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dc.contributor.advisorWoods, Steven P.
dc.creatorFaytell, Marika P.
dc.date.accessioned2017-07-17T16:16:28Z
dc.date.available2017-07-17T16:16:28Z
dc.date.createdMay 2017
dc.date.issued2017-05
dc.date.submittedMay 2017
dc.identifier.urihttp://hdl.handle.net/10657/1888
dc.description.abstractFatigue and memory impairment are each highly prevalent in HIV disease (e.g., Heaton et al., 2011; Jong et al., 2010), and exert independent influences on adherence to antiretroviral therapy. However, the combined effects of fatigue and memory impairments on adherence, as well as possible modulating factors of these effects, remain unknown. This study adopted the Aaronson et al. (1999) model of fatigue, which predicts that fatigue depletes compensatory resources, thus leaving HIV+ individuals vulnerable to the impact of memory impairment on adherence. The first aim was to determine the best-fitting model of the relationships between fatigue, compensatory strategy use, retrospective and prospective memory, and adherence. The second aim was to assess whether changes in fatigue, strategy use, and memory were associated with changes in perceived medication management efficacy over one year. Study participants included 177 HIV+ persons who completed a semi-structured clinical interview, comprehensive neurocognitive battery, a series of questionnaires, and a physical evaluation. cART adherence was obtained behaviorally with MEMS caps and by self-report of medication management. Readministration of these assessments (except for the MEMS) was conducted with 57 participants at follow-up about one year later. Structural equation modeling revealed that adherence was most parsimoniously represented by contributions from measures of perceived medication management efficacy and MEMS. In the first aim, the data were fit best by a model comprised of direct and covarying negative effects of fatigue and strategy use on adherence, which were independent from a direct positive effect of prospective memory (controlled for retrospective memory) on adherence. In the second aim, data were fit best by a model comprised of changes in fatigue and strategy use, but not prospective memory, as significant covariates of change in perceived medication management efficacy. These data revealed dynamic interplay between fatigue, strategy use, and perceived efficacy, with separate and stable contributions of prospective memory to perceived efficacy. These and prior findings are discussed in the context of metacognitive awareness. Ultimately, enhanced understanding of these relationships provides valuable clinical information that can inform efforts to (1) improve patient-specific targeting of fatigue-related assessments and interventions; and (2) develop effective interventions for bolstering adherence in seropositive populations.
dc.format.mimetypeapplication/pdf
dc.language.isoeng
dc.rightsThe author of this work is the copyright owner. UH Libraries and the Texas Digital Library have their permission to store and provide access to this work. Further transmission, reproduction, or presentation of this work is prohibited except with permission of the author(s).
dc.subjectHIV
dc.subjectHIV-associated fatigue
dc.subjectHIV-associated neurocognitive disorders
dc.subjectHAND
dc.subjectprospective memory
dc.subjectretrospective memory
dc.subjectcompensatory strategy use
dc.titleInvestigating the Interrelationships between Fatigue, Memory Impairment, and Medication Adherence among Persons Living with HIV Disease
dc.date.updated2017-07-17T16:16:29Z
dc.type.genreThesis
thesis.degree.nameDoctor of Philosophy
thesis.degree.levelDoctoral
thesis.degree.disciplinePsychology, Clinical
thesis.degree.grantorUniversity of Houston
thesis.degree.departmentPsychology, Department of
dc.contributor.committeeMemberMassman, Paul J.
dc.contributor.committeeMemberNeighbors, Clayton
dc.contributor.committeeMemberCrutchley, Rustin D.
dc.creator.orcid0000-0002-7012-6528
dc.type.dcmitext
dc.format.digitalOriginborn digital
dc.description.departmentPsychology, Department of
thesis.degree.collegeCollege of Liberal Arts and Social Sciences


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