A structural equation model of patient-healthcare provider relationships and HIV-infected patient outcomes in Chinese populations

Abstract

Obtaining maximum antiretroviral therapy (ART) adherence is critical for maintaining a high CD4 count and strong immune function in PLWHA. Key factors for achieving optimum adherence include good medication self-efficacy, decreased medication-taking difficulties, and positive patient-healthcare provider (HCP) relationships. Limited studies have analyzed the correlation of these factors and ART adherence in Chinese population. In this paper, structural equation modeling was performed to assess the proposed model of relations between patient-HCP relationships and adherence. Audio Computer-Assisted Self-Interview (ACASI) software was used to collect data on ART adherence and patient variables among 227 PLWHA in Shanghai and Taipei. Participants completed a one-time 60-minute ACASI survey that consisted of standardized measures to assess demographics, recent CD4 counts, self-efficacy, patient-HCP relationship, adherence, and medication-taking difficulties. The data shown the relationship between patient-HCP relationships and adherence was significantly consistent with mediation by medication self-efficacy. However, patient-HCP interaction did not directly influence medication-taking difficulties, and medication-taking difficulties did not significantly affect CD4 counts. Furthermore, patient-HCP interactions did not directly impact CD4 counts; rather, the relation was consistent with mediation (by either better medication self-efficacy or better adherence) or by improved adherence alone. Future interventions should be designed to enhance self-management and provide better patient-HCP communication. This improved communication will enhance medication self-efficacy and decrease medication-taking difficulties. This in turn will improve medication adherence and immune function among PLWHA.

Keywords: Adherence; Chinese culture; medication-taking difficulties; patient-healthercare provider relationships; self-efficacy.

Figure 1:

Hypothesized Model Observed variables are shown within rectangles. Note: Directional relationships are indicated with +/−.

Figure 2:

Final standardized parameter estimates model after modifications Note: Error variance terms for measured variables are shown as ε. * p<0.5; ** p<0.01 A unit increase in HCP-patient relationship was associated with 0.346 unit increase in medication self-efficacy (SE = 0.108, p = 0.001), and 2.255 unit increase in medical adherence (SE = 0.185, p < 0.001). A unit increase in medical self-efficacy was associated with a 0.132 unit decrease in medication taking difficulties (SE = 0.031, p < 0.001) but a 3.246 unit increase in medical adherence (SE = 0.650, p < 0.001). A unit increase in medication taking difficulty was associated with 3.206 unit decrease in medical adherence (SE = 0.609, p < 0.001). A unit increase in medical adherence was associated with a 0.152 unit increase in transformed CD4 count (SE = 0.023, p < 0.001). Finally, a unit increase in transformed CD4 count was associated with 0.230 unit decrease in patient-HCP relationships (SE = 0.055, p < 0.001). The total effects considering different pathways in this non-recursive system were also significant at 0.05 level. Specifically, 1 unit increase in patient-HCP relationship was associated with 0.344 unit increase in medication self-efficacy (SE = 0.108, p = 0.001), 0.045 unit decrease in medication taking difficulty (SE = 0.014, p = 0.001), 1.30 unit increase in medical adherence (SE = 0.412, p = 0.002), and 0.590 unit increase in transformed CD4 count (SE = 0.099, p < 0.001).