Objective: As a result of advances in medical technology, HIV infection is now considered a chronic disease and many HIV-infected individuals can expect to lead long, rewarding lives. However, certain segments of the HIV/AIDS population have fared less favorably than others. Older, rural, and nonwhite individuals typically progress to AIDS more rapidly than other subgroups. The reason for these variations in outcomes is uncertain but may be related to differences in healthy lifestyle practices among these vulnerable subgroups. Although a growing body of research highlights the importance of personal lifestyle choices in reducing morbidity and mortality in chronic diseases, health promotion in HIV infection is a relatively neglected topic. We will test a model that explores predictors of healthy lifestyles in HIV-infected men. Because the HIV population is becoming more diverse, the model will explore whether age, race/ethnicity, and rurality influence healthy lifestyles. We will also test whether variables found to be significant predictors in other chronic disease studies such as stress, social support, and depression play similar roles in determining healthy lifestyles in HIV infection. We will identify the most common barriers that prevent HIV-infected men from engaging in healthy lifestyles and the reasons individuals fail to adhere to medication regimens and keep their HIV-related clinic appointments.
Design: The design is a descriptive, cross-sectional survey.
Sample, Setting, Years: The sample consisted of 102 HIV-infected men attending the Veterans Affairs infectious disease clinic in Gainesville, Florida between February 2001 and January 2002. The subjects ranged in age from 27 to 70 years with a mean of 46.52 (SD=8.40). Fifty-seven subjects (56%) were white and 45 subjects (44%) were nonwhite. Thirty-seven subjects (36%) lived in rural areas or small towns whereas sixty-five subjects (64%) lived in large towns or suburban and urban areas.
Variables: The dependent variable, healthy lifestyles, had three components. The first component, frequency of performing health-promoting behaviors, was measured by the Health Promoting Lifestyle Profile II (Walker, et al., 1995). In this questionnaire, the researcher can obtain an overall score as well as scores for six subscales (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management). The second component, medication adherence, is the percentage of antiretroviral medications that were appropriately taken during a one-week period and was measured by the Patient Medication Adherence Questionnaire (Glaxo Welcome Inc., 1998). Appointment-keeping behaviors, the last component, was determined by the number of missed HIV-related clinic appointments reported by the subject. The independent variables were stress [Modified Psychiatric Epidemiology Research Interview (Dohrenwend et al., 1978)], social support [Social Support Appraisal Scale (Vaux et al., 1986)] and depression [Center for Epidemiologic Studies Depression Scale (Radloff, 1977)]. The Barriers to Health Activities among Disabled Persons Scale (Becker et al., 1991) and open-ended interview questions identified reasons why HIV-infected men did not practice healthy lifestyles.
Methods: Researchers reviewed medical records and interviewed subjects during their regularly scheduled infectious disease appointments.
Findings: Multiple regression analyses were performed to test the model. Depression and social support were significant predictors of overall lifestyle profile, spiritual growth, and interpersonal relationships (p<.05). Men with higher levels of social support and less depression performed health-promoting behaviors more frequently than other men. Depression was the sole significant predictor of physical activity and stress management. Age, race, level of rurality, and stress were not predictors of any of the three components of healthy lifestyles. Barriers and reasons for failing to adhere to healthy lifestyle choices were varied but typically involved financial concerns, confidentiality issues, and personal problems such as lack of transportation, forgetfulness, fatigue, and HIV-related symptoms.
Conclusions: Age, race, and level of rurality did not predict variations in healthy lifestyles. However, two potentially modifiable variables, depression and social support, were significant predictors. Factors such as lack of money and transportation, symptomatic problems, and confidentiality concerns prevent some HIV-infected men from attaining their full health potential.
Implications: Contrary to expectations, age, race, and level of rurality did not influence an individual’s likelihood of engaging in positive health behaviors. Health promotion interventions should be individualized to all HIV-infected men rather than targeted to specific vulnerable subgroups who are often assumed to need more intensive health teaching and intervention. Social support and depression were predictors of positive health behaviors, and unlike demographic factors, these two variables can be modified or enhanced by nursing interventions. Strategies aimed as overcoming barriers identified in this study can be used to improve future health promotion interventions. In summary, the findings of this study present a theoretical model that can serve as a basis for nursing practice when working with HIV-infected men.
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