Coding Audiotapes of Clinic Visits for Adherence Content

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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.