Control beliefs and health locus of control in Ugandan, German and migrated sub-Saharan African HIV infected individuals

https://doi.org/10.1016/j.jpsychores.2016.02.005Get rights and content

Highlights

  • The experience of migration does not influence the health locus of control in migrated sub-Saharan African HIV patients.

  • Compared to German HIV patients, African HIV patients show a significantly higher external health locus of control.

  • Drug adherence is influenced by the health locus of control, advising patients must consider differences in control belief.

Abstract

Objectives

Little is known about the influence of control beliefs on antiretroviral drug adherence in patients who migrated from sub-Saharan Africa to Europe. The aim of this study was to explore the differences in health locus of control and control beliefs between HIV infected patients from sub-Saharan Africa with and without a lifetime experience of migration.

Methods

A sample of 62 HIV infected consecutive patients referred to the HIV clinics at the University Hospital of Münster (Germany) and at the Rubaga Hospital Kampala (Uganda) were enrolled into this study. We compared three groups of patients: sub-Saharan African migrants, German patients, and local Ugandan patients. We used the German health and illness related control beliefs questionnaire (KKG), the Competence and control beliefs questionnaire (FKK), and the Powe Fatalism Inventory-HIV/AIDS-Version (PFI-HIV/AIDS-Version) and translated these scales into English and Luganda. In addition, the patients' sociodemographic, acculturation, clinical, and immunological data were registered.

Results

Significant results were shown in HIV related external locus of control between migrated sub-Saharan African and local Ugandan patients compared to German patients. General control beliefs showed no significant differences. In the PFI-HIV-Version, there was a significant difference between migrated sub-Saharan African and Ugandan patients compared to German patients.

Conclusions

Our data suggest that the experience of migration does not influence the locus of control. Compared to German HIV patients, African patients in general showed a significantly higher external health locus of control which might have implications for drug adherence.

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.

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