Behavior Management in Clinical HIV Care Part I: Treatment Adherence
Introduction
Powerful new treatment options for people living with HIV/AIDS can have a tremendous impact upon the quality and length of their lives. However, these treatment options depend upon strict adherence to complicated medical regimens. Medical providers are generally the primary source of treatment information for people with HIV. Therefore, to assist patients with treatment adherence, physicians and other providers need to understand the complicated issues that impact on treatment adherence, and implement strategies to assist their patients with adherence. Some problems associated with optimal treatment cannot be remedied by educational interventions (e.g., cost of medications, side effects of medications, and prior use of sub-optimal HIV therapies). Still, high quality treatment education, support, and advocacy are among the most critical elements for treatment success.
This training manual has been developed by Cicatelli Associates Inc. as a resource to help you train physicians and other providers in skills to aid the patient in treatment adherence. The ability that providers will gain in enhancing treatment adherence can have a critical impact on the future course of the HIV/AIDS epidemic and on the lives of people living with HIV and AIDS.
This training manual contains the following modules:
Module One: Introduction Module One provides an introduction to the entire manual, and a brief description of each of the materials included in each of the modules.
Module Two: Training and Presentation Skills Module Two is designed to provide helpful information on how to design and deliver an effective presentation. Materials provided in this module include: skills and characteristics of effective trainers; using training aids; helpful hints in planning and delivering presentations; and strategies for addressing challenging behaviors in groups.
Module Three: Adult Learning Principles Module Three contains basic background information on how adults learn. By incorporating this information into your presentations, you can enhance the learning environment for your trainees. Also included in this module is the “Experiential Learning Cycle,” a model of learning model in which the facilitator, by strategically asking a series of questions, helps the trainees process what they have learned and ultimately to apply their learning to work situations. This module also includes references for further information on adult learning and training.
Module Four: Adherence Background Information Module Four contains background information and research articles on issues affecting treatment adherence.
Module Five: Adherence Training Activities, Part 1 Module Five provides copies of materials you can use in your presentations. The materials in this module include: AETC Faculty Development, Treatment Adherence 2003 Developed by Cicatelli Associates Inc. Steps to Better Adherence: this is a chart that identifies many of the factors that influence adherence. This chart helps clarify the complexity of adherence, and also helps identify the role of the provider in helping patients who may be at each of these “steps” in moving towards treatment adherence. Enhancing Adherence Flow Chart: This flow chart correlates the “Steps to Better Adherence” with the Stages of Change (from the Transtheoretical Model of Behavior Change, developed by Prochaska, DiClemente and Norcross). This model helps providers understand treatment adherence as a behavior change process. An Information-Motivation-Behavioral Skills Model of Adherence: This model looks at the confluence of information, motivation and behavioral skills in treatment adherence behavior. Steps to Promoting Adherence, Role Plays 1 – 9: These role play scenarios can be used to illustrate the importance of identifying a patient’s specific issues in order to help a patient with treatment adherence.
Module Six: Adherence Training Activities, Part 1 Module Six contains additional activities and handouts that you can use in your presentations. The materials in this module include: Characteristics that Are/Are Not predictive of Adherence or Non Adherence: Research shows that certain characteristics may be predictive of Adherence or Non Adherence. Numerous characteristics that one may assume are predictive of Adherence or Non Adherence are not. This activity helps providers identify which characteristics actually may be predictive of adherence or nonadherence, and which do not. The trainer is provided with an answer key. The information from this activity comes from research on adherence, which is included in Module Four. Critical Areas of Concern in Adherence These three handouts divide issues that can make adherence more or less difficult into three categories: Patient Related Issues; Patient-Provider Related Issues; and Treatment Related Issues. Each of these areas of concern must be addressed in order to help patients with adherence. Kleinman’s Tool to Elicit Health Beliefs A patient’s health beliefs will influence his or her behaviors. Uncovering health beliefs, and incorporating those beliefs into the treatment can help increase a patient’s treatment adherence. This questionnaire is a tool to help the clinician elicit a patient’s health beliefs. Questions About Adherence and Trainer’s Guide This material can be used to conduct a discussion, which encourages providers to explore the role and the impact of the provider on treatment adherence, and to develop strategies to work more effectively with patients. Developing the Client-Provider Relationship This handout lists ways providers can enhance their relationship with patients. M & M This activity helps illustrate some of the difficulties patients encounter with adherence, and helps sensitize providers to some of the issues affecting their patients. Materials developed by the NYSDOH AIDS Institute These handouts have been developed by the AID Institute for clinicians to use in working with patients regarding treatment issues.
AETC Faculty Development, Treatment Adherence 2003 Developed by Cicatelli Associates Inc.