Learning Objective 1: The learner will be able to discuss key steps in cross-cultural adaptation of an evidence-based nursing intervention.
Learning Objective 2: The learner will understand the impact of a home visit nursing intervention on medication adherence among people living with HIV/AIDS in south central China.
Methods: In a randomized, controlled trial, 114 subjects were assigned to receive a culturally adapted intervention consisting of monthly visits and interim phone calls plus standard care or standard care alone. The intervention previously demonstrated efficacy in a randomized clinical trial conducted in the United States. All subjects were residents of Hunan, China, living with HIV/AIDS and self-reporting less than 90% adherence to prescribed medications. Measures included a 7-day visual analogue medication adherence scale, a social support rating scale, the Chinese version of the Center for Epidemiological Studies Depression scale Chinese, and an HIV/AIDS stigma scale. Data were collected in structured face-to-face interviews at baseline, 6 months, and 12 months at the time of a regularly scheduled clinical visit. Information regarding ARV regimen, treatment duration, time of diagnosis, CD4 count and HIV-RNA was extracted from the medical record.
Results: Subjects were 72% male (N=82); 52% (N=59) married; and only 28% (N=32) stably employed. Thirty-one percent (N=35) reported past or current drug abuse. The great majority (98%) had a CD4 count at baseline that was less than 350 cells/mm3. At 6 months and 12 months, a greater proportion of subjects in the intervention group self-reported adherence greater than 90% compared to the control group. The difference over time is significant (Extended Mantel-Haenszel Test: 8.8, p=.003).
Conclusions: In spite of significant cultural differences, evidence-based interventions can be implemented effectively in new settings and with new populations.