Identifying structural barriers to antiretroviral therapy adherence

Vermeulen, Jacomina Hendrina (2011-03)

Thesis (MA)--University of Stellenbosch, 2011.

Thesis

ENGLISH ABSTRACT: The topic of antiretroviral adherence remains a subject of continued importance, as it is associated with positive health outcomes amongst patients attending public healthcare facilities. Available literature on adherence behaviour mainly focuses on the psychological and behavioural barriers, while overlooking the multitude of structural barriers within the patient’s environment affecting the patient’s adherence to antiretroviral treatment and care. The present study provides a unique perspective on adherence behaviour amongst persons living with HIV and receiving antiretroviral treatment, as it identifies important structural barriers to clinical attendance and pill-taking. The sample for this study were selected from patients attending an infectious diseases clinic at a major peri-urban secondary hospital and receiving antiretroviral therapy, nurses and doctors providing health services to patients, and patient advocates providing psychosocial support to patients under the auspices of a local non-governmental organisation. The participants included in this study were selected by means of convenience sampling to participate either in semi structured interviews or focus group discussions. Participants were assured of the confidentiality of the process and their anonymity in both cases. Both semi structured interviews and focus groups were digitally recorded and transcribed after which transcriptions were entered into Atlas.ti for textual analysis. Transcriptions were thematically analysed according to the perceptions of various participants. The main themes that emerged from the present study included individual barriers, poverty-related barriers, institutionrelated barriers, and social and community-related barriers. The results of the present study were triangulated by considering the concurrences and discrepancies between the patients, clinicians and patient advocates on the main, and subthemes. These themes were then discussed according to Bronfenbrenner’s (1972) Ecological Systems Theory, which divided the main themes identified according to the different systems operating within the patient’s environment, i.e. the micro-, exo-, and macrosystem. The microsystem included both individual psychological and behavioural barriers and poverty-related barriers. Institutional barriers were considered within the exosystem of the patient’s ecological environment. And the social and community-related barriers were considered within the macrosystem of the patient’s ecological environment. The significance of this study lies in the identification of adherence behaviour as the product of the patient’s environment through the examination of triangulated data. Future research may include effective ways in which patients can be assisted in developing the necessary skills to cope with their environment and to enhance social support. The development of strategies to support newly-enrolled patients also still needs investigation.

AFRIKAANSE OPSOMMING: Volgehoue antiretrovirale behandeling bly ‘n onderwerp van voortdurende belang omdat dit geassosieer word met positiewe gesondheidsuitkomste onder pasiënte wat van openbare gesondheidsfasiliteite gebruik maak. Beskikbare literatuur oor volhoudings gedrag fokus grootliks op sielkundige en gedragshindernisse, terwyl veelvuldige strukturelehindernisse binne die pasiënt se omgewing steeds misgekyk word. Dié studie bied ‘n unieke perspektief op volhoudingsgedrag onder MIV-positiewe pasiënte wat tans antiretrovirale terapie ontvang, aangesien dit belangrike strukturele hindernisse tot kliniek bywoning en die neem van medikasie identifiseer. Dié steekproef sluit pasiënte in wat tans antiretrovirale terapie by ‘n aansteeklike siektes-kliniek by ‘n peri-stedelike sekondêre hospitaal ontvang. Dit sluit ook dokters en verpleegsters in wat gesondheidsdienste aan dié pasiënte verskaf, en pasiënt- advokate wat psigo-sosiale ondersteuning aan pasiënte verskaf onder die vaandel van ‘n plaaslike nieregerings organisasie. Dié deelnemers is deur middel van gerieflikheidssteekproef geselekteer om aan semi-gestruktureerde onderhoude of fokusgroepbesprekings deel te neem. Deelnemers van albei groepe is van hul anonimiteit en die vertroulikheid van die proses verseker. Beide die semi-gestruktureerde onderhoude en die fokusgroepbesprekings is digitaal opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in Atlas.ti gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer volgens die persepsies van die verskeie deelnemers. Die hooftemas wat na vore gekom het, sluit in individuele hindernisse, armoedeverwante hindernisse, institusieverwante hindernisse asook sosiale en gemeenskapsverwante hindernisse. Resultate van dié studie is getrianguleer deur die verskille en ooreenkomste te vind tussen pasiënte, klinici en pasiënt-advokate oor die hoof- en subtemas. Die hooftemas is toe volgens Bronfenbrenner (1972) se Ekologiese Sistemeteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die mikro-, ekso-, en makrosisteem. Die mikrosisteem het individuele sielkundige en gedragshindernisse asook die armoedeverwante hindernisse ingesluit. Institusieverwante hindernisse is binne die eksosisteem van die pasiënt se ekologiese omgewing beskou en sosiale en gemeenskapsverwante hindernisse is beskou binne die makrosisteem van die pasiënt se ekologiese omgewing. Die belang van dié studie lê in die identifisering van volhoudingsgedrag as produk van die pasiënt se omgewing, soos beskou deur die Ekologiese Sistemeteorie. Toekomstige navorsing kan fokus op effektiewe maniere waarop pasiënte bygestaan kan word om die nodige vaardighede te ontwikkel om hul omgewing beter te kan hanteer en beskikbare sosiale ondersteuning te kan verbeter. Die ontwikkeling van strategieë om nuwe pasiënte by te staan, benodig ook verdere navorsing.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/6539
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