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J AIDS Clin Res. 2013 Nov 1;4(11):256.

Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV.

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Assistant Professor,400 West Campus Dr. #22110, Orange, CT 06477, School of Nursing, Yale University, Orange, CT 06477, USA.
Assistant Professor, Rutgers College of Nursing Ackerson Hall 180 University Avenue, Room 330 Newark, NJ 07102, USA.
Assistant Professor, University of North Carolina Wilmington (UNCW) School of Nursing 601 South College Road Wilmington, North Carolina, USA.
Professor, Institute of Health Professions CNY 36 1st Avenue Boston, MA 02116, USA.
Associate Professor, Rutgers College of Nursing 101 Glen Rock Road Cedar Grove, NJ 07009, USA.
Senior Lecturer University of Namibia Main Campus, Mandume Ndemufayo Avenue, Windhoek Block F, Room 204, 3rd Level Namibia.
Dean and Professor Rutgers College of Nursing Ackerson Hall 180 University Avenue, Room 302C Newark, NJ, USA.
Professor and Graduate Program Director, Hunter College, CUNY, Hunter Bellevue SON, 425 East 25 Street, Box 874, New York, NY 10010, USA.
Professor Texas A&M University-Corpus Christi 6300 Ocean Dr. Island Hall, Rm 329 Corpus Christi, TX 78404, USA.
Professor University of Puerto Rico PO Box 365067 San Juan, PR 00936-5067, USA.
Associate Professor University of Washington, School of Nursing PO Box 357266 Seattle, WA 98195, USA.
Professor and Director, Global Health and Academic Partnerships Brigham and Women's Hospital and MGH Institute of Health Professions 36 1st Avenue Boston, MA 02129, USA.
École des Sciences Infirmières, School of Nursing Faculté des Sciences de la Santé, Faculty of Health Sciences Université d'Ottawa, University of Ottawa 451 chemin Smyth Road Ottawa, Ontario, CANADA.
Associate Clinical Professor, The Ohio State University College of Nursing 1585 Neil Ave. #344 Columbus, Ohio 43201, USA.
Associate Professor UCSF School of Nursing Dept. of Community Health Systems San Francisco, CA, USA.
Professor and Chair UCSF, School of Nursing, 2 Koret Way San Francisco, CA 94143, USA.
Director, Nursing Strategic Initiatives Lyndon B. Johnson Hospital, Harris Health System 5656 Kelley Street Houston, TX, USA.
Associate Professor University of Hawaii School of Nursing McCarthy Mall, Webster 439 Honolulu, HI 96822, USA.
Associate Professor UCSF 50 Beale Street, Suite 1300 San Francisco, CA 94105, USA.
Assistant Professor MGH Institute of Health Professions 3047 Bonnebridge Way Houston, TX 77082, USA.
Instructor Case Western Reserve University School of Nursing Cleveland, OH 44106, USA.


The engagement of patients with their health care providers (HCP) improves patients' quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client's choices, and management of client concerns. This study compares country-level differences in patients' engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR -7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = -5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = -3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.


Adherence; Engagement; HIV; Healthcare providers; Quality of life; Self-efficacy; Self-esteem

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