Masters Degrees (Psychology)

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Browsing Masters Degrees (Psychology) by browse.metadata.advisor "De Bruin, Deon"

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    The development of a scale to assess structural barriers to adherence to antiretroviral therapy
    (Stellenbosch : Stellenbosch University, 2011-12) Coetzee, Bronwyne Jo'sean; Kagee, Ashraf; De Bruin, Deon; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: As the only effective treatment for HIV/AIDS, adherence to antiretroviral therapy (ART) is critical for successful treatment outcomes. Despite its open availability since the national rollout in 2004, adherence to ART has remained sub-optimal and the number of individuals shifted to the more expensive second-line therapy on steady increase. The literature reports more commonly on individual, psychological, and behavioural barriers to treatment. However, there has been a vast interest in the structural barriers that prohibit adherence to ART. In previous research, my colleagues and I identified the following structural barriers to treatment adherence: stigma-related barriers, the disincentives associated with disability grants, poor relationships with clinic staff, lack of privacy at clinics for counselling and treatment, transport difficulties in travelling to the clinic, long patient waiting times, food insecurity, substance abuse and the absence of substance abuse programmes, and migration. The data were arrived at by means of triangulated qualitative interviews obtained from patients, patient advocates, doctors, and nurses. Together, these qualitative data formed phase 1 of this study. The next step or phase 2, in this research was to develop a valid and reliable quantitative instrument based on these qualitative data. Therefore the primary aim of the study presented in this thesis was to identify the underlying factor structure of four scales aimed at measuring adherence at two levels namely, adherence to clinic attendance, and adherence to pill-taking. After sampling a group of almost 300 persons living with HIV (PLWH) four valid and reliable scales assessing structural barriers to adherence to ART were derived at with Cronbach alpha coefficients ranging from 0.87 to 0.91. For each scale, a general or higher order factor was determined by means of hierarchical transformation suggesting that the items on each of the scales were dominated by a single underlying factor. The findings of this research suggest that it is possible to assess the structural barriers to adherence that PLWH face on a daily basis. With a proper means, such as these scales, to assess structural barriers to adherence to ART clinicians may be able to identify patients who are likely to default and provide adequate attention to the most distressing barriers.