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The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES)

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Abstract

Adherence to HIV treatment, including adherence to antiretroviral (ART) medication regimens, is paramount in the management of HIV. Self-efficacy for treatment adherence has been identified as an important correlate of medication adherence in the treatment of HIV and other medical conditions. This paper describes the validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) with two samples of HIV+ adults on ART. Factor analyses support subscales measuring Adherence Integration (eigenvalue = 6.12) and Adherence Perseverance (eigenvalue = 1.16), accounting for 61% of the variance in scale items. The HIV-ASES demonstrates robust internal consistency (ρs > .90) and 3-month (rs > .70) and 15-month (rs > .40) test–retest reliability. Concurrent validity analyses revealed relationships with psychosocial measures, ART adherence, clinical status, and healthcare utilization. Findings support the use of the HIV-ASES and provide guidance for further investigation of adherence self-efficacy in the context of treatment for HIV and other diseases.

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Acknowledgments

The NIMH Healthy Living Project Team (see HLP 2007 for details of team). This research was funded by National Institute of Mental Health grants U10-MH57636, U10-MH57631, U10-MH57616, U10-MH57615, and R01MH068208. We also acknowledge input from Albert Bandura, Ph.D. and the assessors in each city who conducted the interviews, to our clinic and community based organization collaborators, to all other support staff involved in the projects, and to the men and women who participated in the interviews.

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Authors and Affiliations

  1. Center for AIDS Prevention Studies, University of California, 50 Beale Street, Suite 1300, San Francisco, CA, 94105, USA

    Mallory O. Johnson, Torsten B. Neilands, Samantha E. Dilworth, Stephen F. Morin & Margaret A. Chesney

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA

    Robert H. Remien

  3. School of Medicine, University of California, San Francisco, CA, USA

    Margaret A. Chesney

  4. The National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD, USA

    Margaret A. Chesney

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  1. Mallory O. Johnson
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  2. Torsten B. Neilands
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  4. Stephen F. Morin
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  5. Robert H. Remien
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Correspondence to Mallory O. Johnson.

Appendix. HIV-ASES Items

Appendix. HIV-ASES Items

I am going to ask you about situations that could occur during your treatment for HIV. Treatment can involve different things for different people. Sometimes, this might refer to taking medications, and other times it could refer to other things that you do to deal with HIV such as diet and exercise or taking vitamins. So, in these questions, when I ask you about your “treatment” or your “treatment plan,” I am talking not only about any medications that you might be taking for HIV, but also other things that make up your self-care.

For the following questions I will ask you to tell me in the past month, including today, how confident you have been that you can do the following things. Use this response scale ranging from 0 (“cannot do at all”) to 10 (“completely certain can do”).

[Note: The term “clinic” may be replaced by “doctor’s office” if participant does not receive care in clinic settings.]

Cannot do at all

00

01

02

03

04

Moderately certain can do

05

06

07

08

09

Completely certain can do

10

In the past month, how confident have you been that you can:

  1. 1.

    Stick to your treatment plan even when side effects begin to interfere with daily activities?

  2. 2.

    Integrate your treatment into your daily routine?

  3. 3.

    Integrate your treatment into your daily routine even if it means taking medication or doing other things in front of people who don’t know you are HIV-infected?

  4. 4.

    Stick to your treatment schedule even when your daily routine is disrupted?

  5. 5.

    Stick to your treatment schedule when you aren’t feeling well?

  6. 6.

    Stick to your treatment schedule when it means changing your eating habits?

  7. 7.

    Continue with your treatment even if doing so interferes with your daily activities?

  8. 8.

    Continue with the treatment plan your physician prescribed even if your T-cells drop significantly in the next three months?

  9. 9.

    Continue with your treatment even when you are feeling discouraged about your health?

  10. 10.

    Continue with your treatment even when getting to your clinic appointments is a major hassle?

  11. 11.

    Continue with your treatment even when people close to you tell you that they don’t think that it is doing any good?

  12. 12.

    Get something positive out of your participation in treatment, even if the medication you are taking does not improve your health?

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Johnson, M.O., Neilands, T.B., Dilworth, S.E. et al. The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med 30, 359–370 (2007). https://doi.org/10.1007/s10865-007-9118-3

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