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Retention in HIV Care from AIDS Patient Care and STDs

Understanding the Behavioral Determinants of Retention in HIV Care: A Qualitative Evaluation of a Situated Information, Motivation, Behavioral Skills Model of Care Initiation and Maintenance

Laramie R. Smith, M.A.,1,2 Jeffrey D. Fisher, Ph.D,1,2 Chinazo O. Cunningham, M.D, M.S.,3 and K. Rivet Amico, Ph.D1
The current study provides a qualitative test of a recently proposed application of an Information, Motivation,
Behavioral Skills (IMB) model of health behavior situated to the social-environmental, structural, cognitiveaffective,
and behavioral demands of retention in HIV care. Mixed-methods qualitative analysis was used to
identify the content and context of critical theory-based determinants of retention in HIV care, and to evaluate
the relative fit of the model to the qualitative data collected via in-depth semi-structured interviews with a
sample of inner-city patients accessing traditional and nontraditional HIV care services in the Bronx, NY. The
sample reflected a diverse marginalized patient population who commonly experienced comorbid chronic
conditions (e.g., psychiatric disorders, substance abuse disorders, diabetes, hepatitis C). Through deductive
content coding, situated IMB model-based content was identified in all but 7.1% of statements discussing
facilitators or barriers to retention in HIV care. Inductive emergent theme identification yielded a number of
important themes influencing retention in HIV care (e.g., acceptance of diagnosis, stigma, HIV cognitive/
physical impairments, and global constructs of self-care). Multiple elements of these themes strongly aligned
with the model’s IMB constructs. The convergence of the results from both sets of analysis demonstrate that
participants’ experiences map well onto the content and structure of the situated IMB model, providing a
systematic classification of important theoretical and contextual determinants of retention in care. Future intervention
efforts to enhance retention in HIV care should address these multiple determinants (i.e., information,
motivation, behavioral skills) of self-directed retention in HIV care.
Volume 26, Number 6, 2012
ª Mary Ann Liebert, Inc.
DOI: 10.1089/apc.2011.0388



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