(ART) in People Living with HIV in Kenya

192 Pages·2016·3.48 MB·English

Seton Hall University
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Seton Hall University Dissertations and Teses
Seton Hall University Dissertations and Teses
(ETDs)
2010
Psychosocial Correlates of Adherence to
Antiretroviral Terapy (ART) in People Living with
HIV in Kenya
Tomas M. Kamau
Seton Hall University
Follow this and additional works at: htps://scholarship.shu.edu/dissertations
Part of the Public Health Commons, and the Social Psychology Commons
Recommended Citation
Kamau, Tomas M., "Psychosocial Correlates of Adherence to Antiretroviral Terapy (ART) in People Living with HIV in Kenya"
(2010). Seton Hall University Dissertations and Teses (ETDs). 1386.
htps://scholarship.shu.edu/dissertations/1386
PSYCHOSOCIAL CORRELATES OF ADHERENCE TO ANTIRETROVIRAL
THERAPY (ART) IN PEOPLE LIVING WITH HIV IN KENYA
Thomas M Kamau
Dissertation Committee:
Dr. Valerie P. Olson, Chair
Dr. Genevieve Pinto-Zipp
Dr. Mary Ann Clark
Submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy in Health Sciences
Seton Hall University
Acknowledgments
I would like to express my profound gratitude to several people who have
assisted me in many ways to develop, refine, and complete this dissertation and,
most importantly, in shaping my academic life.
I am thankful to my academic advisor and chair of the dissertation
committee, Dr. Valerie Olson, for her guidance and commitment to enriching my
academic experience. She has had important roles and responsibilities
throughout the doctoral process. Dr. Olson was always there for me to discuss
the many facets of this dissertation. She provided me with remarkable guidance
in generating, expressing, and organizing complex ideas with clarity. She has
been an excellent listener and encourager and always diligent in providing
direction.
I would also like to express my appreciation to members of my
Dissertation Committee, Dr. Genevieve Zipp and Dr. MaryAnn Clark. Both Drs
Zipp and Clark, who are remarkably talented, generously shared with me their
extensive teaching and mentoring experience. Both were extremely resourceful
in providing timely feedback, fostering development of preparation skills in the
research forum, and developing my self-confidence in undertaking difficult and
challenging tasks. It was great fortune to work with each of them and as a team.
I would also like to express my thanks to the secretary of the Department of
Graduate Programs in Health Sciences, Ms. JoAnn DeBerto. Joann was
instrumental in linking me with my Dissertation Committee and provided a lot of
technical assistance in the preparation of the Institutional Review Board
Application.
There are many other faculty members who were also very helpful in
various ways. I want to thank Dr. Lee Cabell for always being available to
explain and question my use of statistic. He challenged and inspired me to learn
statistics. I would like to thank Dr. Pamela Foley, my multivariate statistics
professor in the Department of Psychology. Dr. Foley continued to assist me by
responding to my emails. Dr. Foley fostered my confidence in multivariate
statistics, which I have used to test the study hypotheses as well as conduct
factor analysis. I must also thank Dr. Sheldon Cohen, the author of the
Interpersonal Support Evaluation List (ISEL), and Dr. Margaret Chesney, the
author of both the Adult Clinical Trial Group Adherence Questionnaire and the
Coping Self-Efficacy Questionnaire, for permitting me to use these instruments
and have them translated from English to Kiswahili.
This study would not have been possible were it not for men and women
living with HIV in Kenya who volunteered to respond to the questionnaires with
great courage, understanding, and sacrifice. I thank the management of
Nazareth Hospital; the Franciscan Sisters of Immaculate Heart of Mary; the
Medical Officer in charge of Nazareth Hospital; and the coordinators, physicians,
and staff of the comprehensive care and treatment centers for their tremendous
support. I thank the hospital management for providing me with free room and
board throughout the period of the field study.
