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Factors Associated with Shared Role in Making Decisions about Antiretroviral Treatment: An Analysis of Data from Project IN-CARE

Loomis, Ashley Marietta (2013)
Master's Thesis (51 pages)
Committee Chair / Thesis Adviser: Sanchez, Travis
Committee Members: Soto, Tomas (AIDS Foundation of Chicago);
Research Fields: Health Sciences, Epidemiology; Health Sciences, Public Health
Partnering Agencies: Community-based non-profit organization (e.g., AID Atlanta)
Keywords: HIV; decision-making; patient-provider relationship; MSM
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/dwg2x

Abstract

Factors Associated with Shared Role in Making Decisions about Antiretroviral Treatment: An Analysis of Data from Project IN-CARE

Objective: Studies have reported that patient and providers equally engaging in making decisions about antiretroviral treatment may be positively associated with treatment uptake and adherence among people living with HIV. However, little research has been done with regards to the patient's demographic and social factors associated with shared role in the decision-making process.

Study population and data: Clients were recruited to participate in Project IN-CARE (Identify, Navigate, Connect, Access, Retain, Evaluate), which serves to evaluate and improve access and linkage to care for HIV positive men in Chicago through a peer health navigation program. 331 HIV positive men who have sex with men (MSM) living in Chicago who were enrolled from June 2010-August 2012 were included in the final dataset for secondary analysis.

Analysis: For each categorical variable, two binary logistic regression analyses were conducted where joint decision-making on HIV treatment was the referent: One comparing the referent to clients who made the decisions themselves, and another comparing the referent to clients who experienced having the provider make all the decisions. Wilcoxon rank sum tests were conducted for the continuous variables comparing the individual to shared roles in decision-making. Significance was determined at p < 0.05.

Results: Among clients included in the data for analysis, eighty-three percent reported joint decision-making, 10% relied on their provider, and 8% made most or all of the decisions themselves. Black or African American men, men who were over the age of 40, and clients who reported higher disagreement with statements about the provider making decisions about a patient's health, were independently more likely play a passive role in decision-making. Clients who made decisions themselves expressed greater distrust in the general use of medications.

Conclusions: These findings may be used to create environments that foster positive patient-provider relationships through empowering older and African American patients to engage more in their appointments and dispelling myths about treatment. Further studies investigating effects by demographic characteristics such as age, race/ethnicity, and level education are recommended.

Table of Contents

Chapter 1: Literature Review ................................................................................1

Chapter 2: Manuscript .........................................................................................8

Introduction ......................................................................................................9

Methods ..........................................................................................................10

Results ............................................................................................................15

Discussion ........................................................................................................17

Tables .............................................................................................................24

Chapter 3: Public Health Implications and Recommendations for Future Studies .............28

References .......................................................................................................32

Appendices .......................................................................................................35

Files

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