Many HIV-infected persons are not capable of benefiting from treatment because they are not constantly betrothed in routine clinical care. Effective medical treatment and correct diagnosis are critical in the quality of life and for the survival of HIV patients. The failure to follow the instructions and recommendation of a health care provider is a barrier to effective medical treatment. A Health Promotion Model (HPM) can assist in improving adherence levels for HIV-infected patients that can lead to a win-win solution where health care providers, patient, and community benefit. HPM is directed to increase a patient's level of wellbeing as they interact with the environment thus, help patients to change and improve their lifestyle to move to a state of optimum health. The HPM focuses on Individual characteristics and experiences Behavior-specific cognitions and affect Behavioral outcomes. HPM in adherence can be explained through designing behavior change strategies and understanding of health behavior: self-regulatory, cognitive, communication, behavioral and biomedical, to scheduled medical appointments and in daily medications. It is not explicit if educational, behavioral, biomedical and self-regulation model is less or more powerful in improving the level of adherence among HIV patients. However, without HPM strategy in adherence to scheduled medical appointments, and in daily medications there is no substantial benefit to HIV patients, resulting in increased costs in health care, low quality of life and poor health outcomes. The relative weight of interventions and the effective theories in the interventions that look to improve adherence need to be measured in future research in scheduled medical appointments, daily medications, gaps in care and surveillance of visit adherence.
TABLE OF CONTENTS
TABLE OF CONTENTS 3
HEALTH PROMOTION MODEL 5
IMPROVING PATIENT ADHERENCE IN AN HIV CLINIC USING HPM 7
1. Individual Characteristics and Experiences 7
Educational Adherence Strategy 8
Self-motivation adherence Strategy 9
Theoretical Models to explain educational and self-motivation Adherence based on Individual Characteristics and Experiences 10
Communication theory 10
Cognitive Theory 11
Self-Regulation Model 12
2. Behavior-specific cognitions and affect 12
Behavioral Perspective Theory to Explain Adherence based on Behavior-specific Cognitions and Affect 14
3. Behavioral outcomes-Health Promotion Behavior 15
The Biomedical Theory to Explain Adherence based on Behavioral outcomes-Health Promotion Behavior 17
There is a continuous treatment for HIV infection globally. However, many infected persons are not capable of benefiting from treatment because they are not constantly betrothed in routine clinical care. Ensuring treatment adherence has shown a significant challenge in health care. Individuals who do not adhere to daily medications and scheduled medical appointments may have a higher mortality and morbidity because of the advancement of their disease (Altice, Kamarulzaman, Soriano, Schechter, Friedland, 2010). Adherence is defined as the extent that patients follow instructions for prescribed treatments (Centers for Disease Control and Prevention, 2012). Effective medical treatment and correct diagnosis are critical in the quality of life and for the survival of HIV patients. The failure to follow the instructions and recommendation of a health care provider is a barrier to effective medical treatment. Non-compliance or non-adherence to HIV care and treatment is the biggest economic burden because of the severe social, economic and human costs (Cohen, Chen, McCauley, et al. 2011). Whenever treatment is interrupted, it may cause drug resistance or reduce treatment efficacy. HIV patients with limited literacy do not have the opportunity or requisite skills to understand efficiently and see the need of maintaining regular HIV scheduled medical appointments or care and daily medications. Thus, non-adherence to medical attention and treatment is a big challenge for the social scientists and medical professionals because their efforts in explaining and improving patient adherence have always been ineffective.
In the United States, non-adherence has led to consequences of yearly expenditures, which is approximated to be in the billions of US dollars (Barnighausen, Tanser, Dabis, Newell, 2012). The estimated costs of hospitalization of HIV victims due to non-adherence are about $13.35 billion annually in the United States (Centers for Disease Control and Prevention, 2012). Besides, non-adherence has led to poor health outcomes leading to about 126000 deaths every year (Centers for Disease Control and Prevention, 2012). The economic burden and death among HIV patients can only be improved by communication between patients and the health care providers and improve the outcomes of HIV patients.
