Adherence to HAART: A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators

BACKGROUND: Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. METHODS AND FINDINGS: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. CONCLUSIONS: We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations

Patterns of service use in a continuing care retirement community

The authors analyzed the use of 16 onsite services reported by 91 residents of a new continuing care retirement community (CCRC). The most frequently used services appear to be those of convenience to the residents, including an onsite pharmacy, insurance billing, and a bank, as well as health and fitness services. Perceived health and multiple illnesses were associated with greater use of health and auxiliary health/fitness services, whereas age and marital status were not. In addition, respondent reports of spouse service use predicted respondent service use, whereas measures of social connectedness and friendship did not. Community service use before relocation to the CCRC was predictive of total CCRC service use only in unmarried respondents, demonstrating the complex nature of the relationship between informal support and the use of formal services. The behavioral model appears to be applicable to the study of CCRCs

Sexual Satisfaction and Marital Well-Being in the First Years of Marriage

We consider the importance of sexual satisfaction in the first years of marriage. First, we examine how husbands' and wives' feelings of affirmation and tension in their marriage relate to levels of sexual satisfaction. Further, we explore the relationship between sexual satisfaction and four dimensions of marital well-being: competence, control, equity and happiness. Data from a longitudinal study of black and white couples were analysed separately by race and gender. In both the first and third years of marriage, feelings of affirmation and tension were associated with sexual satisfaction for all race and gender groups. Sexual satisfaction was related to several dimensions of marital well-being, though not always in the expected direction, and the patterns differed across race and gender groups. Sexual satisfaction is at least as important to wives as to husbands, but it is important to conduct separate analyses for race and gender groups.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68950/2/10.1177_0265407594114002.pd

Perceptions of Conflict in the First Year of Marriage: How Important are Similarity and Understanding?

Perceptions of self and spouse play a central role in marital relationships. Using data from 219 newlywed couples, we examined the relative importance (to marital well-being) of partners' similarity and understanding of conflict styles. These data include reports of behaviors of the self and spouse during their most recent disagreement. Behaviors were categorized as either constructive or destructive to resolving the conflict, and data from each category were analyzed separately. Measures of perceptions of similarity based on one spouse's report, actual similarity between spouses' separate reports and spouses' accuracy in reporting (or `understanding' of) each other's behaviors were derived from these reports. Consistent with earlier studies, perceived similarity was shown to be higher than actual similarity and was a stronger positive predictor of marital well-being. This finding highlights the importance of partners believing that they are similar. The strongest predictor of marital well-being for wives was wives' understanding of their husbands. For husbands, both spouses' self-reports of their own behaviors were the strongest predictors. These gender differences are discussed with regard to differences in orientation toward and power in relationships.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68898/2/10.1177_0265407593101001.pd