Date of Award

2003

Degree Type

Thesis

Degree Name

Master of Science in Applied Pharmaceutical Sciences

Department

Applied Pharmaceutical Sciences

First Advisor

Cynthia Willey

Abstract

Infection by Human Immunodeficiency Virus (HIV) is a multifactor disease process in which the patient must confront an array of physiological, sociocultural, economic, and psychological stressors that have the collective potential for triggering major stress responses and psychological dysfunction. People's reactions to and the outcomes of traumatic events are mediated by their subjective style of coping. Coping is defined as a person's "constantly changing cognitive and behavioral efforts to manage specific external and internal demands that are appraised as taxing or exceeding the resources of a person". Coping, an important psychological construct has been shown to affect outcomes such as disease progression and quality of life in HIV infected patients. But the subjective styles of coping that patients use to cope with HIV have rarely been assessed as predictors of medication adherence. This study aims at determining the role of coping styles as determined by the "Ways of coping questionnaire" modified by Dunkel-Schetter et al. to suit their study of cancer patients as predictors of medication adherence in patients infected with HIV. The five dimensions of coping identified by Dunkel-Schetter et al. were the first to be identified with a large sample of cancer patients and may be representative of the universal dimensions of coping. This study is the first to utilize the dimensions of coping as described by Dunkel-Schetter et al. to predict adherence in HIV patients. The few studies on coping styles and adherence as an outcome use varied coping scales to assess coping like the Billings and Moos coping inventory and original Ways of coping questionnaire. Their results have shown that poor coping strategies like avoidance coping were associated with non-adherence.

Methods: The sample for the study consisted of 145 patients who were currently prescribed medication for HIV. The medication adherence shown by patients with anti-retroviral drugs and protease-inhibitor drugs was assessed separately. A total of 137 patients were on anti-retroviral drugs, while 77 patients were on protease-inhibitor drugs. Medication adherence was determined by using the "percentage of doses missed in the past three months and "Medication Adherence Scale. Coping strategies used by the patients were assessed by the "Ways of coping questionnaire" developed by Lazarus and colleagues and later modified by Dunkel-Schetter et al. to suit their study of cancer patients. The scale comprised of five coping sub-scales: seeking social support, distancing, focusing on positive, behavioral escape avoidance and cognitive escape avoidance and assessed the frequency of use of each coping style. Several demographic variables as well as clinical variables, which are known to affect medication adherence, were examined. Logistic Regression analyses were used to determine whether the coping strategies were predictive of medication adherence controlling for the confounding factors.

Results: In agreement with previous research that shows that poor coping was associated with non-adherence, for the patients prescribed antiretroviral medications, behavioral escape avoidance was found to be significantly and inversely associated with adherence. Seeking social support, distancing, focusing on positive and cognitive escape avoidance were not found to be significantly associated with medication adherence.

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