title: Psychosocial assessments for HIV+ African adolescents: establishing construct validity and exploring under-appreciated correlates of adherence.
abstract: OBJECTIVE
  Psychosocial factors such as outcome expectancy, perceived stigma, socio-emotional support, consideration of future consequences, and psychological reactance likely influence adolescent adherence to antiretroviral treatments. Culturally-adapted and validated tools for measuring these factors in African adolescents are lacking. We aimed to identify culturally-specific factors of importance to establishing local construct validity in Botswana.
  
  
  METHODS
  Using in-depth interviews of 34 HIV+ adolescents, we explored how the psychosocial factors listed above are perceived in this cultural context. We evaluated six scales that have been validated in other contexts. We also probed for additional factors that the adolescents considered important to their HIV medication adherence. Analyses were conducted with an analytic framework approach using NVivo9 software.
  
  
  RESULTS
  While the construct validity of some Western-derived assessment tools was confirmed, other tools were poorly representative of their constructs in this cultural context. Tools chosen to evaluate HIV-related outcome expectancy and perceived stigma were well-understood and relevant to the adolescents. Feedback from the adolescents suggested that tools to measure all other constructs need major modifications to obtain construct validity in Botswana. The scale regarding future consequences was poorly understood and contained several items that lacked relevance for the Batswana adolescents. They thought psychological reactance played an important role in adherence, but did not relate well to many components of the reactance scale. Measurement of socio-emotional support needs to focus on the adolescent-parent relationship, rather than peer-support in this cultural context. Denial of being HIV-infected was an unexpectedly common theme. Ambivalence about taking medicines was also expressed.
  
  
  CONCLUSIONS
  In-depth interviews of Batswana adolescents confirmed the construct validity of some Western-developed psychosocial assessment tools, but demonstrated limitations in others. Previously underappreciated factors related to HIV medication adherence, such as denial and ambivalence, should be further explored.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Epidemiology, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, Department of General Pediatrics, Philadelphia, PA, United States of America; Botswana-UPenn Partnership, Gaborone, Botswana.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Lowenthal
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Tafireyi C
authors.initials: TC
authors.lastname: Marukutira
authors.affiliation: Children's Hospital of Philadelphia, Department of General Pediatrics, Philadelphia, PA, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chapman
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Keboletse
authors.initials: K
authors.lastname: Mokete
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana; University of Pennsylvania Perelman School of Medicine Doris Duke Clinical Research Program, Philadelphia, PA, United States of America; University of Massachusetts Medical School, Worcester, MA, United States of America.
authors.forename: Katherine
authors.initials: K
authors.lastname: Riva
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Ontibile
authors.initials: O
authors.lastname: Tshume
authors.affiliation: Children's Hospital of Philadelphia, Department of General Pediatrics, Philadelphia, PA, United States of America; Villanova University, Villanova, PA, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Eby
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Mogomotsi
authors.initials: M
authors.lastname: Matshaba
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana; Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, United States of America.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Anabwani
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana; University of Pennsylvania Perelman School of Medicine, Departments of Medicine and Epidemiology, Philadelphia, PA, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.affiliation: University of Pennsylvania Perelman School of Medicine and School of Nursing, Departments of Epidemiology and Nursing, Philadelphia, PA, United States of America.
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001290:Attitude; D001902:Botswana; D002648:Child; D003717:Denial, Psychological; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D010349:Patient Compliance / Q000523:psychology*; D011584:Psychology; D000297:Psychology, Adolescent; D012944:Social Support
chemical_list: D044966:Anti-Retroviral Agents