I also thank the Institutional Research and Ethics Committee of Moi
University, Eldoret, Kenya, and Seton Hall University's IRB for reviewing, fine-
tuning, and granting timely approval of my research protocol. Professor Ngare,
Dr. Stephen Njure, and Dr. Joseph Abuya played pivotal roles in the process. I
also thank my research assistants for their well done jobs: Helen, Christopher,
Susan, and Samuel.
I am also particularly very grateful to my mother, brothers, sisters,
nephews, and nieces and friends for their support and encouragement. Special
thanks to Sister Margaret Manganga for providing me with financial support,
prayers, and encouragement. I owe each of my family members and friends a
debt I cannot repay: their unconditional love.
I also thank Father John Fraser, my pastor, and all the parishioners of
Holy Rosary Church, in Hawthorne, New York, for their prayers and generous
financial contribution to support my Kenya trip and to reimburse bus fare to the
respondents in my study.
It is not possible for me to list all who have helped as they are too many.
To all, I am thankful to you and promise to repay your goodness by being good to
all those who will need my help in future.
Table of Contents
Page
ACKNOWLEDGEMENT. .....................................................................2.. .
List of Tables ...................................................................................7. ....
ABSTRACT ....................................................................................................8.. .....
CHAPTER I INTRODUCTION. .......................................................................1..0..
Antiretroviral therapy (ART) ...................................................................1..3..
Adherence and Nonadherence to ART ............................................. 15
Factors Associated with Adherence or Nonadherence to ART .......... 16
Social Support as a Buffer to Psychological Distress .......................1. 8
Summary. ..............................................................................................2..0.. .
Significance of the Study ..........................................................................2..1
Research Questions and Hypotheses. ......................................................2 2
Study Hypotheses .................................................................................2..3.. .
CHAPTER II REVIEW OF THE LITERATURE ..................................................2. 6
Stress. Appraisal. and Coping Theory ..................................................2..7
Cognitive Appraisal .......................................................................2..9.
Coping ...........................................................................................3.1.. .
Coping Self-Efficacy ......................................................................3..2..
Social Support Theory .............................................................................3..3.
Perceived and Received Support ....................................................3.5.
Dimensions of Support ...................................................................3..6.
Social Support and Adherence to ART ............................................3..8
Support and States of Mind ............................................................4..1.
Need for Research ..................................................................................4..4.
CHAPTER Ill METHODOLOGY ......................................................................4..6.
Survey Tools ..........................................................................................4..6..
Demographic Characteristics of Respondents. .........................................4..7
Translation of Validated Instruments. ...............................................4..7
Interpersonal Support Evaluation List (ISEL) ......................................5.5
Coping Self-Efficacy (CSE) Questionnaire. ............................................5..6.
Adult Clinical Trial Group Adherence Questionnaire .................................5. 7
Study Approvals .....................................................................................5..8..
Setting ...................................................................................................5..9.. .
Sample Size and Procedures for Sample Recruitment and Selection .......5 9
Inclusion and Exclusion Criteria ................................................................6..1
Anonymity and Confidentiality ..................................................................6..1
Procedures of Respondents Identification ................................................6..2
Procedures of Administration of the Survey Tools ....................................6..3
Training of Research Assistants ............................................................6..4
Data Analyses .........................................................................................6..4.
. . . .
Descr~pt~vSeta t~st~c..s.. ...................................................................6 5
Factor Analysis ............................................................................6..6.. ..
. .
Scale Reliab~hty.. .........................................................................6..7.. ..
Testing of Study Hypotheses ............................................................6 8
CHAPTER IV RESULTS .................................................................................7..3.
Characteristics of the Sample ............................................................... 73
Factor Analysis for Coping Self-Efficacy Scale (CSE) ..............................7. 4
Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis
(CFA) ...........................................................................................7..4.. ..
. . .
Scale Rel~ab~.l.~..t..y.. ..............................................................................7. 6
Descriptive Statistics .............................................................................7..8.. .
Correlational Analyses ............................................................................8..0
Results of the Tests of Hypotheses ........................................................8..3.
Summary of Findings .............................................................................9..4..
CHAPTER V DISCUSSION. ...........................................................................9..6..
