Being Kind to Your Future Self: Probability Discounting of Health Decision-Making.

INTRODUCTION: Nearly 50 % of patients with chronic medical illness exhibit poor treatment adherence. When making treatment decisions, these patients must balance the probability of current side effects against the probability of long-term benefits. This study examines if the behavioral economic construct of probability discounting can be used to explain treatment decisions in chronic disease. METHODS: Thirty-eight nonadherent and 39 adherent patients with multiple sclerosis (MS) completed a series of hypothetical treatment scenarios with varied risk and benefit probabilities. RESULTS: As described by a hyperbolic probability discounting model, all patients reported decreased medication initiation as the probability of treatment efficacy decreased and the probability of treatment side effects increased. When compared to adherent patients, nonadherent patients significantly devalued treatment efficacy and inflated treatment risk. DISCUSSION: The methods in this study can be used to identify optimal risk/benefit ratios for treatment development and inform the process by which patients make treatment decisions.

ART adherence changes among patients in community substance use treatment: a preliminary analysis from MACH14.

BACKGROUND: Opiate substitution treatment has been associated with better adherence to lifesaving antiretroviral medications, but the impact of other substance abuse treatment on adherence is unknown. FINDINGS: In this study, 215 patients who had been in adherence-focused research studies provided electronically-measured adherence data and a measure of whether the patient had recently been in substance abuse treatment. Recent engagement in substance abuse treatment was independently associated with significantly higher adherence, after covarying for recent substance use and other factors potentially affecting adherence. CONCLUSIONS: The findings suggest that substance abuse treatment is associated with better adherence. Potential mechanisms by which substance abuse treatment improves adherence, such as more stability or more future-orientation, require further study.

Adapting effective narrative-based HIV-prevention interventions to increase minorities' engagement in HIV/AIDS services.

Disparities related to barriers to caring for HIV-positive and at-risk minorities continue to be a major public health problem. Adaptation of efficacious HIV-prevention interventions for use as health communication innovations is a promising approach for increasing minorities' utilization of HIV health and ancillary services. Role-model stories, a widely-used HIV-prevention strategy, employ culturally tailored narratives to depict experiences of an individual modeling health-risk reduction behaviors. This article describes the careful development of a contextually appropriate role model story focused on increasing minorities' engagement in HIV/AIDS health and related services. Findings from interviews with community members and focus groups with HIV-positive minorities indicated several barriers and facilitators related to engagement in HIV health care and disease management (e.g., patient-provider relationships) and guided the development of role-model story narratives.