Coding Audiotapes of Clinic Visits for Adherence Content

描述（由申请人提供）：抗逆转录病毒（ARV）依从性是艾滋病毒感染者面临的紧迫问题。虽然许多人认为，更好的医患关系可以导致更好的抗逆转录病毒药物依从性，但实际上，人们对医患沟通的具体特征一无所知，这些特征可以产生更好的抗逆转录病毒药物依从性。这些知识对于合理设计干预措施至关重要。该R21的广泛、长期目标是通过更好地理解与依从性相关的MD-PT对话来改善患者的抗逆转录病毒药物依从性。我们开发了一种描述MD-PT对话的新方法，称为广义医学相互作用分析系统（GMIAS）。一些编码和分析MD-PT通信的系统已经存在，但这些现有的系统主要是为了描述人际过程和交互的情感特征。它们不包含药物依从性内容。GMIAS是根据言语行为理论的原则开发的，旨在捕捉遵守内容和互动过程。我们建议将这种新的编码系统应用于300份MD-PT就诊录音（150份干预，150份对照），这些录音是作为一项以医生为中心的干预措施的随机、对照、交叉研究的一部分收集的，以提高艾滋病毒抗逆转录病毒药物的依从性。我们的具体目标是：1)开发软件，以便更快速地分析MD-PT就诊的转录录音带，2)使用GMIAS（判别效度）比较干预和对照就诊中依从性相关对话的数量，3)确定依从性相关对话与MEMS评估的后续依从性和病毒载量的关系程度（预测效度），4)使用SA 1和2中描述的方法，将GMIAS的效度与现有的编码系统进行比较（相关效度）。5)确定与依从性相关的内容的特定类别，以及与依从性结果关系最密切的交互过程。该项目具有创新性，因为它实现并测试了一种理解MD-PT对话的新方法的有效性。因此，它推进了与药物依从性相关的基础社会科学研究。虽然这项工作的重点是艾滋病毒疾病的抗逆转录病毒药物的依从性，但GMIAS的设计很容易推广到MD-PT通信中的其他条件和研究问题。

DESCRIPTION (provided by applicant): Antiretroviral (ARV) adherence is a pressing problem for persons with HIV. While many believe that better physician-patient (MD-PT) relationships can lead to better ARV adherence, virtually nothing is known about the specific features of MD-PT communication that produce better adherence with ARVs. Such knowledge is essential to the rational design of interventions. The broad, long term objective of this R21 is to improve patients' ARV adherence by better understanding adherence-related MD-PT dialog. We have developed a new method to describe MD-PT dialogue called the Generalized Medical Interaction Analysis System (GMIAS). Several systems to code and analyze MD-PT communication already exist, but these existing systems are principally intended to characterize interpersonal processes and affective features of the interaction. They do not capture medication adherence content. The GMIAS was developed using the principles of Speech Act Theory, and is designed to capture both adherence content and interaction processes. We propose to apply this new coding system to 300 audiotaped MD-PT visits (150 intervention, 150 control) that are being collected as part of a randomized, controlled, cross over study of a physician-focused intervention to improve adherence with HIV ARVs. Our Specific Aims are to: 1) Develop software to facilitate more rapid analysis of transcribed audiotapes of MD-PT visits, 2) Compare the amount of adherence-related dialogue in intervention and control visits using the GMIAS (discriminant validity), 3) Determine the extent to which adherence-related dialogue is related to subsequent adherence as assessed by MEMS, and to viral loads (predictive validity), 4) Using the approach described in SA 1 and 2, compare the validity of the GMIAS with an existing coding system (correlational validity) and, 5) Identify specific categories of adherence-related content, and the interaction processes in which it occurs, which relate most strongly to adherence outcomes. This project is innovative because it implements and tests the validity of a new methodology to understand MD-PT dialogue. As such, it advances basic social science research related to medication adherence. While this work focuses on adherence with ARVs for HIV disease, the GMIAS has been designed to be easily generalizable to other conditions and research problems in MD-PT communication.