Though there is satisfactory adherence intervention, most have failed, and there is a lack of sufficient explanation power by adherence theories. However, without developing an efficient Nola J Pender HPM in adherence to scheduled medical appointments, and in daily medications there will be no substantial benefit to HIV patients, resulting in increased costs in health care, low quality of life and poor health outcomes (Chesney, 2006). The HPM can assist in improving adherence to scheduled medical appointments and to daily medications, explained through the process involved using theories. The three major components of the HPM model: Individual Characteristics and Experiences, Behavior-Specific Cognitions and Affect, and Behavioral Outcome- Health Promoting Behavior can be used in describing adherence to scheduled medical appointments, and in daily medications using self-regulatory, cognitive, communication, behavioral and biomedical theories. Therefore, this paper, displays how a physician can implement Health Promotion Model (HPM) in an HIV clinic to promote adherence to scheduled medical appointments, and adherence to daily medications.
HEALTH PROMOTION MODEL
Nola Pender Health Promotion Model was designed to be a health protection model that defines health as a state of positive metabolic and functional efficiency of the body and not merely the absence of a disease (College, 2012). HPM is directed to increase a patients level of wellbeing as they interact with the environment. Thus, HPM is described as the art and science that help patients to change and improve their life style to move to a state of optimum health (College, 2012). The HPM focuses on Individual characteristics and experiences Behavior-specific cognitions and affect Behavioral outcomes (College, 2012).
The model maintains that every individual have personal experiences and characteristics that are unique to affect the subsequent actions. The behavior-specific knowledge variables have motivation characteristics that are significant. These behavior variables can be applied in nursing. Thus, Health promotion behavior makes the end point of HPM as a desired behavioral outcome. The behaviors need to enhance better quality of life enhance functional ability and improve health in all development stages.
HPM makes the following assumptions.
Patients must regulate their behavior actively.
Patients, in their biopsychosocial complexity transform the environment as they interact progressively and also being transformed in time.
Physicians and nurses are part of the interpersonal environment that exert influence in the life of patients.
Person-environment interactive patterns help change a patient's behavior.
IMPROVING PATIENT ADHERENCE IN AN HIV CLINIC USING HPM
To improve the HIV patient adherence to scheduled medical appointments, and in daily medications, assessing whether the patient has followed the treatment provided by a physician is critical. Estimating the adherence of patience is not simple and to understand why or whether the patient is capable or chooses to adhere is vague (Cohen, Chen, McCauley, et al. 2011). Health care providers are not well informed on the adherence of their patients and relying on their attempts to catch non-adherence patients is very problematic. The treatment effectiveness is based on the efficacy of adherence to the patient and medication in therapeutic regimen. Health care systems, physicians, and patients all have a responsibility in improving adherence to medication. A single technique is not able to improve adherence of HIV patients to the therapeutic regimen. Instead, it needs a combination, and implementation of diverse methods of adherence focused on improving adherence. There are three major components of the HPM model: Individual Characteristics and Experiences, Behavior-Specific Cognitions and Affect, and Behavioral Outcome- Health Promoting Behavior, that could be instituted for adherence to scheduled medical appointments and daily medications by physicians.
Individual Characteristics and Experiences
Individual characteristics and experiences involve personal factors, which involve personal biological factors, psychological factors and socio-cultural factors. The factors are shaped by the nature of the behavior considered and predictive of a particular behavior. HPM can be instituted for adherence to scheduled medical appointments and daily medications by physicians using the socio-cultural factors and personal psychological factors that include variables like education and self-motivation respectively.
Educational Adherence Strategy
As a didactic cognitive strategy in education that involves providing knowledge through teaching, HIV patients can be educated on the importance of adherence to scheduled medical appointments, and adherence to daily medications. There are different ways that physicians can use in educating HIV patients: via home visits, by e-mail, by telephone, in writing, audio-visually, face to face contact or through individual versus group education (Holstad, DiIorio, Kelley, Resnicow & Sharma, 2011).
Most research supports the effectiveness of patient education about adherence, knowledge and patient outcome. Education positively impacts adherence among HIV patients, especially in daily medications. This may be attributed to the many educational programs that physicians can use like giving instructions and recommendations on self-care activities during medical appointments. Through collaborative care in adherence intervention in primary care physicians, the patient education is improved with an increase in the level of adherence. Physicians can, therefore, do the education through educational programs. By providing HIV patients with adherence related support and information, before initiating or reinitiating patients to antiretroviral, they become self-motivated, thus, physicians must assess the readiness of adherence of the patient. The knowledge of patients needs to be evaluated for the treatment and prevention of HIV disease and give valuable information on CD4 count, viral load, ART and the effects of ART based on strict adherence and non-adherence (Fisher, Amico, Cornman, Shuper, Trayling, et al. 2011). Thus, health care providers need to ensure that HIV patients have the medication ta...
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