Download Behavior Management in Clinical HIV Care

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.
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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.