Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status.

OBJECTIVE: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. DESIGN: Prospective, cross-sectional observational design. MAIN OUTCOME MEASURES: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). RESULTS: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. CONCLUSION: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status.     

Employee and Customer Perceptions of Service Quality in an Indian Firm

Nous présentons un modèle complétant les conceptions existantes de la relation entre employés et clients dans la domaine des services qui propose que la perception de l’efficacité du service par l’agent comme prédictive de l’efficacité du service perçue par le client. L’efficacité du service se réfère à la perception qu’ont les agents de répondre ou même d’aller au‐delà des attentes relatives au service de la part de l’organisation et des clients exteriors. Nous avons enquêté la relation entre l’efficacité du service, la maturité de l’équipe, et la qualité du service dans la filiale indienne d’une organisation internationale de produits de bureaux. Les agents de service appartenant à 18 équipes autonomes ont classé leur propre efficacitéà répondre aux attentes de la direction et des clients extérieurs. Les donées préexistantes sur la maturité de ces équipes étaient recueillies auprès l’organisation. 114 clients de la même société, choisi au hazard, évaluaient la qualité du service fourni, leur satisfaction de ce service et les effets attendus par le client. Nous avons trouvé des liaisons positives entre l’efficacité du service, la maturité du groupe et la qualité de service. Ces resultants servent à enrichir la littérature reliant les comportements des employés aux effets sur les clients pour les sociétés operant dans les economies émergeantes. We proposed a model complementing existing conceptions of the relationship between service employees and their customers, that proposes service effectiveness as an employee‐level predictor of customer‐perceived service quality. Service effectiveness refers to employees’ perceptions of meeting or even exceeding the service‐related expectations of the organisation and external customers. We investigated the relationship between service effectiveness, team maturity, and service quality in an Indian branch of an international office products organisation. Service employees belonging to 18 self‐managed teams rated their own effectiveness in meeting the expectations of management and external customers. Pre‐existing team maturity data for these teams were obtained from the organisation. Simultaneously, 114 randomly selected customers of the same company evaluated the quality of service provided, their satisfaction with the service, and intended customer outcomes. We found positive links between service effectiveness, group maturity, and service quality. These results also help extend the literature linking employee behaviors with customer outcomes to companies operating in emerging economies.