The role of initial coping strategies on subsequent appointment attendance in individuals with HIV: a longitudinal analysis
With advances in HIV treatment regimens, HIV has become a treatable chronic illness that requires extensive clinical management (Kelly, Otto-Salaj, Sikkema, Pinkerton, & Bloom, 1998). Nonadherence to HIV medical regimens is a primary reason for treatment failure. HIV medication regimens are complicated and require extensive time and effort from the patient (Friedland & Williams, 1999). Since the effectiveness of HIV medication regimens can be severely limited by poor adherence, much research has been conducted regarding the influence of psychosocial factors in adherence. However, this research has primarily focused on medication adherence and has not investigated psychosocial aspects associated with other adherence related behaviors such as appointment attendance. Thus, the current literature may be missing an entire group of HIV patients who do not follow through with medical care long enough to receive medications or other available treatments and services. The primary purpose of this study was to evaluate the effects of initial coping strategies on long-term appointment attendance in individuals with HIV. Baseline data collection was conducted between 1992 and 1995 and included information concerning demographic factors, illness severity, depressive symptoms, and coping strategies. The current results were obtained by a retrospective chart review of appointment attendance. It was predicted that problem-focused coping would be associated with attending regularly scheduled clinic visits and emotion-focused coping would be predictive of failure to attend appointments. Multiple regression analysis revealed that the coping style employed by participants did not predict appointment attendance above and beyond the variance predicted by demographic, illness, and distress related factors. However, minority status, depressive symptoms, and history of intravenous drug use did emerge as reliable predictors of failure to attend scheduled clinic appointments over a three-year follow-up period. These results suggest that increased depressive symptoms, a history of intravenous drug use, and being African American negatively impact treatment success by reducing appointment attendance. Further research should evaluate the specific variables associated with poor appointment attendance among minority individuals.
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