Examining theoretic models of adherence for validity in resource-limited settings. A heuristic approach

Mortality and morbidity for HIV-infected patients in resource-limited settings have declined markedly with increased access to combination antiretroviral therapy. One explanation for this is the high rates of adherence that patients in these settings have achieved. To help patients sustain early successes, detailed understanding of adherence processes in these locales is needed. This understanding is best arrived at using socioculturally valid theoretic models as a guide. This article introduces a heuristic schema for examining the validity of conceptual models of adherence in resource-limited settings. The schema consists of 4 analytic questions to be asked of a model being considered for use in a sociocultural context other than the one in which it was developed. To demonstrate use of the schema, an illustrative validation exercise in which the 4 questions are applied to the information-motivation-behavioral skills model of behavioral change is carried out. Examples for the illustrative exercise come from preliminary qualitative research in HIV/AIDS treatment settings in Mbarara, Uganda and Jos, Nigeria.