Using Peplau's Theory to Examine the Psychosocial Factors Associated with HIV-Infected Women's Difficulty in Taking Their Medications

Article excerpt

Abstract: Although combination therapies slow progression of HIV disease, HIV-infected women face new challenges that must be overcome to increase their life expectancy. One challenge is adherence to strict, and often unpleasant, drug regimens. Peplau's Theory of Interpersonal Relationships provides a framework for identifying and examining factors that influence medication adherence, in particular difficulties in taking medication. A descriptive, correlational design was used to test associations between difficulty taking HIV medications and a woman's relationship with her primary healthcare provider (PHCP), depression, HIV-specific emotional and tangible support, present life satisfaction, family functioning, HIV-related symptoms, AIDS beliefs and perceptions, medication side-effects, and hope. Relationship with PHCP (F =5.30, p = . 0235) and present life satisfaction (F= 11.32, p = . 0011) explained 22% of the variance in HIV-infected women's difficulty in taking medications. This study supports the importance of a therapeutic relationship between PHCPs and patients in overcoming difficulties associated with taking HIV medications.

Key Words: Life satisfaction, medication adherence, therapeutic relationship

Women represent one of the fastest growing demographic groups being diagnosed with human immunodeficiency virus (HIV) infection. Since the beginning of the epidemic, approximately 9 million women worldwide have died from complications of AIDS, and an estimated 16.4 million are infected with HIV (Centers for Disease Control, 2000). Although morbidity and mortality remain high in HIV infection, treatment advances using multiple drug therapy have made HIV disease a more chronic illness (Esch & Frank, 2001). Multiple drug therapy, however, requires sustained adherence to complex treatment protocols that often include taking a large number of pills and attention to dietary restrictions (Paterson et al., 2000). Many HIV-infected individuals have equated the activities associated with adhering to these complex regimes with having a "full-time" job (Sowell, Phillips, & Grier, 1998).

A growing body of research documents the difficulty of longterm adherence to multiple drug therapy and the barriers that influence individuals' ability to adhere complicated regimes (Catz et al., 2000a; Catz, et al., 2000b; Proctor, Tesfa, & Tompkins, 1999; Roberts & Mann, 2000). Previous research suggests that lifestyle characteristics, social support networks, trust in the health care provider, and complexity of treatment protocols are important factors in adherence (Catz et al., 2000a; Catz et al., 2000b; Proctor et al., 1999; Roberts & Mann, 2.000). One of the most significant factors identified in decreasing the likelihood of adherence is difficulty in taking medications (Proctor et al., 1999). Although difficulty in taking medications is recognized as an important aspect of adherence, there has been limited research to examine specific factors associated with the ability to take HIV medications. Factors that affect women's ability to take HIV medications may be different than those previously identified in groups of males (Burke & Dunbar-Jacobs, 1995). 1 he purpose of this study was to determine psychosocial factors that are related to overcoming difficulty in taking medications in a cohort of HIVinfectcd women. Greater understanding of psychosocial factors that lead to increased difficulty in taking medications is an essential step in providing HIV-infected individuals with the highest level of care. Peplau's (1952) Theory of Interpersonal Relationships provides an appropriate theoretical basis for the study of psychosocial factors that affect the difficulty that HIVinfected women experience in taking medications. Peplau's theory focuses on communication and underscores the importance of establishing a therapeutic telationship in responding to healthcate problems.

THEORETICAL FRAMEWORK AND RATIONALE

Peplau's theory implies the health care provider's importance in the patient's social network. …