What is the Relationship between Hope and Medication Adherence in HIV Patents

In the past decade, there have been several studies that have mainly been concerned with patients in the advanced stages of either human immunodeficiency virus (HIV) or cancer. The quantitative studies concentrated on the relationship that hope has with such psychosocial variables such as fatigue, activity levels, and age across the dying trajectory. Hope is described as the inner strength or power that does enrich lives and thus enable the individuals to have a view that is beyond their turmoil, suffering and pain. The strategies that were first described by Herth (1990) on how to foster hope among the terminally ill patient are of great importance to nurses who mainly assume the primary role of caring for these patients. The nurses are considered to be in such a position that can either hinder or poster hope among the HIV patients, (Herth 1992).Fostering/ hindering hope among the HIV patientsA strong spiritual base coupled to interpersonal connectedness is some of the factors that foster hope among the HIV patients. Uplifting memories, attainable aims, light-heartedness, affirming relationship, finding meaning, as well as living in the present are some of the other factors that have been shown to foster hope. Isolation/abandonment, devaluation of personhood ad the presence of uncontrollable discomfort or pain are some of the factors that hinder hope. The ability to foster empathic relationship that is based on trust with the HIV patients promotes hope as does respect and courtesy Daar et al., 2003).Medication adherence in HIV patientsAntiretroviral therapy among the patients living with HIV/AIDS have been shown to improve these patients hope and thus do play an important role in improving the quality of life that they lead. The effectiveness of the treatment has been shown to be directly related to adherence level (Wakefield 2000). The main concern of the health experts for the non-adherence is not only because of the potential negative impact it can have on the individual but more so because of the substantial risk it carried on to the general public health. To an individual, non-adherence will mostly result into the development of viruses that are resistant to the drugs Daar et al., 2003).Some of the studies have demonstrated that there is no relationship between sociodemographic factors and the observed adherence behavior in most instances (Herth 1992). Factors that have been shown to be predictive of adherence include an improved t-count, a good doctor-patient relationship, social (emotional) support and a lower viral load. Some of the barriers to adherence that have been identified include alcohol and drug use, forgetfulness, drugs side effect, problems associated with refills and taking the medication at the place of work, psychiatric illness and depression Daar et al., 2003).There are some psychosocial factors that have been found to have an impact on the adherence behavior. Among these include; concerns about body image or weight, alcohol use, psychiatric illness, social support, self-efficacy, positive state of mind (PSOM) which is regarded as an individuals potential to be in a positive interpersonal and cognitive states as well as the ability of the individual to routinize the daily behavior (Wakefield 2000). Among the adolescents who are mostly psychologically disturbed, there are possible barriers to an active antiretroviral therapy (HAART) among the HIV infected adolescents. In this kind of group adherence is closely related to the daily routine to the assumption that assisting the adolescents to improve their organizational skills is necessary to have them improve adherence (Herth 1990).It has been pointed out that medication for HIV infection is complex and usually it produces side effects despite the fact that the drugs have to be taken for long in order to improve the prognosis in the HIV patients. The presence of emotional disturbance and or substance abuse problems has been found to be correlated to the levels of non-adherence. Thus in order to improve adherence among the HIV patents, there would be need to screen and treat any substance abuse and or mental health problems among the HIV positive patients in order to improve adherence to the antiretroviral medication (Herth 1992).Women in particular have been found out not to take part as expected in follow up visits before they become engaged in short courses especially the antiretroviral prophylaxis that is aimed at preventing mother to child HIV transmission (Wakefield 2000). It has been found out that women usually have a negative view of such programs and this together with the difficulties that they experience during contacts wit staff working on a prevention program can significantly contribute to their non effective participation in prophylaxis. Some of the social demographic factors have been found to have less predictive values to adherence behavior. Such factors as literacy, high income, older age, male gender and white race have been are usually correlate to high levels of adherence (Wakefield 2000).Negative impact on the patients’ adherence behavior is often felt when medication related side effects are observed. Thus the complexity of treatment, frequency of medication doses and even the number of the doses all has been found to impact on adherence (Herth 1990)..Hope Herth Index (HHI)The Hope Herth Index (HHI) is an adaptation of the Herth Hope Scale (HHS) that is designed specifically for the use in the clinical setting (Herth 1992). The main aim of having an adaptation tool is to be able to capture the multidimensionality of hope as has been represented on the HHS. Through the adapted tool, there will be a better reflection on the dimensions of hope in populations and also reduce the number and complexity of items and thus render the tool more clinically useful (Herth, 1992). The Hope Herth Hope Index was developed by Kaye Herth, PhD, RN, in 1992.  