Motivation as a Mechanism for Daily Experiences' Effects on HIV Medication Adherence.
Paul F Cook, Sarah J Schmiege, Lucy Bradley-Springer and 2 others
PMID 28967490WHAT IT FOUND
Momentary motivation mediates the link between daily mood, control beliefs, social support, and HIV medication adherence.
Clinicians should assess patient motivation daily rather than retrospectively, as it fluctuates and directly predicts adherence behavior.
Key findings
01Four of five momentary state variables (control beliefs, mood, social support, coping) significantly predicted momentary motivation, while stress did not.
02Motivation served as a mechanism for the effects of control beliefs, mood, and social support on medication adherence, but not for stress or coping.
03Participants took their medication on only 73% of study days despite 91% having undetectable viral loads at baseline.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The final sample size for the mediation analysis was small (58 participants), which may limit the generalizability of the findings. Stress and coping measures had fewer data points because they were only assessed if the participant reported a stressful event that day, potentially reducing the power to detect their effects. Viral load data were taken from medical records and could be up to six months old, so they may not reflect the exact adherence levels during the study period. Most variables were self-reported, which can be influenced by language and memory, although ecological momentary assessment reduces this bias compared to retrospective questionnaires.
Declared interests
The study was funded by NIH grants (NINR and NCRR). Author Paul Cook disclosed consulting fees from Academic Impressions, Inc. and the University of Wyoming. Other authors reported no conflicts.
The easy way to misread this
Do not conclude that stress has no impact on medication adherence. Stress was not a significant predictor of motivation or adherence in this model, but the study design meant stress was only measured on days when participants reported a stressful event, which may have obscured its effects. The finding that motivation is the primary pathway suggests that addressing stress may help adherence only if it successfully boosts motivation.