Un modelo psicológico en los comportamientos de adhesión terapéutica en personas con VIH

SUMMARYIntroductionHIV infection is a disease that demands a consistent and efficientpractice of adherence behaviors related to antiretroviral treatment.However, research findings in the last few years have shown thatpsychological and social variables (e.g., depression, stress, lowmotivation, as well as little or no social support) interfere with thepractice of those behaviors. This facilitates the clinical progression ofthe disease, and reduces the quality of life and survival time in peopleliving with HIV.The intersection area between psychology and health involveswidely diverse theoretical models, including self-regulation, healthbeliefs, and the one linking information-motivation-behavior. Suchmodels have sought to account for the way in which the addressedvariables affect adherence behavior. While analyzing psychologicalfactors, these models usually emphasize either cognitive concepts oradopt a more traditional stance such as relating adherence behaviorto personality, motivation, behavioral skills and stress management.Although this diversity seems inclusive, it fails to integrate explanationson therapeutic adherence under a more comprehensive theoreticalumbrella. Thus, the present study was conducted within the scope ofan interactive-functional model which attempts to articulate theinteraction of sets of biological and psychological variables alongfour phases. The first involves psychological processes and resultsvariables; the second comprises the diagnostic of HIV infection andlater development of other opportunistic diseases; the third containstwo types of behavior: therapeutic adherence and disease-relatedbehaviors; the fourth involves conventional biological indicators andhealth outcomes.This model contrasts with others not only in the sense ofproposing an inter-behavioral approach derived from Kantor’s work,including articulated behavioral and personality theories, but it alsoproposes an interactive and functional emphasis on analyzing thosevariables assumed to determine therapeutic adherence behaviors.Such variables subsume personality phenomena, behavioralcompetencies and motives to behave. Thus, the approach includesthose consistent ways in which HIV-positive persons interact with stress-related situations which contain unpredictable, ambiguous oruncertain stimulus signals and behavior consequences. The behavioralcompetencies category synthesizes what the patient knows on HIV,including those self-care actions that need to be taken efficiently. Forinstance, what is HIV-AIDS, what are the clinical stages of the infection,what medications help, how should they be used and, above all, whyis so important to take medications in a consistent and efficient manneron the basis of the indications of the healthcare personnel. On theother hand, motives or motivation refer, in the traditional conception,to variables related to willing to act. It is said that a person is motivatedto engage in therapeutic adherence behaviors when he/she is willingto behave accordingly, after having understood the relation betweensuch behavior and some specific consequences. Such consequencesmay vary widely, ranging from interpersonal in nature, such as verbalpraise or support from others, and intrinsic, such as self-perceivedphysical and psychological well-being.Materials and methodA cross-sectional study was carried ou t in order to identify predictors ofadherence behaviors related to antiretroviral treatment in a group of68 persons living with HIV. Participants answered two self-administeredquestionnaires: i) psychological factors and adherence behaviors, andii) stress-related situations in three modalities: decision-making,tolerance to ambiguity, and tolerance to frustration. Data analysisincluded univariate statistics, the Pearson’s x