Smith,
Anna (4/09) The impact of perceived stigma on treatment adherence and
self-efficacy in three chronic diseases: HIV, Type II diabetes &
hypertension (Gary Kose, Ph.D.; Joan Duncan, Ph.D.; Marvin Hurvich, Ph.D.)
The effect of perceived stigma on the
variables of healthcare self-efficacy and treatment adherence behavior was
examined in three chronic diseases of differing levels of stigmatization (HIV -
high, type II diabetes - moderate, and hypertension - low), each requiring
continuous adherence to a medication treatment regimen. Ninety subjects (30 in
each disease group) participated. The hypothesis that perceived stigma would
mediate the effect of disease group on treatment adherence and adherence
self-efficacy in direct negative proportion to the differing level of stigma
perceived by each group was tested using Baron & Kenny's three-step
mediational analysis of covariance. No statistical support was found for the
hypothesized declining linear trend in the mean scores of treatment adherence
and self-efficacy, moving from the hypertension group, to the diabetes group,
to the HIV group. However, when the two "more stigmatized" groups
(HIV and diabetes) were pooled and compared to the "less stigmatized"
group, (hypertension), the hypertension group did report significantly higher
levels of treatment adherence and self-efficacy, confirming the hypothesis. A
linear increase in the levels of mean perceived stigma across the three disease
groups was confirmed, with the HIV group reporting the highest level of
perceived stigma, followed by the diabetic group, and lastly the hypertension
group. When the variable of perceived stigma was controlled for as a covariate
in the third step of the analysis, the significant difference between
"more" and "less stigmatized" disease groups in levels of
the treatment adherence - self-efficacy composite variable was no longer found,
verifying that perceived stigma mediated or caused the significant negative effect
of disease group on the outcome variables. The results provide quantitative,
empirical evidence that chronic disease stigma can have a direct negative
impact on treatment adherence and adherence self-efficacy, supporting existing
primarily qualitative research suggesting this. The study hopes to inform the
development of clinical and psychosocial interventions to optimize treatment
adherence for individuals living with a stigmatized chronic disease.