The adapted version of the HHI consists of twelve items. For the shortened instrument. In an effort to increase clinical usefulness, specific attention is given to designing simple items and to relating items to adults experiencing alterations in health status (Herth 1992). The items of the HHI are in Likert-format and are divided over three subscales paralleling those of the HHI.Total possible points on the scale are 48 points. Items were ordered so as to reduce response set, which is no two consecutive items are from the same subscale, and no more than two consecutive items are keyed in the same direction. The items are scored on a four point scale ranging from 1 to 4 where 1 refers to strongly disagree, 2 disagree, 3 agree, and 4 strongly agree (Herth, 1992). Scoring consists of summing the points for the subscale and for the total scale. For analysis, all negative items are reverse scored so that that a higher range from 12 to 48 larger than normal print can be used for improved readability with ill and elderly clients. Scoring for the HHI consist of summing the points for the subscales and the total scale. Subscales are based on three factors. Total possible points on the total point scale are 48. The higher the score on the HHI scoring scale, the higher the level of hope. Items 3 and 6 on the HHI scoring scale are reverse scored. Items are scored, 1. Strongly agree 2. Disagree 3. Agree 4. Strongly agree (Herth, 1992). Items 6, 10, 13, 17, 22, 26 needs to be reversed scored as follows: never applies to me = 0, seldom to me=1, sometimes applies to me=2, often applies to me=3 (Herth, 1992). The test retest reliability range from .75 to .94 for the HHI and the HHS. Criterion related validity was established by correlating the HHI with the parent HHS (r=0.92) a r=-0.73 construct validity was validated.The demographic tool to be used in this study will evaluate the following variables, gender, age, sex, educational background, present financial background, employment status, concurrent losses, ethnic origin, living arrangement, and time since diagnosis, role responsibilities, daily activities and physical energy (Herth 1990).The Brief Medication Questionnaire (BMQ) will be used to screen Human Immunodeficiency Virus (HIV) patients for medication adherence and barriers (Wakefield 2000). The BMQ was developed to use as a self report medication tool for screening adherence and barrier and adherence. The tool has a total of 9 items. This includes a 5 item Regimen Screen that asks patients how they took each medication in the past week, a 2 item Belief Screen that asks about drug effects and bothersome features, and a 2 item Recall Screen about potential difficulties remembering. A positive screen indicates the patient reported some non-adherence in response to a given screen, a negative screen indicates that non-adherence or barrier was reported. Test re-test validity of the BMQ is r=0.67.The BMQ consist of three parts. The first part ask the patient to list all the medications they too in the last week. For each medication, patients are asked to answer each of the questions in the box below:· How many days did you take it?· How many times per day did you take it?·  How many pills did you take each time?·  How many times did you miss taking a pill?·  For what reason were you taking it for?·  How well does the medicine work for you? 1= well1=okay 3= not well€2. Do any of your medications bother you in any way? Yes ____ No___If yes, please name the medications and check below how much it bothers you.3. Below is a list of problems that people sometimes have with their medications. Please check how hard it is for you to do each of the following:Open or close the medication bottleRead the print on the bottleRemember to take all the pillsGet your refills in timeTake too many at the same timeScoring Yes 1 No 2 for all three screensVariablesAgeGenderEducationEthnicScheduled MedicationsMedication TypeMedication lengthMedication RegimenConclusionFor the dying patient, it is important that all team members taking care of the patients have good communication skills in order to maintain a state of hope among the patients. It is paramount that all is done by the entire team taking care of the terminally ill patient esecailly those with HIV inroder to improve and maintain their hope of long life so as to encourage them to adhere to the medication routine. Reference:Daar, E.S., Cohen, C., Remien, R., Sherer, R., & Smith, K. (2003). Improving adherence to ntiretroviral therapy. AIDS Reader, 13, 81-82, 85-86, 88-90Herth K (1992) Abbreviated instrument to measure hope: development andpsychometric evaluation. Journal of Advanced Nursing. 17, 10, 1251-1259.Herth K (1990) Fostering hope in terminally ill people. Journal of Advanced Nursing.15, 11, 1250-1259.Wakefield A (2000) Nurses’ response to death and dying: a need for relentless self-care.International Journal of Palliative Nursing. 6, 5, 245-258.