Medication beliefs and structural barriers to treatment adherence among people living with HIV infection

Background: People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals’ motivations to remain adherent may overcome structural barriers has received limited attention.

Purpose: To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.

Methods: People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.

Results: In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.

Conclusions: Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.     

A Report on a Four-Year Longitudinal Study of Intellectual Development of Engineering Undergraduates

As part of an investigation into the effects of curricular reforms in the undergraduate program in the College of Engineering, a series of Perry-style interviews were conducted over a 4-year period. The study was undertaken in an attempt to assess the impact of collaborative design-based engineering courses that were being implemented. Students who completed the collaborative design course in their first year were higher on the Perry scale than their peers who did not. However, this effect was not sustained through the rest of the curriculum, as more traditional courses dominated. No statistically significant change in Perry position was observed for students in their 1st and 3rd years; however, a growth of approximately one Perry position was observed between the 3rd and 4th years. The relationship of current curricula to this pattern of intellectual development is discussed, and arguments for altering the curriculum to support intellectual development are made.     

Teaching a simple meal preparation skill to adults with moderate and severe mental retardation using video modeling

We evaluated whether adults with mental retardation in the moderate or severe range would acquire simple meal preparation skills via video modeling. Training was conducted in the kitchen of the participants' day treatment setting. The intervention consisted of (i) watching a video of an adult with a developmental disability making a peanut butter and jelly sandwich and (ii) receiving verbal praise for each step of the task that was performed correctly. All three participants mastered the task and demonstrated generalization across settings. All three participants also demonstrated maintenance of the skill one month following mastery. Copyright © 2003 John Wiley & Sons, Ltd.     

The (Non)Impact of Differential Test Taker Engagement on Aggregated Scores

Disengaged test taking tends to be most prevalent with low-stakes tests. This has led to questions about the validity of aggregated scores from large-scale international assessments such as PISA and TIMSS, as previous research has found a meaningful correlation between the mean engagement and mean performance of countries. The current study, using data from the computer-based version of the PISA-Based Test for Schools, examined the distortive effects of differential engagement on aggregated school-level scores. The results showed that, although there was considerable differential engagement among schools, the school means were highly stable due to two factors. First, any distortive effects of disengagement in a school were diluted by a high proportion of the students exhibiting no non-effortful behavior. Second, and most interestingly, disengagement produced both positive and negative distortion of individual student scores, which tended to cancel out much of the net distortive effect on the school’s mean.     

Perceptions of Forgetfulness in Adulthood

Abstract

In two experiments, we examined younger and older participants’ appraisals of memory failures in fictitious characters portrayed as younger (in their 20’s to 30’s) or older (in their 60’s to 70’s) adults. Participants read vignettes where forgetful behavior had minor or more severe consequences for the target character (Experiment 1) or for the character and others in the social environment (Experiment 2). Participants rated potential causes of the forgetfulness and opinions concerning the target character’s cognitive health. In Experiment 1, an age-based double standard was observed, where both age groups rated ability as a cause of forgetting more often for older than younger characters. Ratings of forgetfulness as a sign of mental difficulty, need for memory training, and professional evaluation were also higher for older compared to younger characters. In Experiment 2, the Attribution Type by Target Age interaction effect was replicated. Ability and effort contributed to the significance of the interaction, confirming the reliability and generalizability of the age-based double standard. Forgetfulness was rated as a sign of mental difficulty more often for the older than younger characters, replicating Experiment 1. In both experiments, the consequences of the forgetting had a large impact on the attribution and opinion ratings for younger and older forgetful characters. These data suggest that people of all ages evaluate forgetful characters in light of situational outcomes as well as ageist presumptions of cognitive frailty in later life.