的过程和状态。我们使用正在进行的人类免疫缺陷病毒（HIV）相关研究的数据，检查了该模型的假设前提和临床结局。本文的目的是探讨一种新的衡量HCE是否为理解患者参与艾滋病毒医疗保健提供了方向。使用来自两个正在进行的HIV治疗的社会和行为方面的试验的数据，我们研究了在HIV治疗的背景下HCE的假设临床结果和前因的初步支持。这是一项横断面分析，包括研究1（一项纵向队列研究，研究对象为男性夫妇，其中一方或双方为HIV血清阳性，并服用HIV药物）的12个月数据和研究2（一项随机对照试验，研究对象为HIV血清阳性，但基线时未接受抗逆转录病毒治疗，尽管符合治疗指南）的6个月数据。研究1和2分别纳入了254名和148名参与者。假设的前因包括文化/社会/环境因素（人口统计学，艾滋病毒相关的耻辱），个人资源（社会问题解决，治疗知识和信念，治疗决策，共同决策，决策平衡，自信的沟通，对提供者的信任，提供者的个人知识，社会支持），和个人因素（抑郁症状，积极/消极的影响，和感知的压力）。HCE的假设临床结局包括初级保健预约出勤率、抗逆转录病毒治疗使用、依从性自我效能、药物依从性、CD 4+细胞计数和HIV病毒载量。虽然没有观察到HCE和HIV病毒载量和CD 4+细胞计数之间的关联，但HCE评分与报告最近初级保健就诊的可能性、更高的治疗依从性自我效能和更高的抗逆转录病毒治疗依从性存在显著正相关。假设的HCE的前因包括较高的信念，治疗的必要性和积极的供应商关系。
The Model of Health Care Empowerment (HCE) defines HCE as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. We examined the hypothesized antecedents and clinical outcomes of this model using data from ongoing human immunodeficiency virus (HIV)-related research. The purpose of this paper is to explore whether a new measure of HCE offers direction for understanding patient engagement in HIV medical care. Using data from two ongoing trials of social and behavioral aspects of HIV treatment, we examined preliminary support for hypothesized clinical outcomes and antecedents of HCE in the context of HIV treatment. This was a cross-sectional analysis of 12-month data from study 1 (a longitudinal cohort study of male couples in which one or both partners are HIV-seropositive and taking HIV medications) and 6-month data from study 2, a randomized controlled trial of HIV-seropositive persons not on antiretroviral therapy at baseline despite meeting guidelines for treatment. From studies 1 and 2, 254 and 148 participants were included, respectively. Hypothesized antecedents included cultural/social/environmental factors (demographics, HIV-related stigma), personal resources (social problem-solving, treatment knowledge and beliefs, treatment decision-making, shared decision-making, decisional balance, assertive communication, trust in providers, personal knowledge by provider, social support), and intrapersonal factors (depressive symptoms, positive/negative affect, and perceived stress). Hypothesized clinical outcomes of HCE included primary care appointment attendance, antiretroviral therapy use, adherence self-efficacy, medication adherence, CD4+ cell count, and HIV viral load. Although there was no association observed between HCE and HIV viral load and CD4+ cell count, there were significant positive associations of HCE scores with likelihood of reporting a recent primary care visit, greater treatment adherence self-efficacy, and higher adherence to antiretroviral therapy. Hypothesized antecedents of HCE included higher beliefs in the necessity of treatment and positive provider relationships.