Findings from Study Hypotheses .........................................................1..0. 3
Social Support and Adherence to ART ..................................................1..0 3
Social Support and Coping Self-Efficacy ...............................................1..0 6
Coping Self-Efficacy as a Predictor of Adherence to ART .......................1 08
Coping Self-Efficacy as a Mediator of Support and Adherence ...............1 08
Limitations. .............................................................................................1..0 9
Study Implications. .................................................................................1.1. 1
CHAPTER VI SUMMARY AND CONCLUSIONS ......................................1.1 2
Future Studies ........................................................................................ 116
References. ................... ... ..........................................................1. 19
APPENDICES ................................................................................................1. 28
Appendix A: List of Abbreviations ..........................................................1..2 9
Appendix B: Survey Tools ..........................................................1..3.0
Appendix C: Nazareth Hospital Acceptance letter. .............................1. 68
Appendix D: Moi University's Institutional Research and Ethics Committee
Approval ...............................................................................................1.6..9.
Appendix E: Seton Hall University Institutional Review Board Approval .. 170
Appendix F: Flyer and Recruitment Form ...............................................1. 71
Appendix G: Informed Consent Form ..................................................1.7 5
Appendix H: Training Protocol for Research Assistants ...................... 180
List of Tables
Table 1: Total Variance Explained by Exploratory Factor Analysis for the
CSE ( N= 354) ................................. ... ................................................6..6.
Table 2: Rotated Factor Matrix for the CSE (Using Exploratory Principal
Components Factors Analysis) (N= 354) ...........................................6..7
Table 3: Interpersonal Support Evaluation List (ISEL) Scale Reliability
(Cronbach's Alpha) ( N= 354) ............................................................6..8.
Table 4: Coping Self-Efficacy Reliability (CSE) Scale Reliability (Cronbach's
Alpha) ( N= 354) ...............................................................................6..8.. .
Table 5: During the past 4 days, on how many days have you missed taking
all your doses? ( N= 354) ..................................................................6..9..
Table 6: When was the last time you missed any of your medications?
( N= 354) ...........................................................................................7..0..
Table 7: Pearson Correlational Analysis for Social Support and Coping Self-
Efficacy (N= 354) ..............................................................................7..1.
Table 8: Pearson Correlational Analysis of Coping Self-Efficacy (CSE) and
Subscales of Social Support (N= 354) ...............................................7..2
Table 9: Social Support as a Predictor for Adherence to Antiretroviral Therapy
(ART) (N= 354) .................................................................................7..4.
Table 10: Dimensions of Social Support as Predictors of Adherence to
Antiretroviral Therapy (ART) ( N= 354) ..............................................7..6
Table 11: Subscales of Coping Self-Efficacy (CSE) and Adherence to ART
(N= 354) ...........................................................................................7..8. .
Table 12: Relation Between Social Support and Coping Self-Efficacy (CSE) .... 80
ABSTRACT
PSYCHOSOCIAL CORRELATES OF ADHERENCE TO ART IN PEOPLE
LIVING WITH HIV IN KENYA
Thomas M Kamau
Seton Hall University
2010
Antiretroviral therapy (ART) dramatically slows the progression of
HIVIAIDS, reduces incidences of opportunistic infections, and significantly
extends the survival time of people living with HIV. The proportion of men and
women living with HIV who are being prescribed ART has exponentially grown
from less than 10% in 2003 to over 75% in 2009. However, nonadherence to the
ART may result in virologic failure to suppress HIV adequately, which may cause
development of drug resistant strains. Consequently, the benefits of ART may
be lost. Furthermore, HIV strains may be sexually transmitted from those who
are nonadherent to other persons.
This study sought to determine whether individuals' perceptions of
availability of social support and coping self-efficacy influence adherence to ART
in people living with HIV in Kenya. A cross-sectional study design using
questionnaires was conducted at nine comprehensive care and treatment
centers managed by a major healthcare provider sewing populations in the
central metropolitan city of Nairobi, Kenya.
Data were collected from a convenience sample (N= 354) of men and
women who were prescribed ART. The Interpersonal Support Evaluation List