Associations between Engagement in the Patient-Provider Relationship and Quality of Life and Adherence among Persons Living with HIV/AIDS

Purpose: This cross-sectional, correlational study was conducted to examine the associations between engagement in the patient-provider relationship and quality of life and adherence among persons living with HIV/AIDS. The project is a sub-study of an international, multi-site study examining the adequacy of a self-care symptom management model that hypothesizes relationships among person, illness representation, symptom self-care, perceived effectiveness of self-care activities, adherence, and outcomes appraisal in a large, HIV-positive sample (n=1072). Method: A convenience sample of non-hospitalized persons receiving care at The Ohio State University Infectious Diseases Outpatient Clinic and Children’s Hospital Family AIDS Clinic and Educational Services was recruited from May to November, 2003. IRB approval was obtained from each of the participating sites. A 35-page survey was administered to subjects qualifying for the study who provided informed consent. Subjects received $20 for completing the questionnaire. All measures were self-report. Demographic data gathered included gender, age, race/ethnicity, length of HIV diagnosis, and presence of AIDS diagnosis. The sample included 57 persons living with HIV/AIDS with a mean age of 40 years, of which 28% were women and 58% were white; the mean length of HIV diagnosis was 10 years and 39% had an AIDS diagnosis. Engagement was measured using the 13-item Engagement with Health Care Provider scale. The HIV/AIDS Targeted-Quality of Life scale, a 42-item HIV-specific instrument, was used to measure the following nine dimensions of quality of life: overall function, life satisfaction, health worries, financial worries, medication worries, HIV mastery, disclosure worries, provider trust, and sexual function. Adherence, an assessment of compliance with provider advice and medication regimen, was measured with the 5-item Advice and Instruction scale and the 15-item AIDS Clinical Trials Group (ACTG) Reasons for Nonadherence to Medications checklist, respectively. Findings: Better quality of life was found to be significantly related to engagement with health care provider (p=0.013) as was adherence to provider advice (p=0.001). While positively correlated, no statistically significant relationship was found between engagement and adherence to medication. Implications: Results of this study support existing literature suggesting a positive association between increased engagement with health care provider and better quality of life among persons living with HIV/AIDS. A limitation of the study, particularly in regard to adherence, is the self-report design. Nevertheless, the study does suggest the need to develop and promote strategies that foster a healthy patient-provider relationship in this population to improve quality of life and adherence to treatment