Control beliefs and health locus of control in Ugandan, German and migrated sub-Saharan African HIV infected individuals
Introduction
Although the number of migrants from sub-Saharan Africa has decreased since 2004 due to changes in migration policy, the number of diagnosed HIV infections among migrants from sub-Saharan Africa (SSA) in Germany remained constant. In the group of patients infected by heterosexual transmission in Germany in 2011, 63% were migrants and 71% of them were from SSA. The number of patients from SSA who infected themselves after migrating to Germany has increased. Either transmission takes place in Germany or during visits in SSA [1], [2].
Although health literacy (this includes the competencies related to accessing, understanding, appraising, and applying health information in the domains of healthcare, disease prevention, and health promotion) [3] is mostly on an average level, it has been shown that adherence to antiretroviral drugs is rather poor compared to other samples of patients. Earlier studies have discovered many influencing factors, e.g. cultural, socioeconomic, and individual factors [4], [5]. Morbidity has been shown to be higher and life expectancy to be lower in this subgroup of patients which has consequences for quality of life, the socioeconomic situation, and stigmatisation [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. It is also a burden on the national health care system. Besides psychosocial factors such as stress, social environment [18], and social support [19], intrapsychic factors might influence drug adherence in HIV infected individuals [20].
Our study focused on the exploration of general control beliefs and health related internal and external locus of control and the influence of life time experience of migration in SSA patients in Germany and Uganda. We aimed to discover intrapsychic factors which might influence antiretroviral drug adherence in this subgroup of patients in order to improve patient adherence of migrated patients in Germany in the future.
Section snippets
Participants and procedures
Patients were recruited from the internal medicine and neurological HIV clinics at the University Hospital of Münster (Germany) and from the Rubaga Hospital Kampala (Uganda). We excluded all patients with cognitive impairment (i.e. HIV associated neurocognitive disorder). In total, we enrolled a sample of 20 German HIV infected individuals (G), 20 HIV infected individuals migrated from SSA to Germany (M), and 22 HIV infected Ugandan (U) individuals. The migrated patients from SSA and in Uganda
Results
The sample consisted of 62 patients. 20 German HIV infected patients, 20 SSA HIV infected patients living in Germany, and 22 Ugandan HIV infected patients living in Uganda. For detailed information on sample characteristics, sociodemographic data, medical data, and acculturation see Table 1.
With respect to health locus of control, group comparison of the KKG results showed statistically significant differences between G patients compared to M patients (p = 0.006) and U patients (p = 0.001) in the
Discussion
Our hypothesis was that the experience of migration has an influence on control beliefs and locus of control. Interestingly, however, we could not detect any significant differences between migrated SSA and local Ugandan HIV infected patients. Compared to German HIV infected patients, they showed a significantly higher illness related external health locus of control, which might be a hint at implications for drug adherence, as earlier studies have shown (which surely has implications for drug
Disclosure
The authors report no conflicts of interest.
References (49)
- et al.
Treatment issues for HIV + Africans in London
Soc Sci Med
(1999) - et al.
Examining attribution model of self-stigma on social support and psychological well-being among people with HIV +/AIDS
Soc Sci Med
(2007) - et al.
Adherence to HIV combination therapy
Soc Sci Med
(2000) - et al.
Health locus of control, distress, and untilization of protease inhibitors among HIV-positive men
J Psychosom Res
(2000) - et al.
Health-related quality of life and health locus of control beliefs among HIV-infected treated patients
J Psychosom Res
(2005) HIV bei Migranten in Deutschland
Epidemiol Bull
(2012)- et al.
Konzeption einer Studie zu sexueller Gesundheit bei in Deutschland lebenden Afrikanern. Ein partizipativer Prozess
Präv Gesundheitsf
(2015) - et al.
Health literacy and public health: a systematic review and integration of definitions and models
BMC Public Health
(2012) - et al.
Racial differences in attitudes toward protease inhibitors among older HIV-infected men
AIDS Care
(2000) Adherence to Long-term Therapies: Evidence for Action
(2003)